Abstract
Patient: A 72-year-old male presented to our hospital with complaints of experiencing severe pain in his right mandibular molar upon taking the first bite of a meal. Tenderness was noted in the upper right parotid gland during his initial visit to our department. Based on the clinical symptoms, the patient was suspected of being affected by first bite syndrome, and pregabalin 50mg/day was prescribed. Additionally, the patient was referred to the Department of Diabetes and Endocrinology at our facility due to the non-treatment of hyperglycemia. Consequently, the patient’s treatment was initiated for diabetes mellitus. As the hyperglycemia resolved, the pain at the first bite of a meal and the degree of tenderness in the right upper parotid gland were mitigated. A cataract was diagnosed during an ophthalmology examination, and surgery was conducted. Furthermore, atrial fibrillation and colorectal polyps were detected and treated. As the pain at the first bite of food resolved and the tenderness improved after the initiation of medication for diabetes mellitus, pregabalin administration and patient follow-up were discontinued. However, other treatments were maintained, and the patient did not experience an exacerbation of pain.
Discussion: Idiopathic FBS is believed to be caused by aberrant sympathetic innervation to the parotid gland. In the present case, the dysautonomia caused by diabetes mellitus may have induced FBS and atrial fibrillation. In addition to treating diabetes, pregabalin, which acts on calcium ion channels, a significant intracellular messenger involved in the regulation of water and electrolyte secretion in the salivary glands, was effective in alleviating symptoms.
Conclusion: It is crucial to consider the potential presence of diabetes mellitus when treating idiopathic FBS.
