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Jaw/Mouth/Dental/Facial Pain

Some of the Worst Lyme Related Pain

Since the early 1980's Lyme disease has been reported to be the cause of dental and jaw related pain. The reason for the pain is often miscalculated and many times teeth have been removed in an attempt to stop the pain.  The pain, however, remained and the patient continued to suffer.  

Some patients with facial/dental pain were mistakenly diagnosed in University hospitals with tetanus, which is more commly referred to as "lock jaw".

To assist readers, I've added a few definitions, some selected scientific abstracts and articles and general articles written by dentists.  If you are in search of a health care professional who treats Lyme disease you can go to www.LymeDoc.org    

Lucy Barnes



Definitions

Trigeminal neuralgia, also known as tic douloureux, sometimes is described as the most excruciating pain known to humanity. The pain typically involves the lower face and jaw, although sometimes it affects the area around the nose and above the eye. This intense, stabbing, electric shock-like pain is caused by irritation of the trigeminal nerve, which sends branches to the forehead, cheek and lower jaw.  Source

Temporomandibular joint (TMJ) syndrome is pain in the jaw joint that can be caused by a variety of medical problems. The TMJ connects the lower jaw (mandible) to the skull (temporal bone) in front of the ear. Certain facial muscles that control chewing are also attached to the lower jaw. Problems in this area can cause head and neck pain, facial pain, ear pain, headaches, a jaw that is locked in position or difficult to open, problems with biting, and jaw clicking or popping sounds when you bite. Temporomandibular joint syndrome is also referred to as temporomandibular joint disorder.  Source

Orofacial pain is a broad term used to describe symptoms of pain and/or dysfunction in the head and neck region. Multiple causes for orofacial pain may exist and the symptoms may include such diverse findings as headaches, neck pain, ear pain, dental pain, facial burning or stabbing sensations, and jaw joint pain. Symptoms may also include atypical pains or sensations such as ringing in the ears (tinnitus), dizziness, muscular incoordination or even abnormal itching or tingling in the head and neck region. The complaints may either develop gradually or have a rapid onset and can originate from neurovascular, neuropathic or musculoskeletal causes.  Source


Scientific Articles & Abstracts

J Oral Maxillofac Surg. 1988 Jan;46(1):78-9.

Lyme disease involving the temporomandibular joint.

Author information

1
Oral and Maxillofacial Surgery in New London, Connecticut.

Abstract

Lyme disease is an increasingly common problem that has spread rapidly across the United States. A case of the disease and its correlation to TMJ pain and dysfunction in a 35-year-old female is described. The patient was diagnosed and cured of her symptoms with antibiotics, possibly sparing her from surgery.

PMID:
 
3422274
[Indexed for MEDLINE]


N Y State Dent J. 1989 Nov;55(9):46, 48, 50-2.

Lyme disease misdiagnosed as TMJ syndrome. A case report.

Abstract

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.

PMID:
 
2812630
[Indexed for MEDLINE]


J Prosthet Dent. 1990 Jan;63(1):82-5.

Lyme disease misdiagnosed as a temporomandibular joint disorder.

Abstract

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 disorderLyme 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.

PMID:
 
2295991
[Indexed for MEDLINE]


J Orofac Pain. 1996 Winter;10(1):74-86.

Lyme disease: considerations for dentistry.

Abstract

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.

PMID:
 
8995919



J Neurol. 1996 Apr;243(4):367-8.

Trigeminal neuralgia as a clinical manifestation of Lyme neuroborreliosis.

PMID:
 
8965114


Dent Clin North Am. 1997 Apr;41(2):243-58.

Differentiation of orofacial pain related to Lyme disease from other dental and facial pain disorders.

Author information

1
Department of Oral Pathology, Biology and Diagnostic Sciences, University of Medicine and Dentistry, New Jersey DentalSchool, Newark, USA.

Abstract

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.

PMID:
 
9142482
[Indexed for MEDLINE]



J N J Dent Assoc. 1998 Winter;69(1):19, 21, 62-3 passim.

Lyme disease awareness for the New Jersey dentist. A survey of orofacial and headache complaints associated with Lyme disease.

Author information

1
Department of Oral Pathology, Biology and Diagnostic Services, UMDNJ, USA.

Abstract

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.

PMID:
 
9584762
[Indexed for MEDLINE]


Mund Kiefer Gesichtschir. 2001 Jul;5(4):258-60.

[Acute temporomandibular joint arthritis after Lyme borreliosis].

[Article in German]

Author information

1
Klinik für Mund-, Kiefer- und Gesichtschirurgie, Universitätsklinikum Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg. mkg@uke.uni-hamburg.de

Abstract

CASE REPORT: 

This report is about a rare connection between Lyme disease and an inflammation of the left temporomandibular joint. In this case, an infection was documented in 1998, 5 years after contact with Borrelia burgdorferi. The patient, a 49-year-old female, first came to our department in 1999. She showed the symptoms of a left temporomandibular joint infection.

