 Overview
Chronic Fatigue Syndrome (CFS), a long-term illness whose etiology remains elusive, is diagnosed in an estimated 500,000 people in the
United States. A patient with CFS may have oral manifestations, such as TMJ disorders and Sjogren's syndrome. In addition, commonly
prescribed medications used in management of this syndrome may induce adverse reactions in the oral cavity.
The information provided here is intended as a resource for dentists to assist in the dental management of patients who have been
diagnosed with CFS. If a patient reports symptoms consistent with CFS, the patient should be referred to his or her physician for appropriate
diagnosis and treatment.
Definition
General fatigue and other symptoms similar to CFS were described as early as the 1860s.
1
Awareness of the illness increased in the mid 1980s, when it was nicknamed the “yuppie flu”.
It was subsequently mislabel as “chronic EBV” due to reports that the Epstein-Barr virus was a causative agent, but this
etiology was quickly refuted. In March 1988, the CDC acknowledged the collection of symptoms known as Chronic Fatigue Syndrome, and
developed the following definition:
1) Severe chronic fatigue of six months or longer duration with other known medical conditions excluded by clinical diagnosis;
and 2) concurrently, four or more of the following symptoms: substantial impairment in short-term memory or concentration; sore throat;
tender lymph nodes; muscle pain; multi-joint pain without swelling or redness; headaches of a new type, pattern or severity; unrefreshing
sleep; and post-exertional malaise lasting more than 24 hours. The symptoms must have persisted or recurred during six or more consecutive
months of illness and must not have predated the fatigue.
2-4
Symptoms
The prevalent symptom of CFS is profound fatigue,
especially fatigue that is not improved
by rest or sleep. In addition to the symptoms listed in the CDC
definition of CFS, 20–50 percent of patients with CFS can report
atypical symptoms. These can include insomnia, weakness, abdominal
pain, jaw pain, dry eyes or mouth, alcohol intolerance, bloating,
chest pain, chronic cough, diarrhea, dizziness, earaches, irregular
heartbeat, morning stiffness, nausea, night sweats, shortness of
breath, skin sensations, tingling sensations, weight loss, depression,
irritability, anxiety, and panic attacks (Table 1). If a patient reports
symptoms consistent with CFS, the patient should
be referred to his or her physician for
appropriate diagnosis and treatment.
Diagnosis
A formal diagnosis of CFS must be made by a physician. Since there are currently no specific diagnostic tests for CFS, a differential
diagnosis often comprises exclusion of other known conditions with similar symptoms, including reactions to prescribed medications,
multiple chemical sensitivities, myalgic encephalomyelitis, neurasthenia, chronic mononucleosis, hypothyroidism, cancer, autoimmune disease,
hormonal disorders, fibromyalgia syndrome (myofascial pain), subacute infections, obesity, alcohol abuse, substance abuse, sleep apnea, narcolepsy,
major depressive disorders, bipolar affective disorders, schizophrenia and eating disorders.
Prevalence
Estimates of the prevalence of CFS range from
4 to 200 per 100,000 people, and it is
estimated that up to 500,000 people in the United States have CFS.
There have been varying reports on the incidence of CFS in women,
and estimates range from 60–85 percent of CFS cases diagnosed
in women.5 Additionally,
there appears to be a higher incidence
in the African American population, with the least incidence seen
among Asians and Caucasians.
Etiology
Although there has been much speculation as to the causative agent of CFS, including transient traumatic conditions, stress, toxins,
and latent viral infection, no definite cause or causes have been identified to date. Based on the current available research, there is no
evidence indicating that CFS is a contagious disease. In most likelihood, CFS is a common endpoint resulting from multiple causes.
Treatment
Treatment modalities for patients with CFS are aimed at relief of symptoms rather than curing the disease. Common pharmacologic
therapies that may be prescribed by a physician include the administration of non-steroidal anti-inflammatory drugs (NSAIDs) for pain
relief, low-dose tricyclic antidepressants to improve sleep and relieve mild pain, and anxiolytic agents to treat anxiety (Table 2).
4
In some cases, serotonin reuptake inhibitors prescribed to non-depressed patients have been found to be beneficial.
4
Furthermore, evidence-based systematic reviews have illuminated the beneficial role of light exercise.
6,7
Recovery
The clinical course of CFS varies from patient to patient. For most patients, limited recovery to the point that one can return to work
and undertake other activities occurs within the first five years. However, the syndrome can be cyclical in nature, with intermittent periods of fatigue.
Some patients will experience a complete recovery, whereas others may never fully recover from the syndrome. There does not appear to be any notable
correlation between recovery and symptoms, race, sex, age of onset, or other illness characteristic.
Dental Concerns
Oral manifestations of CFS can include Sjörgren’s syndrome, temporomandibular disorders, and fibromyalgia (myofascial pain).
Furthermore, many of the medications prescribed to manage CFS can induce a variety of oral side effects, most commonly xerostomia (Table 2). Routine and elective dental treatment,
including periodic examination and prophylaxis, are not contraindicated, but accommodations should be taken to care for the patient’s energy level.
This may include scheduling appointments for times when the patient is likely to feel well and limiting elective treatment plans to procedures that are
manageable for the patient. Consultation with the patient’s physician may be indicated for extensive reconstruction procedures, oral surgery or
periodontal surgery.
Additional Resources
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this or any other science-related topic,
please contact the ADA Division of
Science via e-mail or by calling 312-440-2878.
ADA members may use the Association’s
toll-free number and ask for x2878.
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