Can Lyme Disease Cause Jaw Pain?
Jaw pain may be an overlooked symptom of Lyme disease
TMJ arthritis can mimic common jaw disorders
Early diagnosis may prevent unnecessary procedures
Can Lyme disease cause jaw pain? Yes. Lyme disease can affect the temporomandibular joint (TMJ), causing jaw pain, restricted mouth opening, facial discomfort, and difficulty chewing. Because these symptoms resemble common TMJ disorders, Lyme disease may be overlooked, especially in endemic regions.
Although jaw pain is more commonly caused by dental disease or temporomandibular disorders (TMD), Lyme disease should be considered when symptoms develop after possible tick exposure or fail to improve with standard treatment.
Although the knee is the joint most commonly affected by Lyme arthritis, the temporomandibular joint may also be involved. Because TMJ arthritis is uncommon, Lyme disease may not be considered initially, particularly when patients do not recall a tick bite or erythema migrans (EM) rash.
In the article, “Acute arthritis of the right temporomandibular joint due to Lyme disease: a case report and literature review,” the authors describe a 25-year-old woman who presented with acute pain in the right temporomandibular joint and difficulty opening her mouth.1
Case Report: Lyme Arthritis of the Jaw Joint
Over a five-year period, the woman’s distal bite had been treated with removable and fixed orthodontic appliances. Three months after her initial symptoms, she developed worsening right TMJ pain, progressive restriction of mouth opening to 20 mm, and deviation of the lower jaw to the left.
She was initially diagnosed with complete anterior disc displacement without reduction. Anti-inflammatory medications, a bite splint, and a corticosteroid injection failed to improve her symptoms.
Although the patient did not recall a tick bite or EM rash, Lyme disease testing was positive and she was diagnosed with Lyme arthritis affecting the right temporomandibular joint.
This case also illustrates that Lyme arthritis may develop weeks to months after the initial infection, and many patients do not recall a tick bite or erythema migrans rash.
“Early interdisciplinary diagnosis of Lyme disease and early antibiotic therapy are essential to avoid misdiagnosis and unnecessary, sometimes invasive, therapies.”
The patient was treated with a three-week course of cefuroxime. After one week of antibiotic therapy, her jaw pain and mouth opening began to improve.
The authors concluded that Borrelia infection had likely been present within the temporomandibular joint for an extended period before symptoms became clinically apparent.
Why Lyme Disease Is Often Missed in TMJ Disorders
Lyme disease involving the TMJ is frequently mistaken for a routine temporomandibular disorder (TMD).
Patients may initially receive treatment with:
- Anti-inflammatory medications
- Occlusal splints
- Corticosteroid injections
- Physical therapy
- Dental procedures
When these treatments fail, Lyme disease may not immediately be considered.
The authors emphasize that Lyme disease should be included in the differential diagnosis of persistent or unexplained TMJ disorders, particularly in endemic areas or when standard TMJ therapy is unsuccessful.
What Else Can Cause Jaw Pain?
Jaw pain has many possible causes. Common conditions include:
- Temporomandibular joint disorder (TMJ/TMD)
- Dental infection or abscess
- Tooth grinding (bruxism)
- Osteoarthritis
- Rheumatoid arthritis
- Trigeminal neuralgia
- Muscle strain
- Giant cell arteritis
- Lyme disease
Because Lyme disease can mimic several of these disorders, clinicians should consider it when jaw pain is accompanied by other Lyme-compatible symptoms or follows possible tick exposure.
Symptoms of Lyme Disease Jaw Pain
Patients with Lyme disease affecting the jaw may describe symptoms that closely resemble a temporomandibular joint (TMJ) disorder. These symptoms can vary in severity and may fluctuate over time.
- Pain while chewing
- Difficulty opening the mouth
- Jaw stiffness or locking
- Pain in front of the ear
- Clicking or popping of the jaw
- Facial pain or headaches
- Ear pain without an obvious ear infection
- Pain that does not improve with conventional TMJ treatment
Because these symptoms overlap considerably with common TMJ disorders, Lyme disease affecting the jaw may be overlooked, particularly when patients do not remember a tick bite or rash.
Persistent Lyme Arthritis
A recent 50-year review of Lyme arthritis by Steere highlights that many patients improve with recommended antibiotic therapy. However, some patients continue to experience persistent or recurrent arthritis despite an initial course of treatment. These patients may require further evaluation for ongoing inflammation, possible coinfections, or other contributing factors. In my clinical practice, some patients with persistent Lyme arthritis have improved following individualized retreatment for Lyme disease or treatment of recognized tick-borne coinfections.
Frequently Asked Questions
Can Lyme disease cause jaw pain?
Yes. Lyme disease can occasionally affect the temporomandibular joint (TMJ), leading to jaw pain, stiffness, restricted mouth opening, and difficulty chewing.
Can Lyme disease affect the TMJ?
Yes. Although uncommon, Lyme arthritis may involve the temporomandibular joint and can mimic common TMJ disorders.
What does Lyme jaw pain feel like?
Patients may experience aching jaw pain, pain while chewing, jaw locking, facial discomfort, ear pain, headaches, or difficulty opening the mouth.
Can a tick bite lead to jaw pain?
Jaw pain is not caused by the bite itself but may develop weeks to months later if Lyme disease affects the temporomandibular joint.
Does Lyme arthritis affect the jaw?
Yes. While the knee is the joint most commonly affected by Lyme arthritis, the jaw joint can occasionally be involved.
