Dysregulated proprioception in trigeminal pain: A novel perspective on oral dysesthesia, from chaos to balance

Oral dysesthesia (OD) is a chronic orofacial pain disorder characterized by abnormal sensations - burning, tingling, altered taste, or phantom foreign body perception without identifiable mucosal pathology. Frequently conflated with Burning Mouth Syndrome, OD exhibits a heterogeneous clinical profile warranting distinct diagnostic consideration. This narrative review explored potential mechanisms underlying OD, including peripheral and central sensitization, neurotransmitter imbalances, hormonal and psychosomatic influences, and proprioceptive dysregulation, particularly neurosensory mismatch involving trigeminal proprioceptive and nociceptive convergence. Proprioceptive dysregulation may contribute to OD through processes analogous to phantom limb phenomena. Current management - pharmacologic, behavioral, and neuromodulatory - remains limited by mechanistic non-specificity. Preliminary concepts of a custom-fabricated oral device suggest it may modulate proprioception, provide sensory gating, mechanical protection, and potential drug delivery as a non-pharmacologic adjunct. Theoretical application of such a device could influence maladaptive feedback loops, representing a potential multimodal therapeutic approach that warrants further investigation.