Orofacial pain as a manifestation of myocardial ischemia

Cover Page

Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

Not only dentists, but also doctors of various specialties encounter orofacial pain (OFP) in their practice. Odontogenic pain is well and predictably relieved with dental therapy. Nonodontogenic toothache is often difficult to identify and may compromise the clinician’s diagnostic abilities. Incorrect diagnostic assessment of reffered visceral OFP, especially of cardiac origin, can lead to late diagnosis in a patient with cardiac pathology. A search for publications indicating a connection between OFP and coronary artery disease (CAD) was conducted in the PubMed and Scopus databases for the period up to 12/01/2023. Epidemiological evidence suggests that referred OFP in CAD is more common than previously thought. The review addresses the issues of the pathogenesis of OFP of cardiac origin. An analysis of 18 clinical cases in 15 publications was carried out. The results of clinical studies indicating that non-odontogenic orofacial pain during myocardial ischemia occurs on average in 4–5% of patients with coronary artery disease and in some cases may be the only manifestation of myocardial ischemia are presented. Patients with CAD in whom OFP is the only manifestation of myocardial ischemia are at higher risk of misdiagnosis and death. Awareness of the internist and dentist about this atypical symptomatology can be crucial for early diagnosis, timely treatment and favorable prognosis.

Full Text

Restricted Access

About the authors

Dmitry I. Trukhan

Omsk State Medical University

Author for correspondence.
Email: dmitry_trukhan@mail.ru
ORCID iD: 0000-0002-1597-1876

Dr. Sci. (Med.), Associate Professor, Professor at the Department of Outpatient Therapy and Internal Medicine

Russian Federation, Omsk

A. F. Sulimov

Omsk State Medical University

Email: dmitry_trukhan@mail.ru
Russian Federation, Omsk

L. Yu. Trukhan

Omsk State Medical University

Email: dmitry_trukhan@mail.ru
ORCID iD: 0000-0002-4721-6605
Russian Federation, Omsk

