Differences between palpation and static/dynamic tests to diagnose painful temporomandibular disorders in patients with Lyme disease

Magdalena Osiewicz,Frank Lobbezoo,Grażyna Biesiada,Jolanta Pytko-Polończyk,Aleksander Garlicki,Jacek Czepiel,Daniele Manfredini

doi:10.1007/s00784-019-02890-4

Abstract

ObjectivesThe aim was to determine the frequency of Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD)-based pain diagnoses and dynamic/static tests-based pain diagnoses, and to assess the agreement of palpation tests with static/dynamic tests.Materials and methodsEighty-six (N = 86) adult patients with Lyme disease (mean age 57.0 ± 14.3 years; male/female ratio was 42/44) were examined according to techniques described in the RDC/TMD. Additionally, dynamic/static tests were performed. For RDC/TMD-based pain diagnoses and dynamic/static tests-based pain diagnoses, descriptive frequencies were calculated. Differences between the frequency of palpation-based diagnoses and of dynamic/static-based diagnoses as well as the agreement between pain diagnoses established with the two diagnostic approaches were assessed.ResultsRDC/TMD-based pain diagnoses were made in 61 patients for myofascial pain and in 11 patients for arthralgia and/or osteoarthritis. Based on dynamic/static tests, mainly myogenous pain was diagnosed in 6 patients, and a mainly arthrogenous pain in 5. The agreement of palpation tests with static/dynamic tests in Lyme disease population was poor.ConclusionA high prevalence of TMD symptoms was found in patients with Lyme disease. The results suggest that using palpation tests alone could overestimate primary TMDs when comorbid conditions are present.Clinical relevance: Dynamic/static tests should be used as part of the routine TMD assessment. In case of Lyme disease as the actual cause of the facial pain, while the dentist might be suspecting TMD when dynamic/static TMD tests are negative, referral to an appropriate specialist for the diagnosis and treatment of Lyme disease needs to be made.

Highlights

Lyme disease, known as borreliosis, is a multiorgan animal-borne disease, caused by bacteria—spirochetes of the Medicine, Jagiellonian University Medical College, Krakow, Poland 4 Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The NetherlandsBorrelia species, classified as Borrelia burgdorferi (Bb) strain [1]
As for specific Lyme disease diagnoses, early Lyme arthritis (ELA) was confirmed in 14 patients, late Lyme arthritis (LLA) was confirmed in 28 patients, early Lyme neuroborreliosis (ELN) was confirmed in 33 patients, and late Lyme neuroborreliosis (LLN) was confirmed in 11 patients
Myogenous pain based upon palpation tests was diagnosed in 61 patients (70.9%), mainly myogenous pain based on dynamic/static tests was diagnosed in 6 patients (7%), mainly arthogenous pain based on dynamic/static tests was diagnosed in 4 patients (4.6%), while mainly arthogenous pain based on palpation tests was not diagnosed in any patient

Summary

Introduction

Borrelia species, classified as Borrelia burgdorferi (Bb) strain [1]. It is the most common tick-borne infectious disease in Europe [2]. The Asbrink and Hovmark classification defines two stages of the disease: early and late Lyme disease [4]. Erythema migrans (EM), a pathognomic skin lesion that occurs in approximately 80% of Lyme disease patients, is the first symptom of early Lyme disease [3, 5]. Late Lyme disease is very rare and only occurs in patients who were not treated early enough. With the exception of the above-described early changes in the patient’s skin, signs and symptoms are not characteristic of the disease, and blood

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