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Toothache from Lyme?

Date: 21-Jun-2000 at 03:33 PM EDT
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Document Title: Re: Toothache from Lyme?


Lyme Disease and Orofacial Pain
Gary M. Heir, DMD

President Elect, American Academy of Orofacial Pain; Associate Clinical Professor, University of Medicine and Dentistry of NJ; Department of Oral Biology, Pathology and Diagnostic Services.

Adapted from the Newsletter of the American Academy of Orofacial Pain, March 1998.

The healthcare provider involved with the diagnoses and management of orofacial pain disorders must rely on a knowledge of various primary and/or secondary disorders, which may manifest symptoms for which patients seek our aid. While a majority of facial pain complaints are due to primary dental or orofacial pathologies, many patients present with symptoms secondary to a primary systemic illness. Included in these primary conditions is a spirochetal infection; Lyme disease.

Lyme Disease is a rapidly emerging infectious disease. It represents 90% of all vector-borne disease in the United States. Nearly 100,000 cases have been reported since1980. This represents a 26-fo1d increase during the period of 1982-1996. While 70% of reported cases are found in the Northeast, Lyme disease is also found in the North Central and Pacific coastal regions. It must be assumed that children and adults in endemic areas may be exposed to infection during school, work and recreational activities. With the ease of travel, Lyme disease may also present in regions of the country where it is not usually encountered. It is important that all healthcare providers are familiar with the signs and symptoms of this infectious disease.

Symptoms associated with Lyme disease include headache and facial pain that often mimic dental pathology and temporomandibular disorders. Patients with complaints of vague, non-specific dental, facial or head pain, who present with a multi-systemic, multi-treatment history, are suspect.

A nationwide survey via a questionnaire was distributed to patients with Lyme disease. Only those subjects with positive testing were included in the study. Respondents were clustered in the northeastern states, northern California, the north central states of Michigan and Minnesota and central states such as Ohio.

Orofacial Pain Complaints Associated
with Lyme Disease

Recent data suggest that the temporomandibular joints are commonly associated with a traumatic, non-dysfunctional Lyme arthritis. The data from 120 patients with laboratory confirmed Lyme disease responding to the survey found that 75% reported pain of the masticatory musculature and 72% reported symptoms of TMJ pain. Of those responding, only 4 of 90 patients reported a history of a traumatic jaw injury. The majority of these patients reported the spontaneous onset of their temporomandibular pain. Of those with Lyme disease reporting a temporomandibular disorder or myofascial pain, 75% indicated that their symptoms intensified on a cyclical basis with other symptoms related to Lyme disease. In such cases, only palliative treatment is indicated while the patient is medically evaluated.

Dental pain or toothache, often in the absence of clinical or radiographic evidence, is another haracteristic of Lyme disease. Dental pain in the absence of detectable dental pathology was reported by 60% of those responding to this survey. These patients also reported that their dental pain had a tendency to move from tooth to tooth, change quadrants, or move from side to side. Of these, 36% had multiple dental treatments including endodontia and extraction with little benefit. Glossodynia, or burning mouth, was reported by 25% of patients, while 70% reported sore throat.

Facial pain complaints other then those simulating toothache or a temporomandibular disorder are also seen with Lyme disease. A variety of dyesthesias, neuropathic or vascular complaints are more common then previously thought. Of Lyme patients reporting facial pain, 88% associated these complaints with other symptoms of Lyme disease.

Headache is another complaint common to the Lyme patient. It has been previously reported that 53% of Lyme patients hospitalized for neurological manifestations of Lyme disease describe some form of headache disorder. As with other symptoms, these headaches appear to cycle along with other pain complaints associated with Lyme disease. The results of this survey found that 49% of patients reported headache associated with other symptoms of their Lyme disease.

Headache ranged from sinus-like pain through tension-type and migraine. The dental practitioner may also be confronted with patients manifesting neurological symptoms.Unilateral facial nerve palsy was reported by 27% of those responding. Four of the 120 patients reported bilateral paralysis. Trigeminal neuralgia was reported by 25% of patients.


Lyme disease is a debilitating illness that may present as dental or orofacial pain to the dental practitioner. All healthcare providers must be aware of this clinical entity and be able to consider this infectious disease in differential diagnoses.

The dentist and allied health care provider can play a significant role in the early diagnosis and treatment of this often debilitating disease. You are encouraged to learn more about this illness and exercise diligence in evaluating suspect patients. A prompt and appropriate referral to a medial specialist is imperative.

For additional information, contact Dr. Heir at heirgm@umdnj.edu, or at UMD-NJ Dental School, OBPDS, 110 Bergen Street, Newark, NJ 0710

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