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Abdullatef M, Omran M, Bitar A, Alsaid B. Prevalence of classic and non-classic pain sites of coronary artery disease: a cross-sectional study. BMC Cardiovasc Disord 2024; 24:445. [PMID: 39179977 PMCID: PMC11344326 DOI: 10.1186/s12872-024-04127-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 08/16/2024] [Indexed: 08/26/2024] Open
Abstract
STUDY OBJECTIVE This study aims to assess the prevalence of both classic and non-classic pain sites in patients with ischemic heart disease, emphasizing the importance of recognizing and not disregarding non-classic symptoms. METHODS This cross-sectional study included 100 patients diagnosed with coronary artery disease (CAD) who were admitted to two major hospitals in Syria. classic pain was identified as pain located in the precordial area, with or without radiation to the neck, jaw, left shoulder or arm. Patients' demographics and previous medical history were documented to investigate any potential associations with non-classic pain. RESULTS 62% of the patients experienced non-classic pain, while 12% had no precordial pain. For those without precordial pain, the most common pain site was the left chest (66.7%). Non-classic pain was significantly associated with smoking, with 72.2% of smokers experiencing non-classic pain compared to 35.7% non-smokers (p = 0.001). Additionally, patients with previous heart disease were more likely to have non-classic pain (71.7%), compared with patients with no history of heart disease (51.1%) (p = 0.03). Other factors such as age, sex, and diabetes were not statistically significant. CONCLUSION Non-classic pain is common, affecting 62% of individuals, primarily in the right shoulder, right arm, and back. This type of pain could be associated with smoking and prior heart disease. Misdiagnosing coronary artery disease can have serious consequences, as patients with non-classic symptoms may miss important pre-hospital procedures like ECG.
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Affiliation(s)
| | - Maya Omran
- Faculty of Medicine, Damascus University, Damascus, Syria.
| | - Anas Bitar
- Faculty of Medicine, Damascus University, Damascus, Syria
| | - Bayan Alsaid
- Laboratory of Anatomy, Faculty of Medicine, Damascus University, Damascus, Syria
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Xu X, Zheng X, Lin F, Yu Q, Hou B, Chen Z, Wei X, Qiu L, Wenxia C, Li J, Chen L, Wang Z, Wu H, Lu Z, Zhao J, Liang Y, Zhao J, Pan Y, Pan S, Wang X, Yang D, Ren Y, Yue L, Zhou X. Expert consensus on endodontic therapy for patients with systemic conditions. Int J Oral Sci 2024; 16:45. [PMID: 38886374 PMCID: PMC11183232 DOI: 10.1038/s41368-024-00312-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 04/13/2024] [Accepted: 05/10/2024] [Indexed: 06/20/2024] Open
Abstract
The overall health condition of patients significantly affects the diagnosis, treatment, and prognosis of endodontic diseases. A systemic consideration of the patient's overall health along with oral conditions holds the utmost importance in determining the necessity and feasibility of endodontic therapy, as well as selecting appropriate therapeutic approaches. This expert consensus is a collaborative effort by specialists from endodontics and clinical physicians across the nation based on the current clinical evidence, aiming to provide general guidance on clinical procedures, improve patient safety and enhance clinical outcomes of endodontic therapy in patients with compromised overall health.
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Affiliation(s)
- Xin Xu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xin Zheng
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Fei Lin
- Department of Cariology and Endodontology, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology, Peking University, Beijing, China
| | - Qing Yu
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Oral Diseases, Department of Operative Dentistry & Endodontics, School of Stomatology, The Fourth Military Medical University, Xi'an, China
| | - Benxiang Hou
- Center for Microscope Enhanced Dentistry, Beijing Stomatological Hospital, Capital Medical University, Beijing, China
| | - Zhi Chen
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Xi Wei
- Department of Operative Dentistry and Endodontics, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University & Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
| | - Lihong Qiu
- Department of Endodontics, School of Stomatology, China Medical University, Shenyang, China
| | - Chen Wenxia
- College & Hospital of Stomatology, Guangxi Medical University, Nanning, China
| | - Jiyao Li
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Lili Chen
- Department of Stomatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zuomin Wang
- Department of Stomatology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Hongkun Wu
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Geriatric Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Zhiyue Lu
- Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Jizhi Zhao
- Department of Stomatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yuhong Liang
- Department of Emergency, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Beijing, China
| | - Jin Zhao
- Department of Endodontics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Yihuai Pan
- Department of Endodontics, School and Hospital of Stomatology, Wenzhou Medical University, Wenzhou, China
| | - Shuang Pan
- Department of Endodontics, The First Affiliated Hospital of Harbin Medical University & Department of Endodontics, School of Stomatology, Harbin Medical University, Harbin, China
| | - Xiaoyan Wang
- Department of Cariology and Endodontology, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology, Peking University, Beijing, China
| | - Deqin Yang
- Department of Conservative Dentistry and Endodontics, Shanghai Stomatological Hospital & School of Stomatology, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Fudan University, Shanghai, China
| | - Yanfang Ren
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA.