THERAPY: 

We suggested treatment with ceftriaxone 1 x 2 g/day i.v.

PMID:
 
11550610
 
DOI:
 
10.1007/s100060100288
[Indexed for MEDLINE]

J Craniomaxillofac Surg. 2007 Dec;35(8):397-400. Epub 2007 Oct 17.

Temporomandibular joint involvement caused by Borrelia Burgdorferi.

Author information

1
Department of Infectious Diseases and Febrile Conditions, Teaching Hospitals Celje, Slovenia.

Abstract

BACKGROUND: 

Lyme borreliosis is an endemic disease in Slovenia with an incidence of around 

150 patients per 100,000 inhabitants. Although the large joints are most typically affected in 

Lyme borreliosis, there are also periods of disease activity with arthritis or arthralgias 

involving smaller joints, including the temporo-mandibular joint.

PATIENTS: 

During the years between 2000 and 2003, two patients with Lyme borreliosis 

affecting the temporo-mandibular joints were treated. The patients presented with 

fatigue and pain in diverse muscle groups accompanied by arthralgia, which was most 

pronounced in the temporomandibular joint area. None of the patients were febrile or 

had joint effusions.

METHODS: 

Both patients were examined by means of biochemical and serological 

examinations for Borrelia burgdorferi using ELISA assay and Western blot test 

(both for IgM and IgG), plain radiographs, MR and CT scans, and scinti-scan 

of the temporo-mandibular joints. They both had positive serum markers for an acute 

B. burgdorferi infection and were treated with intravenous ceftriaxone.

RESULTS: 

None of the patients had clinical or laboratory signs of chronic Lyme disease 

activity two and four years following therapy, respectively. Roentgenographic and nuclear 

magnetic resonance imaging of the temporo-mandibular joints had not shown any persistent 

sign of acute inflammation.

CONCLUSION: 

There are only few reports of patients with manifest temporo-mandibular joint 

involvement of Lyme borreliosis in the literature. This report emphasizes the importance 

of differential diagnosis of acute temporo-mandibular joint arthralgia, of early diagnosis 

of Lyme borreliosis, and of the necessity for prompt antibiotic treatment.

PMID:
 
17942315
 
DOI:
 
10.1016/j.jcms.2007.06.003
[Indexed for MEDLINE] 


Ann Agric Environ Med. 2010;17(2):319-21.

Orofacial symptoms related to boreliosis--case report.

Author information

1
Department of Conservative Dentistry, Medical University of Lublin, Lublin, Poland.

Abstract

Lyme disease (borreliosis) is an infectious disease caused by the Borrelia spirochaetes, usually transmitted to humans by the Ixodes ticks. It is manifested by a wide spectrum of clinical symptoms varying according to the time elapsed from the infection. The paper describes orofacial symptoms of the disease in a woman who has suffered from a chronic borreliosis for 3 years. Multiorgan clinical manifestations of borreliosis might occur in the masticatory organ and this fact should be taken into consideration in the differential diagnosis of pain by medical and dental practitioners.

PMID:
 
21186776
[Indexed for MEDLINE] 
Free full text



Arthritis Care Res (Hoboken). 2010 Mar;62(3):434-8. doi: 10.1002/acr.20093.

A 46-year-old woman with chin pain and a fainting spell.

PMID:
 
20391493
 
DOI:
 
10.1002/acr.20093
[Indexed for MEDLINE] 
Free full text



Saudi J Anaesth. 2018 Jan-Mar;12(1):112-114. doi: 10.4103/sja.SJA_47_17.

Exacerbation of chronic pain after dental extractions in a patient with post-treatment Lyme disease syndrome.

Author information

1
Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA, USA.

Abstract

A subset of patients who had Lyme disease experience postinfectious signs or symptoms called post-treatment Lyme disease syndrome (PTLDS). PTLDS is a chronic condition including pain in joints and muscles, neurological symptoms including demyelinating diseases, peripheral neuropathy, headaches, sleep disturbances, fatigue, and cardiac conditions. We report a case of difficult acute pain management in a patient with PTLDS who underwent dental extractions and required admission to an intensive care unit for pain control.

