Open wide! Cardiac symptoms diagnosed in the dental chair

1 Apr

by Carolyn Thomas  @HeartSisters  ♥  April 1, 2018

Mary Kay Osborne is a heart patient from Hammondsport, New York. She replied recently to my blog post about early heart attack warning symptoms, and mentioned something that snagged my attention. That post had listed “jaw or teeth pain” as one of several possible early cardiac warning signs – especially in women’s heart attacks, as quoted in Dr. Sheila O’Keefe-McCarthy’s research. Mary Kay replied that she had experienced a number of early warning signs before her first coronary stent was implanted at age 57, including pain in her jaw and teeth:
“I started experiencing symptoms almost eight months before I suspected they were signs of heart issues. The fatigue and anxiety were terrible. And I began having a lot of pain in my jaw and teeth. I had a couple of teeth extracted that I don’t think I needed pulled. My dentist never told me there was an infection – just that they needed to be pulled. But afterwards, I still had pain in the area of the tooth extractions, like phantom pains. The emotional stress was terrible.”  ……

This unusual pain that shows up in the mouth, jaw or face – what dentists call “orofacial pain” – can be a documented cardiac warning sign.
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Researchers in Barcelona, for example, found that orofacial pain that’s actually heart-related tends to be felt in the lower left jaw, but even on both sides, meaning that – unlike toothache pain – you may feel the pain on both sides of the face. The lead author of the study explained that orofacial pain of cardiac origin is considered to be atypical, but present in up to 10% of all people during a heart attack, with or without chest pain.(1)
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Researchers described findings that sounded remarkably like what had also happened to Mary Kay:
“When these orofacial pain of cardiac origin occur, unnecessary dental treatment is often performed
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“There are published clinical cases of patients who have undergone unnecessary dental extractions or have been prescribed pain medications due to misdiagnosis, without curing the orofacial pain.
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This leads to a delay in a cardiac diagnosis, and consequently, a delay in beginning necessary treatment.”

Orofacial pain of cardiac origin is typically a toothache that occurs spontaneously, and is usually made worse with exercise (just as the chest pain of stable angina typically comes on with exertion, and eases up with rest).

Unlike a conventional toothache caused by dental issues, the tooth or jaw pain that’s linked to heart issues can decrease when the coronary vasodilator called nitroglycerin is taken, and can also occur at the same time along with chest, neck, shoulder or throat pain.

The signs suggesting that a toothache may be more than just a simple toothache include:

  • a burning or pulsing pain
  • a pain that goes into remission, or dramatically changes
  • a persistent pain during days or months
  • a spontaneous pain in multiple teeth
  • a pain that does not go into remission even after anaesthetic block (freezing)
  • lack of response to adequate dental treatment
Researchers also reported that, following a correct heart-related diagnosis and appropriate cardiac treatment, the teeth/jaw symptoms were completely resolved in all of the cases studied.
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Interestingly, researchers learned that the intensity of reported pain was higher in patients with a real toothache than in those experiencing jaw/teeth pain of cardiac origin.
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How does heart pain end up masquerading as a toothache or jaw pain? Often it’s what we know as referred pain, as I wrote about in “Why Does Your Arm Hurt During a Heart Attack?”
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As cardiologist Dr. Larry Weinrauch explained, occasionally heart-related symptoms do not affect the chest or upper abdomen at all!  For example:
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“Heart pain can also be noted in the jaw and teeth. It is more common for heart-related discomfort to affect the lower jaw than the upper jaw.

“The reason for heart pain is an inadequate amount of blood flow reaching the heart muscle. Our nervous system senses this as ‘pain’ or ‘discomfort’ most of the time. Our bodies do not always tell us the cause, or even the organ that is the source of the problem.

“So, we have to look carefully at the things that either relieve or  increase discomfort.

“If simple motions of the arm, shoulder, or jaw make things worse, it is probably not due to the heart.

“If rotating the muscles of your trunk (twisting from side to side) make things worse, it is not likely to be due to a heart problem.

“If pressing on a trigger point causes exquisite discomfort, it is also not likely a heart problem.

“If making chewing motions or moving your jaw hurts, it is more likely that the discomfort has nothing to do with your heart.

“If taking a deep breath makes things worse, it is not likely that a heart attack is the problem.