| | - Lin Yue
- Department of Cariology and Endodontology, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology, Peking University, Beijing, China.
| | - Xuedong Zhou
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
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3
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Ding S, Chan L, Sillman J, Noonan K. Review article: Otalgia as presenting symptom of myocardial infarction. Am J Otolaryngol 2024; 45:104120. [PMID: 38029534 DOI: 10.1016/j.amjoto.2023.104120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 11/19/2023] [Indexed: 12/01/2023]
Abstract
OBJECTIVE There are many etiologies for otalgia, most of which are benign conditions. However, it can also be the initial symptom for life threatening emergencies such as a myocardial infarction (MI). This case report and review of literature describes diagnosis of MI with the initial primary complaint of unilateral otalgia. PATIENT A 77-year-old female with intermittent left-sided otalgia with exertion for many years that recently worsened. In the clinic, she had a normal otologic exam and denied any other associated symptoms. The following day, her symptoms progressed to otalgia radiating down her arm and dyspnea on exertion. After progression of symptoms, a nuclear stress test was performed revealing a large and severe apical infarct. INTERVENTIONS Diagnosis of referred otalgia from a cardiac source. She had subsequent medical management of cardiac risk factors and treatment of angina. RESULTS Resolution of otalgia with medical management for coronary artery disease (CAD) after treatment of unstable angina. CONCLUSIONS Otologists should be aware of the atypical presentations of angina because a missed diagnosis is potentially fatal. Otalgia, either unilateral or bilateral, may be the only presenting symptom of underlying cardiac ischemia and a high index of suspicion is needed for early diagnosis. Patients with otalgia related to exertion, no abnormal findings on otoscopic examinations, and significant risk factors for cardiac disease should undergo systematic evaluation including a cardiac rule out.
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Affiliation(s)
- Samuel Ding
- Tufts University School of Medicine, 145 Harrison Ave, Boston, MA 02111, USA.
| | - Livia Chan
- Department of Otolaryngology - Head & Neck Surgery, Tufts Medical Center, 800 Washington St, Boston, MA 02111, USA
| | - Jonathon Sillman
- Tufts University School of Medicine, 145 Harrison Ave, Boston, MA 02111, USA; Department of Otolaryngology - Head & Neck Surgery, Tufts Medical Center, 800 Washington St, Boston, MA 02111, USA
| | - Kathryn Noonan
- Tufts University School of Medicine, 145 Harrison Ave, Boston, MA 02111, USA; Department of Otolaryngology - Head & Neck Surgery, Tufts Medical Center, 800 Washington St, Boston, MA 02111, USA
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4
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Park HJ, Auh QS. Age and sex differences in comorbidities in adult temporomandibular disorders: A cross-sectional study using Korea National Health and Nutrition Examination Survey (KNHANES). PLoS One 2024; 19:e0296378. [PMID: 38166052 PMCID: PMC10760688 DOI: 10.1371/journal.pone.0296378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 12/11/2023] [Indexed: 01/04/2024] Open
Abstract
OBJECTIVES To investigate the relationship between Temporomandibular disorder (TMD) and associated comorbidities in groups matched according to age and sex. METHODS Using data from the cross-sectional fifth Korea National Health and Nutrition Examination Survey (KNHANES). Of the 25,534 eligible KNHANES, 17,762 adults aged ≥19 years who responded to survey questionnaire on TMD and comorbidities. Subjects were classified into eight groups according to age and sex. Logistic regression analyses were performed to evaluate the association between TMD and comorbidities according to age and sex. RESULTS Of the enrolled participants, 2,107 (11.86%) complained of ≥1 TMD symptoms. In all groups, odds ratios (ORs) for prevalence of TMD were >1 in those with tinnitus. Rhinitis was closely associated with TMD in 6 groups. ORs for TMD with comorbidities according to age and sex were as follows: hypertension, men aged 50-64 years (OR 0.62; CI 0.41-0.94); ischemic heart disease, men aged 35-49 years (4.38; 1.54-12.47); osteoarthritis, women aged 50-64 years (1.38; 1.03-1.86); diabetes mellitus, men aged 35-49 years (0.21; 0.05-0.88); depression, men aged 50-64 years (1.68; 1.00-2.83), women aged 35-49 years (1.39; 1.05-1.85) and women aged 65-80 years (2.01; 1.46-2.77); migraine, men aged 50-64 years (1.60; 1.14-2.25), women aged d35-49 years (1.44; 1.14-1.81) and women aged 35-49 years (1.43; 1.07-1.90); cold hypersensitivity in the hands and feet, men aged 19-34 years (1.64; 1.05-2.58), men aged 35-49 years (1.68; 1.04-2.70), men aged 65-80 years (1.74; 1.09-2.75) and women aged 35-49 years (1.45; 1.15-1.84); olfaction disorder, men aged 50-64 years (2.49; 1.39-4.43); voice disorder, men aged 50-64 years (2.25; 1.28-3.96) and women aged 65-80 years (1.69; 1.09-2.63). CONCLUSIONS This study confirmed that the types and effects of comorbidities related to prevalence of TMD may differ according to the patient's age and sex and this result will increase the predictability of the onset of TMD.
