Sometimes it's the rare cases that provide a great learning experience :)
Recently, I had a patient with a chief complaint of general pain in the jaw. As usual, most dentists will work through the usual differential diagnoses: chipped tooth, infected tooth, infected gums, TMJ issues, external/internal injury etc. However, this case was interesting in that the patient could only point to a general area but not a specific structure (e.g a particular tooth). After consulting with some of our specialist colleagues and doing some quick research, we decided that it was a cardiac issue and told him to go to the ER as soon as possible.
A nice paper in the Journal of the American Dental Association in 2007 summed it quite nicely:
Craniofacial pain commonly is induced by cardiac ischemia. This must be considered in differential diagnosis of toothache and orofacial pain.
The most common areas for pain were the throat, left mandible, right mandible and left TMJ region and teeth. This pain is found more often in females than males.
Source: Kreiner et al, Craniofacial pain as the sole symptom of cardiac ischemia: A prospective multicenter study, JADA, 138 (1): 74. (2007).
Hans Skariah, B.Sc., DMD
Promenade Court Dental Health Group in Mississauga
2233 Hurontario St., Mississauga, ON, Canada
(1/2 km north of the QEW in the Dome Building)