“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.” ……
“When these orofacial pain of cardiac origin occur, unnecessary dental treatment is often performed“.“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..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
“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..“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!”
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.
.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.
“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.”
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.
- 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.
John Liljestrand, “Association of Endodontic Lesions with Coronary Artery Disease”. Journal of Dental Research. Vol. 95(12). July 27, 2016, 1358–1365.
NOTE FROM CAROLYN: I wrote more about cardiac symptoms (like Mary Kay’s) and many other kinds of 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.”
Q: Did your own heart disease symptoms include any episodes of jaw or teeth pain?