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Affiliation(s)
- Hye-Ji Park
- Department of Oral Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Q-Schick Auh
- Department of Oral Medicine, Kyung Hee University College of Dentistry, Kyung Hee University Medical Center, Seoul, Korea
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Choi E, Lee YH, Park HK. Orofacial Pain with Cardiac Origin of Coronary Artery Disease: A Case Report and Literature Review. Case Rep Dent 2023; 2023:6304637. [PMID: 37475834 PMCID: PMC10356533 DOI: 10.1155/2023/6304637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 07/04/2023] [Accepted: 07/05/2023] [Indexed: 07/22/2023] Open
Abstract
When diagnosing orofacial pain, clinicians should also consider non-odontogenic origin and systemic diseases as possible etiological factors, along with odontogenic origin. This case report aimed to provide information for early detection of orofacial pain of cardiac origin by dentists, when pain due to coronary artery disease is the only presenting symptom. A 60-year-old male patient with unexplained isolated bilateral jaw pain that had persisted for the past 5 years was referred to a dentist by an anesthesiologist who suspected temporomandibular joint disorder. In oral examination, no specific pathological changes were observed in the oral cavity, including teeth, surrounding alveolar bone, and buccal mucosa. Magnetic resonance imaging and conventional radiography showed no pathological destruction or abnormalities of bone and soft tissue in the temporomandibular joint region. However, pain was precipitated by ordinary daily activities, and the pain alleviating factor was rest. Eventually, the patient was referred to a cardiologist for further evaluation since his pain was induced by physical activity. Coronary artery disease (CAD) was diagnosed using coronary computed tomography angiography, and the pain was considered to be angina pectoris. Percutaneous coronary intervention was successfully done for the patient, after which his orofacial symptoms disappeared. To conclude, isolated craniofacial pain of cardiac origin may lead to patients seeking dental care or visiting orofacial pain clinics. In these settings, dentists and orofacial pain specialists may contribute to the diagnosis of CAD and refer patients for cardiac evaluation and appropriate management.
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Affiliation(s)
- Eunhye Choi
- Dental Research Institute, Seoul National University School of Dentistry, Seoul 03080, Republic of Korea
- Department of Oral Medicine and Oral Diagnosis, Bucheon Apple Tree Dental Hospital, 20, Bucheon-ro, Bucheon-si, Gyeonggi-do, Republic of Korea
| | - Yeon-Hee Lee
- Department of Orofacial Pain and Oral Medicine, Kyung Hee University Dental Hospital, Kyung Hee University School of Dentistry, #613 Hoegi-dong, Dongdaemun-gu, Seoul 02447, Republic of Korea
| | - Hee-Kyung Park
- Department of Oral Medicine and Oral Diagnosis, Dental Research Institute, Seoul National University School of Dentistry, Seoul 03080, Republic of Korea
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6
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Khan IA, Karim HMR, Panda CK, Ahmed G, Nayak S. Atypical Presentations of Myocardial Infarction: A Systematic Review of Case Reports. Cureus 2023; 15:e35492. [PMID: 36999116 PMCID: PMC10048062 DOI: 10.7759/cureus.35492] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2023] [Indexed: 02/27/2023] Open
Abstract
There is a rising incidence of coronary artery diseases and myocardial infarction (MI). Mortality associated with acute MI (AMI) is directly linked to the time to receive treatment and missed diagnoses. Although health professionals are aware of typical AMI presentation, atypical MI is difficult to diagnose, which on the other hand, is likely to have an impact on morbidity and mortality. Therefore, it is prudent to know such atypical presentations, especially for emergency and primary care physicians. We aimed to systematically evaluate the clinical presentations of atypical MI and analyze them to characterize the common clinical presentations of atypical MI. We researched the PubMed database, did citation tracking, and performed Google Scholar advanced search to find the cases reported on the atypical presentation of MI published from January 2000 to September 2022. Articles of all languages were included; Google Translate was used to translate articles published in languages other than English. A total of 496 (56 PubMed articles, 340 citations from included PubMed articles, and 100 articles from Google Scholar advanced search) were screened; 52 case reports were evaluated, and their data were analyzed. Atypical presentations of myocardial infarction are vast; patients may have chest pain without typical characteristics of angina pain or may not have chest pain. No typical characterization could be done. Most patients were in their fifth decade or above of their life and commonly presented with pain and discomfort in the abdomen, head, and neck regions. Prodromal symptoms were consistent findings, and many patients had two to three comorbidities out of four common comorbidities, i.e., diabetes, hypertension, dyslipidemia, and substance abuse. A patient who is 50 years old or more, having comorbidities such as diabetes, hypertension, dyslipidemia, history of tobacco or marijuana usage, presenting with prodromal symptoms like shortness of breath, dizziness, fatigue, syncope, gastrointestinal discomfort or head/neck pain should be suspected for atypical MI.