KEYWORDS: 

Acute pain; Lyme disease; dental

PMID:
 
29416466
 
PMCID:
 
PMC5789468
 
DOI:
 
10.4103/sja.SJA_47_17


Articles
On Lyme Disease
By Dentists

QUOTE-  "Symptoms of Lyme disease can vary a LOT from patient to patient. Many of those symptoms can also be associated with OTHER medical conditions, which can result in misdiagnosis. For example, most folk do not realize that jaw pain associated with Lyme disease may actually look like a tooth abscess, or a TMJ (jaw joint) problem. It is actually often misdiagnosed as TMJ! SO, if you have a jaw or tooth pain that your dentist cannot explain, you should consider the possibility of Lyme disease. Some of those symptoms of Lyme disease listed above only occur if the disease becomes systemic and spreads throughout the whole body."


Lyme Disease Have You Ticked? Ask Your Dentist! 
Lyme disease, which is initiated by the bite of an immature deer tick, is difficult to diagnose, but your dentist may be able to detect this mysterious disease, reports the Academy of General Dentistry, an organization of general dentists dedicated to continuing dental education. Patients with Lyme disease report pain in their teeth, chewing muscles and jaw joint, which drives them to the dentist. 

"Unfortunately, most patients are not diagnosed properly until their Lyme disease is at a later stage, and when it is more difficult to treat," says Manuel Cordero, DDS, a spokesperson in New Jersey for the Academy of General Dentistry. "Diagnosing this disease is very tricky because it can hide itself behind many dental problems, including toothaches and jaw pain." 

A study of 120 patients with Lyme disease revealed that about 75 percent of patients reported pain in the chewing muscles and 72 percent reported temporomandibular joint pain. Burning mouth was reported by 25 percent of these patients, and 70 percent reported a sore throat. About 47 percent of the patients visited up to 10 doctors before being properly diagnosed. 

"Your dentist may suspect Lyme disease if you have a mysterious toothache that can't be attributed to cavities," says Dr. Cordero. "The disease may be really causing you to feel pain underneath the tooth." 

About 70 percent of patients with Lyme disease reported dental pain in the absence of dental disease, and the dental pain tended to move from tooth to tooth. Of these patients, 36 percent had multiple dental treatments, including root canals and tooth extraction unnecessarily. 
Source Links Broken
http://www.agd.org/consumer/topics/tmj/lyme.asp
http://www.agd.org/support/articles/?ArtID=1348



Lyme disease. Lyme disease also should included in the differential diagnosis of TN (trigeminal neuralgia). Lyme disease or Lyme borreliosis is an infectious, tick-transmitted disease, caused by spirochetes of the Borrelia burgdorferi species complex. Lyme disease can manifest with an array of symptoms involving multiple organs and systems, such as skin, heart, eye, joints and the peripheral nervous system and the CNS.42  Neurological manifestations of the disease may include meningitis, single or multiple cranial neuropathies, painful radiculopathies and diffuse polyneuropathies.43,44 On rare occasions, patients with Lyme disease may have neurogenic pain similar to that of TN.45,46 This possibility should be ruled out via hematologic assessment for Lyme titers. 

Failure of dental treatment to provide long-term pain relief should raise the suspicion 
of trigeminal neuralgia. 

Dental pain. When the sharp, paroxysmal pain of TN is localized in the dentition or the surrounding structures, it may be misdiagnosed as dental pain.16,36 Frequently, patients with TN undergo numerous dental procedures until the diagnosis of TN is made. These procedures may offer temporary pain relief for a few weeks; however, the pain always recurs and often is even worse. Failure of dental treatment to provide long-term pain relief should raise the suspicion of TN. An important feature that distinguishes TN from dental pain is that TN typically does not interrupt the patient’s sleep. Moreover, pain originating from dental pathology usually is progressive, and its character changes with time. Tooth vitality tests and radiographic examination also will serve to exclude dental pathology.
Source- http://jada.ada.org/cgi/content/full/136/4/469

QUOTE-  "Lyme gravitates toward some teeth. It is my experience that Lyme gravitates especially to the upper and lower centrals, and to the upper and lower first molars. That's eight teeth."...   Root canals and old extractions are common focal infection sites. When you have a root canal, a dead tooth is left in the mouth. The dead tooth lacks a blood supply to its interior. Antibiotics circulating in the bloodstream have no way to penetrate this dead tissue. Over time, the material packed inside the dead tooth shrinks a bit.

Now bacteria come in and morph. The tooth has both bacteria and toxins as a result of being dead for so many years and these toxins are infiltrating into the bloodstream. In extraction sites, the healing may not take place correctly. If the healing is incorrect, the space can fill in with fatty tissue, dead bone, improper bone, or it can fill in with infected material. All of these processes are wrong and the organ associated with that extraction site will always show this improper healing."  Lyme Disease Often Resides in the Mouth-  Link Here

QUOTE- "It is my conclusion, therefore, that the impact of Lyme disease on the peripheral and central nervous systems can produce nerve and muscle pain that mimics the symptoms of TMJ."  Source













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