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Due to the high incidence of
Lyme disease, the ease with which it can be misdiagnosed, and its potential for causing irreversible neurologic or cardiac complications and fatalities if left untreated, all patients living in known epidemic areas who manifest intractable facial pain, or what appears to be a case of temporomandibular joint syndrome that does not respond to therapy should be tested for
Lyme Borelliosis. It should be remembered however, that not all patients with active
Lyme disease produce antibodies, and it is thus imperative for the clinician to obtain a detailed patient history with a focused series of questions directed at the known presentations of the
disease, with specific emphasis placed on the prior appearance of an ECM lesion.