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7
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Kreiner M, Viloria J. A novel artificial neural network for the diagnosis of orofacial pain and temporomandibular disorders. J Oral Rehabil 2022; 49:884-889. [PMID: 35722743 DOI: 10.1111/joor.13350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 04/28/2022] [Accepted: 06/02/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Temporomandibular disorders (TMD) and orofacial pain are highly prevalent. This prevalence can be compared to that of leading non-communicable diseases (NCDs). However, it is surprising to still find a high degree of controversy regarding its diagnosis and management. Patients usually experience treatment delays, missed diagnoses, and receive unnecessary therapies. New artificial intelligence algorithms have helped diagnose numerous diseases. Nevertheless, no studies have focused on the use of artificial intelligence to diagnose these conditions. OBJECTIVES This study aimed to develop and test the performance of a novel neural network (multilayer perceptron) with diagnostic capabilities in orofacial pain and TMD, including some types of referred pain. METHODS A multilayer perceptron (MLP) was developed with one input layer, five hidden layers, and one output layer. It was trained using backpropagation algorithms. Several categories of orofacial pain and TMD clinical cases were presented to 12 general dental clinicians, and their diagnoses were contrasted to those provided by the artificial intelligence neural network. RESULTS Overall, the diagnostic accuracy of the artificial intelligence was superior to that of the general dental clinicians (p = .0072). This was more evident in the clinical cases involving non-dental and referred orofacial pains (e.g. neuropathic pain, referred cardiac pain, neurovascular pain). CONCLUSIONS This study showed, for the first time, that an artificial neural network can help medical and general dental clinicians diagnose several types of orofacial pain and dysfunction, including TMD, neuropathic, neurovascular, and referred cardiac pain. In some cases, the MLP appears to have a life-saving role.
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Affiliation(s)
- Marcelo Kreiner
- Department of General and Oral Physiology, School of Dentistry, Universidad de la República, Uruguay, Montevideo, Uruguay
| | - Jesús Viloria
- Craniomandibular Function and Orofacial Pain Research Group, Universidad de la República, Uruguay, Montevideo, Uruguay
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8
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Atypical manifestations of acute coronary syndrome — throat discomfort: a multi-center observational study. Front Med 2022; 16:651-658. [DOI: 10.1007/s11684-021-0859-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 04/08/2021] [Indexed: 11/04/2022]
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9
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You Y, Ma X, Chen L. Marfan Syndrome With Recurrent Lower Left Posterior Toothache as the First Symptom: A Report on a Rare Case. J Endod 2021; 47:1328-1331. [DOI: 10.1016/j.joen.2021.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 04/29/2021] [Accepted: 05/03/2021] [Indexed: 01/16/2023]
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10
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Myers DE. The receptive field for visceral pain referred orofacially by the vagus nerves. Clin Anat 2020; 34:24-29. [PMID: 32279338 DOI: 10.1002/ca.23604] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 04/05/2020] [Accepted: 04/06/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND The nociceptive receptive field of the vagus nerves in animals includes virtually the entire thoracic, abdominal and laryngopharyngeal regions. However, the role of the vagus nerves in the transmission of visceral pain in humans, with the exception of pain from coronary artery diseases, is believed to be insignificant. AIM The purpose of this report is to map out the clinical visceral pain receptive field of the vagus nerves relative to its nociceptive counterpart in animals. MATERIALS AND METHODS The PubMed database and PMC were searched for case reports of patients with orofacial pain believed by the author(s) of the article to be referred from underlying non-cardiac thoracic, laryngopharyngeal or abdominal diseases. Reports of diseases for which non-neural explanations for the orofacial spread of pain were suggested were excluded. RESULTS A total of 52 case reports of jaw pain and/or otalgia referred from laryngopharyngeal and noncardiac thoracic sources were discovered. In addition, a multicenter prospective study found that 25.8% of more than 3,000 patients with thoracic aortic dissection experienced pain in the head and neck region. In stark contrast, no case reports of orofacially referred pain from abdominal diseases were found. DISCUSSION The results indicate that the laryngopharyngeal and thoracic portions of the vagal receptive field are capable of referring pain orofacially while the abdominal portion is not. The roles of the somatotopic organization of the trigeminal sub nucleus caudalis and neuromodulation in this referral of pain were discussed. CONCLUSION Referred orofacial pain can lead to delayed diagnosis and poorer outcome in visceral diseases.
