Borreliosis & Jaw-, Dental- and Facial Pain
Lader E. Lyme
disease misdiagnosed as TMJ syndrome. A case report. N Y State Dent J 1989 Nov; 55(9): 46, 48, 50-2
Due to the high incidence of
Lyme disease, the ease with which it can be misdiagnosed, and its potential for
causing irreversible neurologic or cardiac complications and fatalities if left
untreated, all patients living in known epidemic areas who manifest intractable
facial pain, or what appears to be a case of temporomandibular joint syndrome
that does not respond to therapy should be tested for Lyme Borelliosis. It
should be remembered however, that not all patients with active Lyme disease
produce antibodies, and it is thus imperative for the clinician to obtain a
detailed patient history with a focused series of questions directed at the
known presentations of the disease, with specific emphasis placed on the prior
appearance of an ECM lesion.
Lader E. Lyme
disease misdiagnosed as a temporomandibular joint disorder. J Prosthet Dent 1990 Jan; 63(1): 82-5
Craniomandibular disorders
cause many pleomorphic and seemingly unrelated clinical manifestations that
mimic other more serious medical problems and thus can present physicians and
dentists with a challenge that invites misdiagnosis and improper treatment
planning. Conversely, misdiagnosis and ineffective treatment planning are
facilitated when serious medical problems manifest a range of signs and
symptoms that are clinically similar to temporomandibular joint muscle
dysfunction. At times, the patient's response to therapy may be the best method
of corroborating a diagnosis, as illustrated in this report of a patient with
Lyme disease that was misdiagnosed as a temporomandibular joint disorder. Lyme
disease has already reached epidemic proportions in several parts of the United
States and its geographic distribution is spreading. Because Lyme disease is a
life-threatening illness whose clinical manifestations can mimic
temporomandibular joint/myofascial pain-dysfunction, it is the responsibility
of every dentist who treats craniomandibular disorders to become familiar with
the clinical presentations of Lyme disease and more proficient in its
differential diagnosis.
Goldfarb D, Sataloff RT. Lyme
disease: a review for the otolaryngologist. Ear Nose Throat J 1994 Nov; 73(11): 824-9
Lyme disease is an important
consideration in the differential diagnosis of patients seen by the
otolaryngologist. Facial paralysis is the most common sign. The
otolaryngologist may also see patients with temporal mandibular joint pain,
cervical lymphadenopathy, facial pain, headache, tinnitis, vertigo, decreased
hearing, otalgia and sore throat. The incidence is increasing and known to be
endemic to certain areas of the United States and abroad. This paper reviews
the various ways Lyme disease appears to the otolaryngologist. Three cases
along with a discussion including epidemiology, vector, animal host
relationship, clinical manifestations and pathophysiology are included. The
literature is reviewed and the treatment discussed.
Heir
GM, Fein
LA. Lyme
disease: considerations for dentistry. J Orofac Pain 1996 Winter; 10(1): 74-86
Although Lyme disease has spread rapidly and it is difficult to
diagnose, a review of the dental literature does not reveal many references to
this illness. Dental practitioners must be aware of the systemic effects of
this often multiorgan disorder. Its clinical manifestations may include facial
and dental pain, facial nerve palsy, headache, temporomandibular joint pain,
and masticatory muscle pain. The effects precipitated when performing dental
procedures on a patient with Lyme disease must also be considered. This study
discusses the epidemiology and diagnosis of Lyme disease, its prevention, and
factors to consider when making a differential diagnosis. Dental care of the
patient with Lyme disease and currently available treatments also are
considered. Three case reports are presented.
Heir
GM. Differentiation
of orofacial pain related to Lyme disease from other dental and facial pain
disorders. Dent Clin North Am 1997
Apr; 41(2): 243-58
The diagnostic process for the orofacial pain patient is often perplexing. Compounding the process of solving a diagnostic mystery is the multiplicity of etiologic factors. The propensity for Lyme disease to present with symptoms mimicking dental and temporomandibular disorders makes the task even more complex. It is hoped that the reader is cognizant of the fact that a pathologic process of dental structures--the teeth and their attachments to the mandible and maxilla, the temporomandibular joints, masticatory musculature, and vascular supply and sensory innervation of the oromandibular anatomy--may also be the source of facial pain. Although unique, similar complaints may also be manifestations of other causes, including pain associated with Lyme disease. The informed and fastidious clinician does not overlook these possibilities when evaluating the headache and facial pain patient. The clinician should be equipped with the knowledge and minimal armamentarium to evaluate the patient appropriately. To paraphrase from Sherlock Holmes, we must first eliminate the impossible, whatever is left is the truth, no matter how unlikely. A differential diagnosis must be achieved based on clinical experience, unbiased observations, and probability.
Heir
GM, Fein
LA. Lyme
disease awareness for the New Jersey dentist. A survey of orofacial and
headache complaints associated with Lyme disease. J N J Dent Assoc 1998;69(1):19
The incidence of Lyme disease is increasing in New Jersey. In 1996, 2,190 cases were reported, representing an increase of 487 cases from the 1,703 reported in 1995 [Table 1]. Symptoms associated with Lyme disease include headache and facial pain that often mimics dental pathology and temporomandibular disorders. Patients with complaints of vague, non-specific dental, facial or head pain, who present with a multisystemic, multi-treatment history, are suspect. This article discusses Lyme disease in New Jersey and the clinical presentation of Lyme disease that the dental practitioner may encounter. A summary of data is provided which was collected from 120 patients diagnosed with laboratory confirmed Lyme disease. The most common orofacial, head and dental complaints seen in the Lyme disease patient are reviewed. This information will hopefully aid in establishing a diagnosis and appropriate referral where indicated.