Orofacial Manifestations of Lyme Disease: A systematic review

Purpose: Orofacial manifestations of Lyme disease can affect head and neck anatomical structures that are frequently examined by dental professionals. The purpose of this systematic review was to examine the literature for types and frequencies of orofacial manifestations documented in populations in the United States (US) with Lyme disease.Methods: Four electronic databases (Dentistry and Oral Sciences, PubMed, Cinahl Plus, and Medline) were systematically searched during the summer of 2019 using keywords and MeSH terms to identify relevant studies. Search term alterations and synonyms were cross-checked using the US National Library of Medicine Unified Medical Language System Metathesaurus. Full-text, English language studies were included if they reported on US populations with Centers for Disease Control and Prevention confirmed cases of Lyme disease. The review followed guidelines set forth in Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Quality was assessed with a modified version of the Cochrane Data Collection Form for Randomized Control Trials and Non-randomized Control Trials. Extracted data was organized by themes of manifestations and the frequencies were calculated.Results: An initial search extracted 217,381 articles; 43 met the inclusion criteria and were further reviewed for quality. Twelve articles published from 1992-2017 were deemed appropriate for inclusion. All were from non-dental journals and fewer than half (n=6) reported on Lyme disease endemic states. Eight incidences of orofacial manifestations within head/neck regions were documented in Lyme disease patients (n=951) and included: headache (39.5%), facial palsy (42.5%), temporomandibular joint arthralgia (42.0%), altered taste (11.0%), stiff neck (13.6%), sore throat (3.0%), neck pain/arthralgia (7.5%), and erythema migrans rash (5.2%).Conclusion: Eight orofacial manifestations of Lyme disease were revealed by this systematic review. Future research regarding the orofacial manifestations of Lyme disease is needed so this medical condition can be better understood by oral health care providers and result in improved health outcomes for infected patients.