“But on the other hand, if walking fast aggravates the symptoms or causes shortness of breath, I would be concerned. If the discomfort persists even when lying quietly, I would be concerned. And, if you are getting short of breath for any reason, I would be concerned.
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“It cannot be emphasized enough that a heart attack can have symptoms other than chest pain, and these symptoms should be checked immediately. I have had many patients sent to me for ‘unusual pains.’ The classic example was the patient with lower dentures who was having tooth pain while walking after heavy meals. This one was, indeed, cardiac!”
Dr. Weinrauch warns that, if you are at higher risk of heart disease because of age, family history, high blood pressure, high cholesterol, a history of smoking, etc., it’s better to be safe than sorry – and get checked by a health care professional.

Pain should be respected, he adds. “It’s evidence that there is something wrong. Even if it is not cardiac, it deserves your attention.”

In another study, researchers found what they described as a “significant relationship” between orofacial pain of cardiac origin and smoking or high cholesterol.(2)  They added:

“Dental practitioners should be thoroughly aware of this symptomatology to prevent misdirected dental treatment and delay of medical care.”

Speaking of teeth, you may have heard of the association between gum disease and heart disease. There’s also a type of tooth infection that can be dangerous, according to a University of Helskinki study published in the Journal of Dental Research.(3)  Acute coronary syndrome (ACS, an emergency condition that’s the precursor to heart attack) is almost three times more common among people with infections at the tip of a tooth root – even if they have no tooth symptoms.

Their study found that 58% of the patients already diagnosed with ACS also suffered from inflammatory lesions at the root tip, a condition called apical periodontitis (usually those untreated by a root canal procedure).  This type of low-grade inflammation is similar to that found in gum disease which affects the tissues around the teeth and has been regarded as an independent risk factor for coronary artery disease.

Most of these tooth infections are detected only by chance on dental x-rays.

In Mary Kay Osborne’s own case, her toothache pain wasn’t the only cardiac symptom that was being ignored during a long eight-month period.

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After her dental woes, Mary Kay accidentally fell hard on her kitchen floor one day; on the following day, she started feeling pain in her arm and pressure in her chest. She told her husband that she thought she was having a heart attack. But when they went to the ER for help, she was sent home after being misdiagnosed with acid reflux. She went to another doctor for her ongoing symptoms, who told her she had likely just pulled a muscle from the fall in her kitchen. Finally, her primary care physician ordered a treadmill stress test. She says that she lasted one minute, and then almost passed out. Further tests indicated a 95% blockage in one of her coronary arteries.
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Mary Kay now says:

“I don’t think my dentist was clued in on heart issues. This whole heart thing has changed my life so much. So if I can help just one person by telling this story, it would be a good thing.”

  1. José López-López, “Orofacial pain of cardiac origin: Review literature and clinical cases.” Medicina Oral Patologia Oral y Cirugia Bucal. 2012 Jul; 17(4): e538–e544.
  2. Bakhshi, Mahin et al. “Frequency of Craniofacial Pain in Patients with Ischemic Heart Disease.” Journal of Clinical and Experimental Dentistry.25 Mar. 2017. 9.1 e91–e95.
  3. John Liljestrand, “Association of Endodontic Lesions with Coronary Artery Disease”. Journal of Dental Research. Vol. 95(12). July 27, 2016, 1358–1365.
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NOTE FROM CAROLYN: I wrote more about both atypical cardiac symptoms (like Mary Kay’s) and many other typical symptoms in Chapter 1 of my book, “A Woman’s Guide to Living with Heart Disease” (Johns Hopkins University Press, November 2017)

  Interesting ANGINA FACTOID that I learned from the Barcelona study while researching this article: “Episodes of stable angina chest pain typically last between 1-10 minutes. A pain lasting less than 30 seconds or continuous pain throughout the day is rarely of cardiac origin.”

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Q: Did your own heart disease symptoms include any episodes of jaw or teeth pain?

See also:

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7 Responses to “Open wide! Cardiac symptoms diagnosed in the dental chair”

  1. Carol Ann Twetan April 11, 2018 at 7:28 pm #

    Yes, I was having jaw pain that would come and go the two weekends before my heart attack. I kept saying, I think I have an ear infection.