References

  1. Международная классификация орофациальной боли, 1-е издание (ICOP). Адаптированная русскоязычная версия. Альманах клинической медицины. 2022;5 (Suppl.):3–80. [International Classification of Orofacial Pain, 1st edition (ICOP) Official Russian translation Translated on the initiative of Russian Headache Research Society (RHRS) Almanac Clin Med. 2022;50(Suppl.):3–80 (In Russ.)]. doi: 10.18786/2072-0505-2022-50-005.
  2. Трухан Д.И., Сулимов А.Ф., Трухан Л.Ю. и др. Орофациальная боль в период пандемии новой коронавирусной инфекции (COVID-19). Клинический разбор в общей медицине. 2022;4:54–65. [Trukhan D.I., Sulimov A.F., Truk- han L.Yu., et al. Orofacial pain during the new coronavirus infection (COVID-19) pandemic. Clin Rev General Pract. 2022;4:54–65. (In Russ.)]. doi: 10.47407/kr2022.3.4.00153.
  3. Okeson J.P. Non-odontogenic toothache. Northwest Dent. 2000;79(5):37–44.
  4. Yatani H., Komiyama O., Matsuka Y., et al. Systematic review and recommendations for nonodontogenic toothache. J Oral Rehabil. 2014;41(11):843–52. doi: 10.1111/joor.12208.
  5. Myers D.E. Review of visceral throat and chest disorders causing nonodontogenic orofacial pain. J Am Dent Assoc. 2022;153(8):769–75. doi: 10.1016/j.adaj.2022.01.007.
  6. Germain L. Differential diagnosis of toothache pain. Part 2, nonodontogenic etiologies. Dent Today. 2012;31(8):84, 86, 88–9.
  7. Myers D.E. Toothache referred from heart disease and lung cancer via the vagus nerve. Gen Dent. 2010;58(1):e2–5.
  8. Foreman R.D. Neurological mechanisms of chest pain and cardiac disease. Cleve Clin J Med. 2007:74(Suppl. 1):S30–3. doi: 10.3949/ccjm.74.suppl_1.s30.
  9. Myers D.E. Vagus nerve pain referred to the craniofacial region. A case report and literature review with implications for referred cardiac pain. Br Dent J. 2008;204(4):187–89. doi: 10.1038/bdj.2008.101.
  10. Kreiner M., Okeson J.P. Toothache of cardiac origin. J Orofac Pain. 1999;13(3):201–7.
  11. Lopez-Lopez J., Adserias-Garriga M.J., Garcia-Vicente L., et al. Orofacial pain of cardiac origin, serial of clinical cases. Med. Oral Patol. Oral Cirugía Bucal. 2012;17(4):e633–37. doi: 10.4317/medoral.17689.
  12. Kikuta S., Dalip D., Loukas M., et al. Jaw pain and myocardial ischemia: A review of potential neuroanatomical pathways. Clin Anat. 2019;32(4):476–79. doi: 10.1002/ca.23367.
  13. Matson M.S. Pain in orofacial region associated with coronary insufficiency: report of a case. Oral Surg Oral Med Oral Pathol. 1963;16(3):284–85. doi: 10.1016/0030-4220(63)90290-1.
  14. de Norman J.E. Facial pain and vascular disease: some clinical observations. Br J Oral Surg. 1970;8(2):138–44. doi: 10.1016/S0007-117X(70)80007-5.
  15. Natkin E., Harrington G.W., Mandel M.A. Anginal pain referred to the teeth: report of a case. Oral Surg Oral Med Oral Pathol. 1975;40(5):678–80. doi: 10.1016/0030-4220(75)90378-3.
  16. Tzukert A., Hasin Y., Sharav Y. Orofacial pain of cardiac origin. Oral Surg Oral Med Oral Pathol. 1981;51(5):484–86. doi: 10.1016/0030-4220(81)90006-2.
  17. Groah S.L., Menter R.R. Long-term cardiac ischemia leading to coronary artery bypass grafting in a tetraplegic patient. Arch Physical Med Rehabilit. 1998;79(9):1129–32. doi: 10.1016/S0003-9993(98)90183-6.
  18. de Oliveira Franco A.C., de Siqueira J.T., Mansur A.J. Bilateral facial pain from cardiac origin. A case report. Br Dental J. 2005;198(11):679–80. doi: 10.1038/sj.bdj.4812380.
  19. Franco A.C., Siqueira J.T., Mansur A.J. Facial pain of cardiac origin: a case report. Sao Paulo MedJ. 2006;124(3):163–64. doi: 10.1590/S1516-31802006000300012.
  20. Christoforidou A., Bridger M.W. Angina masquerading as sinusitis. J. Laryngol Otol. 2006;120(11):961–62. doi: 10.1017/S002221510600212X.
  21. Laurent F., Segal N., Foucher J., Augustin P. Acute coronary syndromes. Br Dental J. 2010;209(1):3. doi: 10.1038/sj.bdj.2010.584.
  22. Dalband M., Mortazavi H., Hashem-Zehi H. Bilateral temporomandibular joint pain as the first and only symptom of ischemic cardiac disease: a case report. Chang Gung Med. J. 2011;34(Suppl. 6):1–3.
  23. Turner M.J., McMillan K.G., Gibbons A.J. Angina presenting as orofacial pain: a case report. Oral Surg. Oral Med. Oral Pathol Oral Radiol. 2013;116(6):e443–44. doi: 10.1016/j.oooo.2012.02.028.
  24. Fazlyab M., Esnaashari E., Saleh M., et al. Craniofacial pain as the sole sign of prodromal angina and acute coronary syndrome: a review and report of a rare case. Iranian Endodontic J. 2015;10(4):274–80. doi: 10.7508/iej.2015.04.013.
  25. Choi E., Lee Y.H., Park H.K. Orofacial Pain with Cardiac Origin of Coronary Artery Disease: A Case Report and Literature Review. Case Rep Dent. 2023;2023:6304637. doi: 10.1155/2023/6304637.
  26. Kreiner M., Okeson J.P., Michelis V., et al. Craniofacial pain as the sole symptom of cardiac ischemia: a prospective multicenter study. J Am Dent Assoc. 2007;138(1):74–9. doi: 10.14219/jada.archive.2007.0024.
  27. Kreiner M., Alvarez R., Waldenstrom A., et al. Craniofacial pain of cardiac origin is associated with inferior wall ischemia. J Oral Facial Pain Headache. 2014;28(4):317–21. doi: 10.11607/ofph.1257.
  28. Kreiner M., Alvarez R., Michelis V., et al. Craniofacial pain can be the sole prodromal symptom of an acute myocardial infarction: an interdisciplinary study.Acta Odontol. Latinoam. 2016;29(1):23–28.
  29. Danesh-Sani S.H., Danesh-Sani S.A., Zia R., Faghihi S. Incidence of craniofacial pain of cardiac origin: results from a prospective multicentre study. Aust Dent J. 2012;57(3):355–58. doi: 10.1111/j.1834-7819.2012.01698.x.
  30. Bakhshi M., Rezaei R., Baharvand M., Bakhtiari S. Frequency of craniofacial pain in patients with ischemic heart disease. J Clin Exp Dent. 2017;9(1):e91–5. doi: 10.4317/jced.53078.
  31. Kreiner M., Falace D., Michelis V., et al. Quality difference in craniofacial pain of cardiac vs. dental origin. J Dent Res. 2010;89(9):965–69. doi: 10.1177/0022034510370820.
  32. Kreiner M., Okeson J., Tanco V., et al. Orofacial Pain and Toothache as the Sole Symptom of an Acute Myocardial Infarction Entails a Major Risk of Misdiagnosis and Death. J Oral Facial Pain Headache. 2020;34(1):53–60. doi: 10.11607/ofph.2480.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c) 2024 Bionika Media

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies