Pain from cardiac ischaemia can have a range of presentations. This can include chest, arm, shoulder pain, face or jaw pain.  While sudden chest pain that may travel down the arm is a typical presentation classic teaching is that cardiac ischemia can present with tooth, jaw, or facial pain as its sole symptom.  The aim of this review is to investigate the incidence of jaw, tooth, or facial pain as the sole symptom of cardiac ischemia.

A search was conducted in the PubMed database for all studies in humans in which cardiac pain originated in the face, teeth, or jaw.  Only English language papers were included.  Studies were assessed for bias and quality.

• 18 studies were included (2 prospective cohorts and 16 case reports).
• All except one of the case reports related to a single patient.
• 9 reports were categorized as weak, 8 moderate, and one strong methodological quality.
• 7 studies noted jaw, tooth, or facial pain as the lone symptom of cardiac origin. The study with the strongest methodology reported that 6% of patients with pain of cardiac origin had jaw or face pain as their only symptom, but all of these patients except one described the pain as ‘pressure’ or ‘burning’.

The authors concluded

Cardiac ischemia may present in no anatomic location other than face or jaw.  However, despite frequent claims in the literature to the contrary, the lack of methodological quality of the studies investigated impedes a firm conclusion of face, jaw, or tooth pain as the only symptom of cardiac insufficiency.

Comment

As only a single database was searched and only English language articles were included it is likely that other relevant articles could have been missed.  While the available evidence is limited as the authors note that there is the possibility of atypical presentations of cardiac ischaemia as tooth, jaw, or facial pain.

Links

Jalali N, Vilke GM, Korenevsky M, Castillo EM, Wilson MP. The Tooth, the Whole Tooth, and Nothing But the Tooth: Can Dental Pain Ever Be the Sole Presenting Symptom of a Myocardial Infarction? A Systematic Review. J Emerg Med. 2014 Jan 25. pii: S0736-4679(13)01397-8. doi: 10.1016/j.jemermed.2013.11.071. [Epub ahead  of print] PubMed PMID: 24472352.