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11
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De Laat A. Differential diagnosis of toothache to prevent erroneous and unnecessary dental treatment. J Oral Rehabil 2020; 47:775-781. [DOI: 10.1111/joor.12946] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 01/09/2020] [Accepted: 02/09/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Antoon De Laat
- Department of Oral Health Sciences and Department of Dentistry University Hospitals KU Leuven Leuven Belgium
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12
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Kikuta S, Dalip D, Loukas M, Iwanaga J, Tubbs RS. Jaw pain and myocardial ischemia: A review of potential neuroanatomical pathways. Clin Anat 2019; 32:476-479. [PMID: 30847968 DOI: 10.1002/ca.23367] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 02/12/2019] [Accepted: 03/05/2019] [Indexed: 02/06/2023]
Abstract
Cardiac pain is usually manifested as a crushing, squeezing, or sensation of pressure in the center of the chest. The pain can be referred to the left shoulder, neck, jaw, and epigastric region as well as the temporomandibular region, paranasal sinuses, and head in general. Although not well understood, during myocardial ischemia, the process of cardiac referred pain to craniofacial structures can be explained by the convergence of visceral and somatic relays at the trigeminal nucleus in the brain stem. The goal of this article is to review the possible pathways for referred jaw pain due to myocardial ischemia. Clin. Anat. 32:476-479, 2019. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
- Shogo Kikuta
- Seattle Science Foundation, Seattle, Washington.,Dental and Oral Medical Center, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Dominic Dalip
- Department of Anatomical Sciences, St. George's University, St. George's, Grenada
| | - Marios Loukas
- Department of Anatomical Sciences, St. George's University, St. George's, Grenada
| | - Joe Iwanaga
- Seattle Science Foundation, Seattle, Washington.,Dental and Oral Medical Center, Kurume University School of Medicine, Kurume, Fukuoka, Japan.,Division of Gross and Clinical Anatomy, Department of Anatomy, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - R Shane Tubbs
- Seattle Science Foundation, Seattle, Washington.,Department of Anatomical Sciences, St. George's University, St. George's, Grenada
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13
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Jenzer AC, Jackson H, Berry-Cabán CS. Temporomandibular Joint Pain Presentation of Myocardial Ischemia. J Oral Maxillofac Surg 2018; 76:2317.e1-2317.e2. [DOI: 10.1016/j.joms.2018.06.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 06/08/2018] [Indexed: 01/08/2023]
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14
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Ugalde I, Anjum I, Lo Presti S, Tolentino A. Myocardial Infarction Presenting as Ear Fullness and Pain. J Investig Med High Impact Case Rep 2018; 6:2324709618761753. [PMID: 29552570 PMCID: PMC5846929 DOI: 10.1177/2324709618761753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 01/29/2018] [Accepted: 02/03/2018] [Indexed: 11/17/2022] Open
Abstract
Acute coronary syndrome usually presents with retrosternal chest pain, nausea, vomiting, sweating, and jaw and arm pain. Some patients only present with neck, epigastric, or ear discomfort. A 47-year-old male with a history of hypertension and coronary artery disease presented to the emergency department complaining of bilateral otalgia. He never felt chest pain, jaw pain, nausea, diaphoresis, or shortness of breath. He had a history of 2 acute coronary events and had a stress test 2 months prior to admission, which was unremarkable. The initial electrocardiography was sinus rhythm with Q-waves in the inferior leads and nonspecific ST changes in the lateral leads. His troponin on admission was normal but subsequently elevated to 20.00 mg/mL after 24 hours. He underwent left heart catheterization, which found significant occlusive disease of the second and fourth obtuse marginal branches and 2 drug-eluting stents were placed. His ear pain resolved soon after cardiac catheterization. The pathophysiology of this referred pain is thought to be related to the neuroanatomy of the nerves innervating the heart and ear. The auricular nerve branch of the vagus nerve supplies the inner portion of the external ear. Only a few cases with the complaint of otalgia have been reported. Patients were older, more frequently women, and with diabetes or heart failure. Clinicians should be aware of the atypical presentation of angina that may be life-threatening cardiac ischemia. Ear pain and fullness could be the sole presenting symptom in a patient with acute coronary syndrome.
