The Impact of Lyme Disease on Oral Health

By Paige Anderson, CRDH

For many people, Lyme disease is not something they think about often, if ever. Unfortunately, rates of infection have spiked in recent years. One research site in New York recorded 20-30% more ticks that can carry the disease in 2025 than in 2024, suggesting that this trend won't be stopping soon. Let's take a look at what that means for your practice.

With Lyme cases becoming more common throughout the US, it's important to be aware of the risks and identify potential Lyme disease as early as possible for dental patients.

In general, people with Lyme disease can have flu-like symptoms, fever, fatigue, and stiffness in the early stages, with pain, weakness, and other systemic issues worsening over time. However, Lyme can cause many symptoms in the head and neck, which may lead them to believe they have a dental problem, so your practice may be the first place they go for care.

Lyme disease can also directly affect patients' oral health, and common dental treatments can cause complications for patients who are currently infected or have been in the past. To understand the link between Lyme disease and oral health, let's start with some basic information.

A Brief Primer on Lyme Disease

Lyme disease is a bacterial infection caused by Borrelia burgdorferi, a spirochete. Your dental school training may be coming back to you, as spirochetes are one class of bacteria implicated in severe periodontal disease.

Spirochetes are known to trigger systemic inflammation, and B. burgdorferi is no exception. Like other spirochetes, B. burgdorferi can travel throughout the body and even affect the nerves and brain. In fact, it has been implicated as possibly having a role in the development of some cases of dementia, just like periodontal spirochetes such as T. palladium.

The bull's-eye rash is often the first indicator of Lyme disease, but it doesn't happen in all cases and may not be noticeable in people with darker skin tones. In many cases, patients may not realize they've been infected until they develop symptoms.

Head and Neck Symptoms of Lyme Disease Include:

• Headache
• Neck pain or stiffness
• Facial palsy
• Muscle weakness in the face (unilateral or bilateral)
• Facial numbness
• Painful swelling in the face or salivary glands
• Dry mouth
• Burning or tingling
• Tooth sensitivity
• Difficulty eating, speaking, or swallowing
• Changes in taste
• TMJ pain, stiffness, or dysfunction

How Does Lyme Disease Affect Oral Health?

According to a systematic review of the literature, there are several possible ways in which Lyme disease can affect oral health. We need more research to prove causative links in some cases, but we know a few things with certainty.

1. Lyme disease causes inflammation

Lyme disease triggers the same inflammatory markers as periodontal pathogens and has a strong autoimmune aspect, meaning it can affect the periodontium like other gram-negative bacteria. Whether that means exacerbating existing periodontal disease or possibly triggering it remains to be seen. There are also reports of Lyme disease causing pulpitis, although the literature is limited.

2. Lyme disease affects trabecular bone

The potential for Lyme to cause arthritis by damaging bone tissue in the joints is well established. This was previously understood to be a function of inflammation, but mouse models show that B. burgdorferi can cause bone loss by interfering with normal remodeling.

These models suggest that the correlation between Lyme disease and periodontal disease could have a directly causative element.

Beyond bone loss, Lyme is also well known to cause TMJ symptoms. While this may be due to joint inflammation or nerve involvement, damage to the condyles or nearby bone structures should also be considered.

3. Lyme disease affects the nerves of the head and face

While the literature continues to evolve, Lyme is known to affect the nervous system, particularly cranial and facial nerves, causing pain, tingling, or burning sensations in the jaws, face, or mouth. This may mimic burning mouth syndrome, trigeminal neuralgia, and other pain conditions, or even cause facial palsy.

This can also lead to reduced salivary flow (and all sequelae that come with xerostomia), changes in the sense of taste, extreme tooth sensitivity, and difficulty chewing, swallowing, and speaking.

Treatment Planning and Patient Management

1. Lyme may cause complications with some treatments

If a patient has been diagnosed with Lyme, it may be necessary to consult their physician before root canal treatment, tooth extraction, and other procedures involving the pulp or periodontium. The research is sparse at best, but there is some evidence to suggest that interventions like RCT, EXT, or periodontal surgery could stir up any B. burgdorferi populating involved tissues, allowing them to spread and causing the infection to flare up.

However, more severe stages of Lyme disease can take months to treat successfully, so putting off needed dental treatments may not be possible or advisable.

2. Chronic pain from Lyme may need consideration for post-op management

Post-operative pain management is a major consideration for patients who are being treated for Lyme, or who have had Lyme in the past. Post-treatment Lyme disease syndrome (PTLDS) can last months or even years. This can make it difficult for patients to tolerate treatment and may make their post-operative pain difficult to manage.

3. Lyme disease treatments can cause oral health side effects

Because Lyme is best treated with tetracycline-class antibiotics, intrinsic staining is a concern for young children. Of course, the current recommendation is to use penicillin for young and pregnant patients, but there may be cases where this is not possible.

Like many medications and any course of antibiotics, Lyme treatment can cause oral side effects like disruption of the oral and digestive microbiomes, dry mouth, and oral inflammation.

Are You in a Lyme-Prone Area?

While a vaccine for Lyme exists for dogs, it is not currently available for humans. If one becomes available, dentists should be prepared to recommend it to patients to help reduce risks for lifelong oral health complications.

If you practice in a high-risk area for Lyme disease, it's important to include possible Lyme in differentials. Practices in Lyme-prone areas may want to add an item to patient intake forms that includes a history of Lyme disease. It's especially important to know if patients are currently undergoing treatment.

As your team chats with patients, direct them to ask about outdoor activities and tick prevention habits. Many people don't realize they've had a tick bite, and your team could make the difference in getting timely treatment or helping your patients avoid it altogether.

Author: Paige Anderson is a certified registered dental hygienist with eight years of clinical experience and an English degree. She blends her two areas of expertise to create resources for dental providers so they can change lives by giving their patients the highest possible standard of care.