Craniofacial pain as the sole symptom of cardiac ischemia: A prospective multicenter study

Marcelo Kreiner, Jeffrey P. Okeson, Virginia Michelis, Mariela Lujambio, Annika Isberg

Research output: Contribution to journalArticlepeer-review

55 Scopus citations


Background. Craniofacial pain can be the only symptom of cardiac ischemia. Failure to recognize its cardiac source can put the patient's life at risk. The authors conducted a study to reveal the prevalence of, the distribution of and sex differences regarding craniofacial pain of cardiac origin. Methods. The authors prospectively selected consecutive patients (N = 186) who had had a verified cardiac ischemic episode. They studied the location and distribution of craniofacial and intraoral pain in detail. Results. Craniofacial pain was the only complaint during the ischemic episode in 11 patients (6 percent), three of them who had acute myocardial infarction (AMI). Another 60 patients (32 percent) reported craniofacial pain concomitant with pain in other regions. The most common craniofacial pain locations were the throat, left mandible, right mandible, left temporomandibular joint/ear region and teeth. Craniofacial pain was preponderantly manifested in female subjects (P = .031) and was the dominating symptom in both sexes in the absence of chest pain. Conclusions. Craniofacial pain commonly is induced by cardiac ischemia. This must be considered in differential diagnosis of toothache and orofacial pain. Clinical Implications. Because patients who have AMI without chest pain run a higher risk of experiencing a missed diagnosis and death, the dentist's awareness of this symptomatology can be crucial for early diagnosis and timely treatment.

Original languageEnglish
Pages (from-to)74-79
Number of pages6
JournalJournal of the American Dental Association
Issue number1
StatePublished - Jan 2007

Bibliographical note

Funding Information:
The Universidad de la República (Comisión Sectorial de Investigación Científica and the School of Dentistry), Montevideo, Uruguay; the Faculty of Medicine, Umeå University, Sweden; and the Swedish Medical Research Council (Project 6877), Stockholm, Sweden, funded this study. The funders had no involvement in the data collection, data analysis, data interpretation or writing of the report, or the decision to submit the report for publication.


  • Angina pectoris
  • Cardiac ischemia
  • Myocardial infarction
  • Orofacial pain
  • Toothache

ASJC Scopus subject areas

  • Dentistry (all)


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