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Affiliation(s)
| | - Ibrar Anjum
- Akhtar Saeed Medical and Dental College, Lahore, Pakistan
| | - Saberio Lo Presti
- Columbia University, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Alfonso Tolentino
- Columbia University, Mount Sinai Medical Center, Miami Beach, FL, USA
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15
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Kyaw K, Latt H, Aung SSM, Tun NM, Phoo WY, Yin HH. Atypical Presentation of Acute Coronary Syndrome and Importance of Wellens' Syndrome. AMERICAN JOURNAL OF CASE REPORTS 2018; 19:199-202. [PMID: 29467360 PMCID: PMC5829624 DOI: 10.12659/ajcr.907992] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Patient: Female, 74 Final Diagnosis: Acute coronary syndrome Symptoms: Throat pain Medication: — Clinical Procedure: Percutaneous coronary intervention Specialty: Cardiology
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Affiliation(s)
- Kyaw Kyaw
- Institute for Heart and Vascular Health, Renown Regional Medical Center, Reno, NV, USA
| | - Htun Latt
- Department of Internal Medicine, University of Nevada-Reno, School of Medicine, Reno, NV, USA
| | - Sammy San Myint Aung
- Institute for Heart and Vascular Health, Renown Regional Medical Center, Reno, NV, USA
| | - Nay Min Tun
- Institute for Heart and Vascular Health, Renown Regional Medical Center, Reno, NV, USA
| | - Wut-Yi Phoo
- Department of Internal Medicine, University of Nevada-Reno, School of Medicine, Reno, NV, USA
| | - Htwe Htwe Yin
- Department of Internal Medicine, University of Nevada-Reno, School of Medicine, Reno, NV, USA
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16
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Sierecki M, Marchetti M, Verdier M, Ghazali A. An Unusual Cause of Ear Pain. A Life Threatening Disease Revealed by a Common Symptom. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791602300607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A 40-year-old woman presented to the emergency department (ED) for bilateral otalgia as her sole complaint. The physician's otoscopic examination was normal and the rest of the examination was unremarkable except for previously unknown high blood pressure. The patient had no chest pain or dyspnea. She was discharged from the ED with antihypertensive therapy, pain-relief medications, and an appointment with a cardiologist. Twelve days later, transthoracic echocardiography revealed pericardial effusion and dilated ascending aorta. Computed tomography scan finally diagnosed an aortic dissection (AD) type A (Stanford classification) which necessitated emergency surgery.
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Affiliation(s)
| | | | - M Verdier
- University Hospital Center of Poitiers, Department of Radiology, 2, rue de la Milétrie 86000 Poitiers, France
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17
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Ahmed EK, Alkodaymi MS, Soliman MM, Shujaa AS. ST-Elevation Myocardial Infarction Due to Left Anterior Descending Artery Occlusion Presenting Primarily with Otalgia. AMERICAN JOURNAL OF CASE REPORTS 2017; 18:1044-1047. [PMID: 28959003 PMCID: PMC5633101 DOI: 10.12659/ajcr.905511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Myocardial infarction (MI) is one of the most serious conditions presenting to the Emergency Department. Typical/classical symptoms of MI include chest pain and tightness that is referred to the left arm. CASE REPORT We present a case of ST-elevation myocardial infarction (STEMI) with a primary atypical presentation of right ear pain. The patient was diagnosed with STEMI based on electrocardiogram (ECG) and cardiac markers. As a result, the patient underwent percutaneous intervention (PCI), which showed an occluded left anterior descending artery (LAD) compared to the previous reported studies with similar presentation in which the right coronary artery (RCA) was affected. CONCLUSIONS While MI is known for its typical presentation, being vigilant to patients who present atypically especially when they possess risk factors is extremely important and doing so can be critical to the outcome because MI treatment is dependent on fast and prompt management.
