Quality difference in craniofacial pain of cardiac vs. dental origin.
Kreiner M, Falace D, Michelis V, et al. J Dent Res. 2010;89(9):965-969.
Craniofacial pain, whether odontogenic or caused by cardiac ischemia, is commonly referred to the same locations, posing a diagnostic challenge. We hypothesized that the validity of pain characteristics would be high in assessment of differential diagnosis. Pain quality, intensity, and gender characteristics were assessed for referred craniofacial pain from dental (n = 359) vs. cardiac (n = 115) origin. The pain descriptors "pressure" and "burning" were statistically associated with pain from cardiac origin, while "throbbing" and "aching" indicated an odontogenic cause. No gender differences were found. These data should now be added to those craniofacial pain characteristics already known to point to acute cardiac disease rather than dental pathology, ie, pain provocation/aggravation by physical activity, pain relief at rest, and bilateralism. To initiate prompt and appropriate treatment, dental and medical clinicians as well as the public should be alert to those clinical characteristics of craniofacial pain of cardiac origin.
While the number of reported medical emergencies in dental practices that result in death is very low (1%), the most likely cause of patient death is acute cardiac failure. In fact, an article reviewing the prevalence of medical emergencies in general dental practices over a 10-year period placed the estimated risk of encountering a patient death over a 40-year career between 1:12 to 1:19.1 A important feature of acute myocardial infarction is that some patients have atypical symptoms and are misdiagnosed. In fact, irrespective of culture, women with myocardial infarction tend to present with atypical chest pain symptoms and, therefore, they should be aggressively investigated. Of importance, early intervention and treatment of coronary heart disease improves the prognosis of survival.
This research report provides the practitioner with important information that has not been reported before. While much of the focus is on dental implications, especially periodontal disease and chronic endodontic lesions, and their impact on heart disease progression, this article discusses the implications of data collection for craniofacial pain that might not be odontologic in origin but may be caused by cardiac ischemia and symptoms of possible myocardial infarction. We need to be alert to craniofacial symptoms reported by patients that may need a differential diagnosis by a physician to rule out cardiac disease.
1. Atherton GJ, McCaul JA, Williams SA. Medical emergencies in general dental practice in Great Britain. Part 1: Their prevalence over a 10-year period. Br Dent J. 186:72-79.
2. Khan JJ, Slbarran JW, Lopez V, Chair SY. Gender differences on chest pain perception associated with acute myocardial infarction in Chinese patients: a questionnaire survey. J Clin Nurs. 2010;19:2790-2799.
Commentary by Howard E. Strassler, DMD
Professor and Director of Operative Dentistry
Department of Endodontics, Prosthodontics and Operative Dentistry
University of Maryland Dental School