Is Your Craniofacial Pain Dental Related, or Is a Heart Issue to Blame?
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While it is true that the number of reported deaths resulting from medical emergencies in a dental practice is low, when they do occur it is likely that the cause of death is due to acute heart failure. However, when a sudden heart attack occurs, it is often confused with other conditions, including at times craniofacial pain that is believed to be of dental origin.
On the flipside, people who are experiencing craniofacial (head and face) pain can also be misdiagnosed, as the pain can come from a heart-related problem or be dental in origin. That’s right – your toothache may actually be unrelated to your teeth and could be a heart attack in disguise! This presents a challenge, as by the time your health care provider figures out what’s really going on, it may be too late. It’s important that you, as your own best advocate, are aware of the connection and can potentially help to differentiate between true craniofacial pain or pain that is cardiac in origin.
What is Craniofacial Pain?
With craniofacial pain, you’ll generally experience one or more of the following symptoms:
Jaw pain, in particular, is a type of craniofacial pain that can often cause confusion of a clear diagnosis. People who experience jaw pain with no accompanying oral pathology to support that pain should consider cardiac problems as a cause. On the other hand, jaw pain with an obvious dental infection and swelling may mask the initial stages of heart disease. There are several reports of patients who visited an emergency room with right-side jaw pain, with the cause seeming to be an infected and swollen tooth. After dental repair and treatment, pain and swelling subsided. But then, several weeks later, the exact same symptoms returned for these patients. It then became clear that these symptoms were not from failed dental treatment, but actually from a heart attack.
How Can You Tell the Difference Between Craniofacial and Heart-Related Pain?
Craniofacial pain, no matter what the cause, is commonly felt in the same location. Pain that can be described as “pressure” and “burning” is more likely to be of cardiac origins, while “throbbing” and “aching” are more descriptive of a dental problem. Pain that is aggravated by physical activity, with relief at rest, typically indicates a cardiac problem.
Pain that continues after dental treatment can often indicate either treatment failure or a cardiac disorder. An awareness and recognition of the correct symptoms is the only way to prevent a potentially life-threatening problem. Years ago, doctors and health professionals were not aware that specific oral bacteria can enter into gingival blood vessels and ultimately cause a stroke or heart attack. It is only with recent research that these problems have become known. If you experience pain symptoms that you think are dental related, but which do not go away with proper dental care, see a specialist about a potential heart-related issue.
TMJ and Other Craniofacial Pain Syndromes
Researchers believe that there is a significant portion of the brain that processes and interprets trigeminal autonomic, sensory and motor function information. This is a theory that is supported by most neurobiologists who estimate that around 70% of the brain is devoted to the trigeminal nerve (the fifth cranial nerve).
The most common craniofacial pain syndrome is called is trigeminal neuralgia ("TMJ" or jaw joint pain). Trigeminal neuralgia is a type of facial pain that usually develops in people who are over 50 years old. It is the most common syndrome for facial pain in this specific age group. Rarely, different types of neuralgias from other cranial nerves can mimic trigeminal neuralgia. It is essential to distinguish these atypical facial pains from these neuropathic syndromes.
The causes are unknown, but there is considerable evidence that vascular compression of a nerve root may be the cause. This may be due to the branches of the superior cerebellar artery, the basilar artery, or any local veins that are compressing on the root of the trigeminal nerve. Trigeminal neuralgia can also be caused by tumors in the cranial nerve V region or (more commonly) by multiple sclerosis in younger people. Due to these possibilities, each one must be ruled out.
The main characteristic trigeminal neuralgia feeling is described as "electric-like shocks" that last a few seconds, but are extremely intense. They are generally on one side of the face, mostly in the upper cheek and down to the jaw. These painful attacks can occur spontaneously, but are more often caused by a stimulus in a specific trigger area. Trigger points are commonly located at the eyebrow, the upper lip and the lower molar teeth. Stimuli may be cold, touch, wind, talking, chewing or clenching teeth. Pain can disappear for minutes or up to weeks, but long-term relief is rare. These attacks can cease during sleep, but often present upon first waking up in the morning.
While it is possible to suffer both a TMJ disorder and cardiac problems at the same time, if the most dominant pain is from trigeminal pain, facial pain, or tooth pain, you should likely visit a dentist rather than an emergency room. As to the reason for cardiac-induced referred pain to the craniofacial region, there is no known link.
Points About Craniofacial Pain in Cardiac Patients
So while many consider chest pain or pain in your left arm as the classic sign of a heart attack, pain in the craniofacial region may actually be far more common. It’s an important point to be aware of, as this is often missed, even by doctors and dentists.
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Source
Managing Craniofacial Pain the Multi-Disciplinary Way
Quality difference in craniofacial pain of cardiac vs. dental origin.
Dr. Nigel W. Bunnett Named Chair, Department of Basic Science and Craniofacial Biology, New York University College of Dentistry
Diagnose My Migraine
Compendium, Volume 33, Issue 3
The Internet Journal of Emergency Medicine. 2011 Volume 7 Number 1
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