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Affiliation(s)
- Elhaitham K Ahmed
- Department of Medical Intern, Alfaisal University, Riyadh, Saudi Arabia
| | - M Salim Alkodaymi
- Department of Medical Intern, Alfaisal University, Riyadh, Saudi Arabia
| | | | - Asaad Suliman Shujaa
- Department of Emergency Medicine, Specialized Medical Center, Riyadh, Saudi Arabia
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18
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Bakhshi M, Rezaei R, Baharvand M, Bakhtiari S. Frequency of craniofacial pain in patients with ischemic heart disease. J Clin Exp Dent 2017; 9:e91-e95. [PMID: 28149470 PMCID: PMC5268115 DOI: 10.4317/jced.53078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 05/26/2016] [Indexed: 11/23/2022] Open
Abstract
Background Referred craniofacial pain of cardiac origin might be the only symptom of ischemic heart accidents. This study aimed to determine the frequency of craniofacial pain in patients with ischemic heart disease. Material and Methods This cross-sectional study was accomplished on 296 patients who met the criteria of having ischemic heart disease. Data regarding demographics, medical history and referred craniofacial pain were recorded in data forms. In addition, patients underwent oral examination to preclude any source of dental origin. Chi-square test, Student’s t-test and backward regression model were used to analyze the data by means of SPSS software version 21. P<0.05 was considered significant. Results A total of 296 patients were studied comprising of 211 men (71%) and 85 women (29%) with the mean age of 55.8. Craniofacial pain was experienced by 53 patients out of 296, 35 (66%) of whom were male and 18 (34%) were female. None of the patients experienced craniofacial pain solely. The most common sites of craniofacial pain were occipital and posterior neck (52.8%), head (43.3%), throat and anterior neck (41.5%) respectively. We found no relationship between craniofacial pain of cardiac origin with age, diabetes, hypertension, and family history. On the other hand, there was a significant relationship between hyperlipidemia and smoking with craniofacial pain of cardiac origin. Conclusions Radiating pain to face and head can be expected quite commonly during a cardiac ischemic event. Dental practitioners should be thoroughly aware of this symptomatology to prevent misdirected dental treatment and delay of medical care. Key words:Craniofacial pain, ischemic heart disease, myocardial infarction, angina pectoris, referred pain.
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Affiliation(s)
- Mahin Bakhshi
- Associate Professor, Dept. of Oral Medicine, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Rezvan Rezaei
- Resident of Pediatric Dentistry, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Baharvand
- Professor, Dept. of Oral Medicine, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sedigheh Bakhtiari
- Associate Professor, Dept. of Oral Medicine, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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20
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Yatani H, Komiyama O, Matsuka Y, Wajima K, Muraoka W, Ikawa M, Sakamoto E, De Laat A, Heir GM. Systematic review and recommendations for nonodontogenic toothache. J Oral Rehabil 2014; 41:843-52. [PMID: 25040436 DOI: 10.1111/joor.12208] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2014] [Indexed: 01/26/2023]
Abstract
Nonodontogenic toothache is a painful condition that occurs in the absence of a clinically evident cause in the teeth or periodontal tissues. The purpose of this review is to improve the accuracy of diagnosis and the quality of dental treatment regarding nonodontogenic toothache. Electronic databases were searched to gather scientific evidence regarding related primary disorders and the management of nonodontogenic toothache. We evaluated the level of available evidence in scientific literature. There are a number of possible causes of nonodontogenic toothache and they should be treated. Nonodontogenic toothache can be categorised into eight groups according to primary disorders as follows: 1) myofascial pain referred to tooth/teeth, 2) neuropathic toothache, 3) idiopathic toothache, 4) neurovascular toothache, 5) sinus pain referred to tooth/teeth, 6) cardiac pain referred to tooth/teeth, 7) psychogenic toothache or toothache of psychosocial origin and 8) toothache caused by various other disorders. We concluded that unnecessary dental treatment should be avoided.
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Affiliation(s)
- H Yatani
- Department of Fixed Prosthodontics, Osaka University Graduate School of Dentistry, Osaka, Japan
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21
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Jalali N, Vilke GM, Korenevsky M, Castillo EM, Wilson MP. The Tooth, the Whole Tooth, and Nothing But the Tooth: Can Dental Pain Ever Be the Sole Presenting Symptom of a Myocardial Infarction? A Systematic Review. J Emerg Med 2014; 46:865-72. [DOI: 10.1016/j.jemermed.2013.11.071] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 10/18/2013] [Accepted: 11/16/2013] [Indexed: 10/25/2022]
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22
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Israel HA, Davila LJ. The Essential Role of the Otolaryngologist in the Diagnosis and Management of Temporomandibular Joint and Chronic Oral, Head, and Facial Pain Disorders. Otolaryngol Clin North Am 2014; 47:301-31. [DOI: 10.1016/j.otc.2013.12.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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23
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Turner MJA, McMillan KG, Gibbons AJ. Angina presenting as orofacial pain: a case report. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 116:e443-4. [PMID: 24237730 DOI: 10.1016/j.oooo.2012.02.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Revised: 12/29/2011] [Accepted: 02/06/2012] [Indexed: 10/28/2022]
Affiliation(s)
- Mark J A Turner
- Peterborough City Hospital, Edith Cavell Campus, Bretton Gate, Peterborough, United Kingdom
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24
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Case of the Month. JAAPA 2013; 26:73. [DOI: 10.1097/01720610-201305000-00019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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25
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Abstract
This clinical perspective presents an overview of current and potential uses for magnetic resonance imaging (MRI) in musculoskeletal practice. Clinical practice guidelines and current evidence for improved outcomes will help providers determine the situations when an MRI is indicated. The advanced competency standard of examination used by physical therapists will be helpful to prevent overuse of musculoskeletal imaging, reduce diagnostic errors, and provide the appropriate clinical context to pathology revealed on MRI. Physical therapists are diagnostically accurate and appropriately conservative in their use of MRI consistent with evidence-based principles of diagnosis and screening.
