title: Differentiation of orofacial pain related to Lyme disease from other dental and facial pain disorders.
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.
authors.affiliation: Department of Oral Pathology, Biology and Diagnostic Sciences, University of Medicine and Dentistry, New Jersey Dental School, Newark, USA.
authors.forename: G M
authors.initials: GM
authors.lastname: Heir
mesh_terms: D003937:Diagnosis, Differential; D005157:Facial Pain / Q000209:etiology*; D005356:Fibromyalgia / Q000175:diagnosis; D006261:Headache / Q000209:etiology; D006801:Humans; D008193:Lyme Disease / Q000150:complications / Q000175:diagnosis*; D009209:Myofascial Pain Syndromes / Q000175:diagnosis; D009437:Neuralgia / Q000175:diagnosis; D013282:Stomatitis, Denture / Q000175:diagnosis; D013705:Temporomandibular Joint Disorders / Q000150:complications / Q000175:diagnosis* / Q000209:etiology; D014098:Toothache / Q000209:etiology