Orofacial Pain and Toothache as the Sole Symptom of an Acute Myocardial Infarction Entails a Major Risk of Misdiagnosis and Death

Marcelo Kreiner; Jeffrey Okeson; Verónica Tanco; Anders Waldenström; Annika Isberg

doi:10.11607/OFPH.2480

Orofacial Pain and Toothache as the Sole Symptom of an Acute Myocardial Infarction Entails a Major Risk of Misdiagnosis and Death

Marcelo Kreiner, Jeffrey Okeson, Verónica Tanco, Anders Waldenström, Annika Isberg

Research output: Contribution to journal › Article › peer-review

7 Scopus citations

Abstract

Aims: To provide an update of knowledge regarding the clinical presentation and neurophysiologic aspects of orofacial pain of cardiac origin in the form of a literature review. Methods: The peer-reviewed databases Scopus/Embase, NCBI (PubMed), and Science Direct were searched up to December 2018. Results: Patients with myocardial infarction presenting without chest pain run a higher risk of death due to missed diagnosis and subsequently a significantly greater delay between the onset of symptoms and arrival at the hospital. During myocardial ischemia, orofacial pain is reported by 4 in 10 patients and described as oppressive and/or burning. Up to 4% of myocardial infarction patients experience pain solely in the orofacial structures, women more of ten than men. Orofacial pain during myocardial ischemia is associated with ischemia within the inferior wall of the heart, suggesting the involvement of the vagal system. Conclusion: The clinician’s awareness of the full spectrum of clinical characteristics of a myocardial infarction constitutes a key factor in accurate diagnosis. Health care professionals and the general public should be aware of the possibility of myocardial infarction presenting with orofacial pain, toothache, or ear/temporomandibular joint pain as the only symptom

Original language	English
Pages (from-to)	53-60
Number of pages	8
Journal	Journal of Oral and Facial Pain and Headache
Volume	34
Issue number	1
DOIs	https://doi.org/10.11607/OFPH.2480
State	Published - 2020

Bibliographical note

Funding Information:
This paper was supported by grants from the Comisión Sectorial de Investigación Científica (CSIC), Universidad de la República, Uruguay, and the Medical Faculty, Umea University, Sweden. The authors report no conflicts of interest.

Funding Information:
This paper was supported by grants from the Comisión Sectorial de Investigación Científica (CSIC), Universidad de la República, Uruguay, and the Medical Faculty, Umeå University, Sweden. The authors report no conflicts of interest.

Publisher Copyright:
© 2020. by Quintessence Publishing Co Inc. All Rights Reserved.

Keywords

cardiac ischemia
cardiac pain
myocardial infarction
orofacial pain
toothache

ASJC Scopus subject areas

Dentistry (miscellaneous)
Clinical Neurology
Anesthesiology and Pain Medicine

Access to Document

10.11607/OFPH.2480

Cite this

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title = "Orofacial Pain and Toothache as the Sole Symptom of an Acute Myocardial Infarction Entails a Major Risk of Misdiagnosis and Death",

abstract = "Aims: To provide an update of knowledge regarding the clinical presentation and neurophysiologic aspects of orofacial pain of cardiac origin in the form of a literature review. Methods: The peer-reviewed databases Scopus/Embase, NCBI (PubMed), and Science Direct were searched up to December 2018. Results: Patients with myocardial infarction presenting without chest pain run a higher risk of death due to missed diagnosis and subsequently a significantly greater delay between the onset of symptoms and arrival at the hospital. During myocardial ischemia, orofacial pain is reported by 4 in 10 patients and described as oppressive and/or burning. Up to 4% of myocardial infarction patients experience pain solely in the orofacial structures, women more of ten than men. Orofacial pain during myocardial ischemia is associated with ischemia within the inferior wall of the heart, suggesting the involvement of the vagal system. Conclusion: The clinician{\textquoteright}s awareness of the full spectrum of clinical characteristics of a myocardial infarction constitutes a key factor in accurate diagnosis. Health care professionals and the general public should be aware of the possibility of myocardial infarction presenting with orofacial pain, toothache, or ear/temporomandibular joint pain as the only symptom",

keywords = "cardiac ischemia, cardiac pain, myocardial infarction, orofacial pain, toothache",

author = "Marcelo Kreiner and Jeffrey Okeson and Ver{\'o}nica Tanco and Anders Waldenstr{\"o}m and Annika Isberg",

note = "Funding Information: This paper was supported by grants from the Comisi{\'o}n Sectorial de Investigaci{\'o}n Cient{\'i}fica (CSIC), Universidad de la Rep{\'u}blica, Uruguay, and the Medical Faculty, Umea University, Sweden. The authors report no conflicts of interest. Funding Information: This paper was supported by grants from the Comisi{\'o}n Sectorial de Investigaci{\'o}n Cient{\'i}fica (CSIC), Universidad de la Rep{\'u}blica, Uruguay, and the Medical Faculty, Ume{\aa} University, Sweden. The authors report no conflicts of interest. Publisher Copyright: {\textcopyright} 2020. by Quintessence Publishing Co Inc. All Rights Reserved.",

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AU - Waldenström, Anders

AU - Isberg, Annika

N1 - Funding Information: This paper was supported by grants from the Comisión Sectorial de Investigación Científica (CSIC), Universidad de la República, Uruguay, and the Medical Faculty, Umea University, Sweden. The authors report no conflicts of interest. Funding Information: This paper was supported by grants from the Comisión Sectorial de Investigación Científica (CSIC), Universidad de la República, Uruguay, and the Medical Faculty, Umeå University, Sweden. The authors report no conflicts of interest. Publisher Copyright: © 2020. by Quintessence Publishing Co Inc. All Rights Reserved.

PY - 2020

Y1 - 2020

N2 - Aims: To provide an update of knowledge regarding the clinical presentation and neurophysiologic aspects of orofacial pain of cardiac origin in the form of a literature review. Methods: The peer-reviewed databases Scopus/Embase, NCBI (PubMed), and Science Direct were searched up to December 2018. Results: Patients with myocardial infarction presenting without chest pain run a higher risk of death due to missed diagnosis and subsequently a significantly greater delay between the onset of symptoms and arrival at the hospital. During myocardial ischemia, orofacial pain is reported by 4 in 10 patients and described as oppressive and/or burning. Up to 4% of myocardial infarction patients experience pain solely in the orofacial structures, women more of ten than men. Orofacial pain during myocardial ischemia is associated with ischemia within the inferior wall of the heart, suggesting the involvement of the vagal system. Conclusion: The clinician’s awareness of the full spectrum of clinical characteristics of a myocardial infarction constitutes a key factor in accurate diagnosis. Health care professionals and the general public should be aware of the possibility of myocardial infarction presenting with orofacial pain, toothache, or ear/temporomandibular joint pain as the only symptom

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Orofacial Pain and Toothache as the Sole Symptom of an Acute Myocardial Infarction Entails a Major Risk of Misdiagnosis and Death

Abstract

Bibliographical note

Keywords

ASJC Scopus subject areas

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