A Dental Dilemma
LOUISE, age 58, first noticed her toothache while playing tennis outside on a brisk autumn day. After a particularly vigorously played point she felt a nagging sensation on the left side of her face. I really should get that old filling checked, she thought. She continued to play tennis and tried to ignore the pain in her jaw. The set soon ended and she was pleased that the discomfort had finally eased. That night while rushing to her bridge game she felt the dull ache again for a few minutes. This time she vowed to schedule her long overdue dental appointment.
Normally loathe to visit the dentist; she was glad that he was able to see her the next day. But to her surprise, the doctor found nothing wrong. He asked her some more specific questions about her discomfort and it became clear that her tooth pain only occurred with exertion. The dentist suggested she see a cardiologist.
The cardiologist examined Louise exercised on the treadmill, the tooth discomfort returned. The doctor explained that her symptoms during the test were also accompanied by EKG changes and that she should have an angiogram. A few days later the angiogram revealed a single, but severe narrowing of one of her coronary arteries. A stent was placed and she was discharged home the following morning. It wasnt long before she was back on the tennis court, this time without her toothache.
The classic symptom of a coronary artery blockage is angina, characterized as a dull ache, pressure, heaviness or tightness that typically occurs with exercise or emotional stress and is relieved by rest or nitroglycerin. Symptoms typically occur in the middle of the chest behind the breastbone (sternum). Sometimes, the discomfort is present in the back, jaw, either arm or shoulder. In a minority of people, the only symptom of angina is facial or dental pain. Facial pain is more common in women and can involve the throat, left or right jaw, the left temporomandibular joint/ear region and the teeth. Most people will experience facial pain along with typical chest discomfort. In one study however, 15% of people had facial pain as their only manifestation of angina.
Failure to diagnose cardiac pain that is referred to the face, head, neck and teeth can delay treatment and result in a myocardial infarction. It is important that all healthcare
professionals, including dentists, as well as patients themselves, be aware that facial and dental pain may indeed be related to the heart.
Dina R. Katz, MD
This article first appeared in the September/October 2007 issue of Heart & Health Reports. For a subscription, call 1-877-HEART-12.
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