Objective: To characterize the common errors or pitfalls in the recognition of edentulous stereotypy

Background: Edentulous stereotypy is a well-characterized abnormal movement of the jaw and mouth, which occurs in elderly edentulous persons. Though quite common, it is often associated with pitfalls in recognition and management.

Method: We collected series of cases between Jan 2010 to Dec 2021, who presented with edentulous stereotypy where pitfalls in its recognition lead to inappropriate investigations and management prior to reference to us.

Results: Amongst the 27 patients with edentulous stereotypy [ES] seen, 11 were referred as oromandibular dystonia [OMD], 5 as functional disorder, 7 as focal seizures, 2 as Parkinson’s disease and  2 were referred to as autoimmune encephalitis. The patients had received initial consultation by general physician [15], psychiatrist [ 7] , general neurologist [5]. The major pitfall for the consideration of  OMD was the intermittent movement of jaw. The reason for the pitfall was that the detailed history and examination was not done. The important features of ES which were missed were: absence of tongue movements, movement occurring only in edentulous patients, having a poor denture satisfaction index, the movement being only “unvoluntary” [occurring passively when patient not paying attention, which is very much controllable by the patient, and the control not causing any sensory “discomfort”]. 8 of the patients misdiagnosed as OMD prior to our consultation were prescribed tetrabenazine, clonazepam, haloperidol, leading to adverse events like somnolence, confusion and imbalance. The patients misdiagnosed as focal seizures also were treated with anti seizure medicines, with adverse events without benefit. All the patients did not have a major discomfort due to movements, rather their relatives had consulted doctors for the abnormal movement. All the patients improved with stopping the unneeded medicines, counselling about the diagnosis, lifestyle management like sugar candy or dry berry sucking or wearing proper dentures. 11 of the patients could not adjust to 2 trials of different denture sets and were happy without any dentures and could learn to control the stereotypy voluntarily.

Conclusion: It is important that physicians and neurologists are well aware of the diagnosis and recognition of edentulous stereotypy in order to avoid common pitfalls in its recognition and management.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/edentulous-stereotypy-common-lacunae-in-the-identification-of-an-old-malady/