An interesting article titled “Orofacial Manifestations of Lyme Disease: A systematic review” appears in the The Journal of Dental Hygiene written by Brenda T. Bradshaw and et al. (vol. 95, no. 4, August 2021). The article seeks to perform a systematic review of the types and frequencies of orofacial manifestations of people in the the United States with Lyme disease.
In the article the authors performed their systematic review by starting from 217,381 articles that had been searched by a university librarian. The authors weeded these results down substantially due to duplication and to meet their exclusion criteria that included if not with US populations, if not available in English in full text, and if does not have a CDC diagnosis of Lyme disease. This resulted in twelve articles for the analysis with seven from the 1990s, three from the 2000s, and two from the 2010s. None of the articles were from dental journals but instead from journals like The New England Journal of Medicine, Pediatrics, and Neurology. A total of 951 patients with confirmed Lyme disease were explored in these twelve articles.
The authors found eight orofacial manifestations among the patients in the twelve articles including altered taste, sore throat, headache, facial palsy, temporomandibular joint pain, stiff neck, neck pain, and erythema migrans rash on the head or neck. Those that experience headache was 39.5% (376/951), those that experience facial palsy was 42.5% (404/951), those that experienced temporomandibular joint pain was 0.42% (4/951), those that experience altered taste was 0.11% (1/951), those that experience stiff neck was 13.6% (129/951), those that experienced sore throat was 3.0% (29/951), those that experienced neck pain was 7.5% (71/951), and those that experience erythema migrans rash on the head or neck was 5.2% (49/951). The authors state:
“There is a need for this timely research to appear in dental and dental hygiene journals so that the oral health care community is informed regarding the various ways this growing infectious disease may be manifested within their patient populations.”
For those unaware, Lyme disease is a vector-borne disease transmitted by ticks infected with Borrelia burgdorferi sensu stricto (Bbss) or Borrelia mayonii. It is transmited through the bite of a deer tick or blacklegged tick. Lyme disease was recognized in the 1970s and has quickly spread across sates in the U.S. to be considered endemic in 14 US states at the time the article published. In recent years around 30,000 cases of Lyme disease are reported to the CDC in the US each year but this numer is potentially 10 times or more smaller than the actual number of cases.
The authors conducted the because they feel that dental professionals might be unaware of the orofacial manifestations linked to Lyme disease and by being more aware they can help lead to an earlier diagnosis and improve patient quality of life. When Lyme disease is diagnosed early it can be cured. Thus the authors feel that when a dentist’s clinical examination can not find a specific oral health pathology that could explain the symptoms from the list of eight found in their study then dentists should consider Lyme disease as a possibility. The authors state:
“It is important for dental professionals to be aware of the orofacial manifestations of Lyme disease and to have a referral and follow-up plan with primary care physicians to achieve the best possible health outcomes for their patients.”
Several limitations of the study are mentioned by the authors including not including data from populations in 8 of the 14 current US states were Lyme disease is endemic and in general just needing more data from other geographic areas to be able to better apply to the whole population. The authors also mentioned that they are aware of some case sudies were other orofacial manifestations of Lyme disease are reported but they were not included in their study. Thus the authors feel that additional research for the orofacial manifestations of Lyme disease is needed.