Orofacial Pain of Cardiac Origin: A Dental Diagnostic Challenge

SOUTH KOREA: In the field of dentistry, diagnosing orofacial pain often involves a comprehensive evaluation of odontogenic factors. However, a case report sheds light on the importance of considering non-odontogenic origins, particularly cardiac causes, in patients presenting with craniofacial pain.

The study, titled “Orofacial Pain with Cardiac Origin of Coronary Artery Disease: A Case Report and Literature Review,” was led by researchers Eunhye Choi, Yeon-Hee Lee, and Hee-Kyung Park. It was published in the Journal of Dental Research and offers valuable insights into this dental diagnostic challenge.

The Puzzling Case

The case that prompted this research involved a 60-year-old male patient who sought dental care due to enduring bilateral jaw pain that had persisted for an astounding five years. What made this case particularly intriguing was the escalating intensity of the pain over two months. To the patient’s bewilderment, this agony was triggered by mundane daily activities such as walking but would miraculously subside during periods of rest. Initial oral examination revealed no discernible dental or craniofacial irregularities.

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Suspicions of Cardiac Involvement

The absence of a local etiology for the pain raised suspicions of a cardiac origin, especially since the discomfort worsened with movement. Recognising the need for a comprehensive evaluation, the patient was referred for a cardiologist’s assessment. This decision proved pivotal.

Coronary computed tomography angiography unveiled a startling diagnosis: significant coronary artery disease (CAD). The patient’s orofacial pain was attributed to angina pectoris, a cardiac condition characterised by chest pain or discomfort due to reduced blood flow to the heart muscles.

Percutaneous coronary intervention was performed to treat the CAD. Once the stents were in place, the patient’s orofacial symptoms vanished entirely, bringing much-needed relief.

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Lesson for Dentists

This case highlights the significance of considering cardiac causes when confronted with craniofacial pain of unexplained origin. Cardiac diseases, mediated by the vagus nerve, can lead to referred pain in the orofacial region. Accurate diagnosis in such cases is pivotal, as untreated cardiac issues can exacerbate the patient’s condition.

Dentists and orofacial pain specialists play a crucial role in early detection and referral of patients with orofacial pain potentially linked to cardiac issues. This collaborative approach ensures that patients receive timely cardiovascular evaluation and appropriate management.

In the realm of dental care, it is a reminder that orofacial pain may have diverse and unexpected origins, necessitating a comprehensive and interdisciplinary approach to diagnosis and treatment.