Ross A. Hauser, MD.

There is a great controversy in the medical literature when it comes to temporomandibular disorders and Lyme disease. The controversy is whether the patient has TMD if diagnosed with Lyme disease, or if the pain they feel in the jaw and the masticatory muscle pain is not TMD but a symptom of Lyme disease.

In my article, Neck Pain and Lyme Disease: Will Treating Neck Pain Make Lyme Disease Symptoms go Away? I suggest that in the many patients we see with cervical spine instability, chronic neck pain, and neurological challenges, there is sometimes a concurrent diagnosis of Lyme Disease. It is often thought that neck pain is a symptom of Lyme Disease, and that is why the neck pain is there, for many people it is. Neck pain is also a symptom of cervical spine instability in some Lyme Disease patients; the neck problems were already there, and now these neck problems are compounding their Lyme disease symptoms.

The same can be said for TMD and pain in the TMJ temporomandibular joint. TMJ pain is also a symptom of cervical spine instability, as we discussed above. The challenge is that the TMD makes Lyme disease worse. Is Lyme disease making TMD worse? Is it not TMD at all, but the Lyme disease acting on the masticatory muscles?

A July 2019 study in the Journal of Clinical Medicine (1) attempted to determine the occurrence of temporomandibular disorders in patients with Lyme disease and to estimate the contribution of factors that may identify TMD among Lyme disease patients. The focus of identifying TMD is Lyme disease centered on Bruxism.

• In seventy-six adult patients with Lyme disease (average age about 57 years old) and 54 healthy non-Lyme volunteers with a mean age, the two groups did not significantly differ in the frequency of disc displacement diagnoses and function-dependent pain diagnoses.
• Lyme disease showed a significantly higher frequency of osteoarthrosis than the control group.
• For the prediction of pain diagnoses in Lyme disease patients, age, sleep bruxism, and awake bruxism, were isolated as factors with sleep bruxism and awake bruxism much more significant. This investigation suggests that the impact of bruxism in predicting the presence of TMD pain in patients with Lyme disease is high.

In August 2021 doctors presented a case history in the journal BioMed Central Oral Health (2). In this case report, a 25-year-old woman presented extensive symptoms of temporomandibular disorder. She had extensive treatments for her temporomandibular joint and it was only after the failure of these treatments was a delayed diagnosis of Lyme disease made.

The need to differentiate between Lyme disease pain and TMD pain is illustrated by the doctor’s summary of this case: “Early interdisciplinary diagnosis of Lyme disease and early antibiotic therapy is essential to avoid misdiagnosis and unnecessary, sometimes invasive, therapies.”

More reading

Neck pain and Lyme Disease: Will treating neck pain make Lyme Disease symptoms go away?

Our published research

The association between mandibular position to cervical spine and internal jugular vein diameters in upright position. Have we been ignoring critical generators of head and neck pathology? Lockerman LZ, Hauser R. The association between mandibular position to cervical spine and internal jugular vein diameters in upright position. Have we been ignoring critical generators of head and neck pathology? Cranio. 2023 Sep;41(5):403-406. [Google Scholar]

Dextrose Prolotherapy and Pain of Chronic TMJ Dysfunction Hauser R., Hauser H, Blakemore KA. Dextrose Prolotherapy and Pain of Chronic TMJ Dysfunction. (2007) [Google Scholar]

References

1 Osiewicz M, Manfredini D, Biesiada G, Czepiel J, Garlicki A, Aarab G, Pytko-Polończyk J, Lobbezoo F. Prevalence of function-dependent temporomandibular joint and masticatory muscle pain, and predictors of temporomandibular disorders among patients with Lyme disease. Journal of clinical medicine. 2019 Jun 28;8(7):929. [Google Scholar]
2 Weise C, Schulz MC, Frank K, Cetindis M, Koos B, Weise H. Acute arthritis of the right temporomandibular joint due to Lyme disease: a case report and literature review. BMC Oral Health. 2021 Dec;21(1):1-3. [Google Scholar]