What is first bite syndrome?

First bite syndrome is an orofacial pain condition that does exactly what is says. The patient feels pain when they first bite something or first taste something. It usually comes after surgery to the parapharyngeal space.

Other difficult conditions in dentistry that may be similar to first bite syndrome.

This is the 9th in a series of 9 posts about orofacial pain with difficult to diagnosis or unusual origin.

1. Cracked tooth syndrome
2. Trigeminal neuralgia
3. Atypical odontalgia     JADA article Marbach Feb 96 JADA      Great lit review
4. Neuralgia-inducing cavitational osteonecrosis or NICO
5. Referred pain
6. Myofascial pain 
7. Burning Mouth Syndrome 
8. Oral dysesthesia
9. First bite syndrome
10. Barodontalgia

First Bite Syndrome Etiology and Symptoms

The cause is almost always post-surgery or a tumor in the parapharyngeal area. Surgeries such as cervical lymph node dissection, TMJ replacement, carotid surgery, Eagle’s syndrome surgery, and bimaxillary osteotomy can trigger first bite syndrome.

We believe it is a misfiring of nerve fibers due to a loss of sympathetic innervations to the parotid gland. This condition is not the same as phantom bite syndrome where the patient just feels their bite is off.

Symptoms are pain when one first bites or starts to salivate. There is sharp pain in the parotid gland area when one starts to masticate and the pain decreases as chewing continues.

Treatment options

Botox is one treatment method. Nayak JOMFP 2020  Botox injections into the parotid gland is what Dubyk JADA 2021 shows to be an effective treatment.