    But now that I think back I had been canoeing the first weekend and boogie board surfing right before the pain started. The only other sign was my left upper arm felt wind burn but it wasn’t, and my arms had been covered while I was outside swimming and canoeing. I had no health issues and the arm feeling funny was a mystery. Since my stent I have not had the pain or funny feeling in my arm.

    Liked by 1 person

    • Carolyn Thomas April 12, 2018 at 7:10 am #

      Interesting… None of those symptoms (jaw pain, ‘wind burn’) would have alarmed the average person, all by themselves. It’s often only in hindsight we can look back and connect the dots. Glad you’re feeling better now, Carol Ann.

      Like

  2. Meghan April 2, 2018 at 6:24 am #

    This post made me think of several things. I know a woman who apparently had an infection in her teeth and was totally unaware of it because she had had root canals and felt no pain. She ended up having to have a valve transplant because of the damage it caused to her heart.

    Also, the cardiologist who did both of my stents gave a talk once and shared that he had worked with another cardiologist who told him he had seen jaw pain in heart patients so often that just from where their jaw pain symptoms were located, he knew exactly which coronary artery was blocked. So while dentists might not get it at first, there are some heart doctors out there who totally get it!

    I myself experienced neck and jaw discomfort when my heart went into a “classic” a-fib episode on March 3rd. My husband has a-fib and listened to my heart when it happened, and we were both pretty sure we knew what was happening and that it wasn’t a heart attack, but the neck pain scared me enough to take a nitro, which eased it right away. It was kind of like an achy feeling more in the neck than jaw, not severe but definitely there.

    Unfortunately, after I mentioned this pain to my cardiologist, she now thinks I need another treadmill stress test. Phooey! Just when I thought I was doing really well — in November she said I didn’t have to see her again for 6 months. Plus she wants me on a blood thinner and I have many reservations about that, although I do understand the risk of stroke from this. And she wants me to have a sleep study done as well.

    I feel like once you have heart disease, it’s like a never-ending downward spiral into the vortex of medical testing and intervention!

    I so related to what you wrote in your book about just wanting to be a person and not a patient anymore. 8^(

    Liked by 1 person

    • Carolyn Thomas April 2, 2018 at 8:23 am #

      Hi Meghan – you raised so many interesting points. First, I was impressed by your cardiologist’s comments that he could even predict which coronary artery was involved based on jaw pain symptom location! Also, your own jaw and neck pain that was reduced by nitro is a good hint that the symptom is heart-related (since non-cardiac neck/jaw pain wouldn’t respond to nitro) AND that you didn’t describe your pain as severe, more like just “achy” – all important things for women to know when they’re assessing their own symptoms.

      And of course, you’re correct – the discouraging reality is that heart disease isn’t like acute care medicine at all (in which you get sick, you get treated, you get better, you thank your brilliant doctor!). So many relentless decisions to make… It’s a chronic and progressive diagnosis. It took me a long time to wrap my brain around THAT reality! Best of luck to you as you figure out these new questions. You are not alone…

      Liked by 1 person

  3. mmarkwlmotherofthebride April 1, 2018 at 6:54 pm #

    I’m wondering how common jaw and tooth pain are with cardiac symptoms. Every time I have an angina attack, it starts with jaw pain, proceeds to tooth pain and when a bad one, to tingling in my arms and an elephant sitting on my chest!

    Luckily I’ve got meds now and a correct diagnosis of MVD and sick sinus syndrome courtesy of Mayo Clinic. I suffer from much fewer episodes now and feel fairly well most of the time. It’s nice to know I’m not alone. Thanks.

    Liked by 1 person

    • Carolyn Thomas April 1, 2018 at 8:41 pm #

      It’s interesting that your symptoms all seem to follow a pretty specific pattern, isn’t it? According to the Barcelona researchers mentioned in this post, about 10% of people diagnosed with heart disease report jaw or teeth pain (often after the fact, I’m guessing!) I’m glad to hear that your symptoms seem nicely managed most of the time now.

      Like

      • mmarkwlmotherofthebride April 2, 2018 at 5:03 am #

        Thanks. I am, too. It was really hard when the doctors didn’t really know what was going on. I’m 5 years into this heart journey and just keep plugging along.

        Take care.

        Mary

        Liked by 1 person

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