Management of first bite syndrome: systematic review of recent evidence

First bite syndrome refers to pain in the parotid region during the first bite when eating that improves with subsequent bites. There is a paucity of evidence in the literature to justify recommending optimal management therefore this study aimed to review the latest evidence for its management.

A literature search across four databases was conducted using a Population, Intervention, Comparison, Outcome-generated search strategy between 2012 and 2022. Screening was done by two reviewers according to pre-determined inclusion and exclusion criteria, demonstrated in a Preferred Reporting Items for Systematic Reviews and Meta-Analyses flowchart.

Eleven articles were included. Six articles used repeated botulinum toxin injection, which in all the studies resulted in complete symptoms resolution. Four articles found a watch-and-wait technique to be effective. There were conflicting results on the efficacy of medical treatments such as opioids or anticonvulsants.

Studies have shown that first bite syndrome symptoms eventually resolve with conservative management, but repeated botulinum toxin appeared efficacious for quicker symptom resolution. Further higher-quality studies should be conducted to identify the optimal management.