Clinical Takeaway
Lyme disease should remain in the differential diagnosis for persistent or unexplained jaw pain, particularly in patients living in or traveling to endemic regions. Although temporomandibular joint (TMJ) involvement is uncommon, early recognition and appropriate treatment may help prevent unnecessary dental procedures, corticosteroid injections, or prolonged treatment for presumed TMJ disorders.
Considering Lyme disease early in patients with unexplained jaw pain may shorten the time to diagnosis and improve outcomes.
Related Articles
Learn more about Lyme disease and musculoskeletal complications:
Lyme Arthritis
Bell’s Palsy and Lyme Disease
Persistent Lyme Disease Symptoms
Lyme Disease Symptoms Guide
5 Cases of Lyme Arthritis Following an Operation
References
- Weise C, Schulz MC, Frank K, et al. Acute arthritis of the right temporomandibular joint due to Lyme disease: A case report and literature review. BMC Oral Health. 2021;21:400.
- Steere AC. Lyme Arthritis: A 50-Year Journey. J Infect Dis. 2024;230(Suppl 1):S1-S10.
Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.
Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention
For years I had right face TMJ pain. I went through all the dental treatments available including equilibration and Tens. It helped for a while but the horrible nerve pain would return. As I was further into my miserly I was sitting by a vase of Lilies. Soon my ear pain started and I had to leave. As I got farther from the house the pain eased off. This was the same thing I felt in Church from flowers and smells like perfume. I had just started allergy treatments and was really into things I came in contact with and my bodies response. Seems, I figured this out, my Eustachian tube filled up due to reaction and was pressing on a nerve, maybe the 5th. I finally found an Ear Dr that bought my theory and inserted 3 tubes, the last being bigger to help drain the fluid and a graft to the drum to accommodate. After a few months it stopped hurting. I have twinges now and then when the Barometric Pressure is high or I smell something I’m really allergic to. I’ve had Lyme for almost twenty years and I know it affects my body’s nervous system and has days where it reeks havoc on my whole body.
I typically look a second time for persistent infection in patients who have unusual presentations.
Dear Dr. Daniel Cameron,
Thank you for your recent article on TMJ/TMD.
Around age 25, I began to get TMJ /TMD, as well as other symptoms consistent with Lyme disease and tick-borne illness.
My CDC Lyme disease test was negative and I was advised to take prescribed) ibuprofen for 3 weeks.
5 years later, I still suffer from TMJ/TMD and a host of the same multi-system illness symptoms.
Can you help me? What can I do?
Thank you,
Brittney
I have Lyme disease patients whose TMJ pain has resolved if I treat their underlying Lyme disease. Some have not.
pain yes,but tinnitus and hyperacusis omvolved jass ligament ,what treatment can help?
The authors added Lyme disease to long list of considerations. I advise my patients with TMJ with clinical manifestations of Lyme disease to consider treatment.
I have seen TMJ clear in some of my Lyme disease patients. I have included ENT and dentists in my evaluation.
what is the most reliable Lyme’s test? My daughter was diagnosed with toxic mold exposure and has had fatigue anxiety and depression for years among other issues. Her functional medicine Dr wants to test for lymes with the Galaxy test. How reliable are these tests? I am concerned she is talking herself into diagnosis and figures it is a quick fix with a pill.
Galaxy is a research lab best known for Bartonella testing. I do not know how reliable the testing is.
I am searching for the underlying cause of acute thoracic parastesia, L’Hermittes Sign and TMJ among other symptoms. I did find a physical therapist who does dry needling. It was near instant relief for my TMJ. I have not had pain in my jaw for 8 weeks now!
My daughter has recently been diagnosed with bilateral Trigeminal Neuralgia with left cerebral artery impinging on superior surface and venous structure on right side impinging on trigeminal nerve. We don’t know the cause of the constant and sharp pains. Might a lyme evaluation be indicated? Can lyme affect the trigeminal nerve in this way? Your feedback is most appreciated. Thank you.
You never know. Dr. Halperin, a neurologist, stated “”Other cranial nerves can be involved – the trigeminal nerve causing numbness and pain, the nerves to the extraocular muscles causing paralysis of innervated eye muscles and diplopia, or the acousticovestibular nerve affecting hearing and balance.” in the literature. Here is the link. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4440423/ I have had a few patients where it has been difficult to be sure of the diagnosis. My Lyme disease patients often have other issues that help with diagnosis.
Disseminated Lyme can also mimic toothache.
Mello I, Peters J, Lee C. Neuropathy mimicking dental pain in a patient diagnosed with Lyme disease. Journal of Endodontics. 2020 Sep 1;46(9):1337-9.
DOI: 10.1016/j.joen.2020.06.011
https://pubmed.ncbi.nlm.nih.gov/32562700/
This post made me consider testing for lyme in a patient who’s had chronic athralgias, severe TMJ, brief paralysis of the lower extremities years ago, and closed eye visual hallucinations at night (he sees racing images of random people and places – very atypical of any primary psych disorder).
I have seen patient with similar symptoms including distorted vision despite a normal ophthalmologist and Brain MRI that resolves with Lyme treatment.
Lyme disease can mimic dental and endodontic pain.
Reference: Mello, I., Peters, J., & Lee, C. (2020). Neuropathy Mimicking Dental Pain in a Patient Diagnosed with Lyme Disease. Journal of Endodontics, 46(9), 1337-1339: doi: 10.1016/j.joen.2020.06.011. Epub 2020 Jun 17. PMID: 32562700.