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Affiliation(s)
- Gail Dean Deyle
- Army-Baylor University Doctoral Fellowship in Orthopaedic Manual Physical Therapy, Brooke Army Medical Center, Fort Sam Houston, TX, USA
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26
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López-López J, Adserias-Garriga MJ, Garcia-Vicente L, Jané-Salas E, Chimenos-Küstner E, Pereferrer-Kleiner D. Orofacial pain of cardiac origin, serial of clinical cases. Med Oral Patol Oral Cir Bucal 2012; 17:e633-7. [PMID: 22322498 PMCID: PMC3476027 DOI: 10.4317/medoral.17689] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2011] [Accepted: 08/08/2011] [Indexed: 12/03/2022] Open
Abstract
Objective: To determine the clinical characteristics of the orofacial pain of cardiac origin in patients visited when doing a treadmill exercise test, at the cardiology service of the Can Ruti Hospital in Badalona (Barcelona, Spain). Study design: The sample of that study included thirty patients visiteding when doing a treadmill exercise test, at the cardiology service. The questionnaire has been asked to a sample of 30 patients. Results: Eleven of the 30 patients included in this study presented craniofacial pain before or during the cardiac seizure. The location of the pain was bilateral, non-irradiated at the mandible in all cases. The intensity of the pain was from slight to severe. The frequency of the appearance of the pain was paroxysmal in 8 cases and constant in three cases, and the duration was from a few hours to a maximum of 14 days. Discussion: The cardiac pain in craniofacial structures is usually bilateral, compared to odontogenic pain which is always unilateral. The pain of cardiac origin is considered atypical because of its location, but about the 10 % of the cases, the cardiac ischemia has its primary manifestation in orofacial structures. Conclusions: Eleven patients referred a bilateral non-irradiated mandibular pain, with intensity from slight to severe, and with a paroxystic frequency in eight cases and a constant frequency in three cases. Just one patient referred pain during the treadmill exercise test. In all cases the pain disappeared after the cardiac surgery or the administration of vasodilators.
Key words:Orofacial pain, toothache, angina pectoris, mandibular pain, myocardial infarction, angina pectoris.
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Affiliation(s)
- José López-López
- Oral Medicine, Faculty of Dentistry, University of Barcelona, Barcelona, Spain.
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López-López J, Garcia-Vicente L, Jané-Salas E, Estrugo-Devesa A, Chimenos-Küstner E, Roca-Elias J. Orofacial pain of cardiac origin: review literature and clinical cases. Med Oral Patol Oral Cir Bucal 2012; 17:e538-44. [PMID: 22322488 PMCID: PMC3476012 DOI: 10.4317/medoral.17636] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2011] [Accepted: 04/03/2011] [Indexed: 02/07/2023] Open
Abstract
The most common types of orofacial pain originate at the dental or periodontal level or in the musculoskeletal structures. However, the patient may present pain in this region even though the source is located elsewhere in the body. One possible source of heterotopic pain is of cardiac origin.
Objectives: Report two cases of orofacial pain of cardiac origin and review the clinical cases described in the literature.
Study Design: Description of clinical cases and review of clinical cases.
Results and conclusions: Nine cases of atypical pain of cardiac origin are recorded, which include 5 females and 4 males. In craniofacial structures, pain of cardiac origin is usually bilateral. At the craniofacial level, the most frequent location described is in the throat and jaw. Pain of cardiac origin is considered atypical due to its location, although roughly 10% of the cases of cardiac ischemia manifest primarily in craniofacial structures. Finally, the differential diagnosis of pain of odontogenic origin must be taken into account with pain of non-odontogenic origin (muscle, psychogenic, neuronal, cardiac, sinus and neurovascular pain) in order to avoid diagnostic errors in the dental practice as well as unnecessary treatments.
Key words:Orofacial pain, ischemic heart disease, heterotopic pain, odontalgia.
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Affiliation(s)
- José López-López
- Departament of Stomatology. School of Dentistry, University of Barcelona, Barcelona, Spain.
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28
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Danesh-Sani SH, Danesh-Sani SA, Zia R, Faghihi S. Incidence of craniofacial pain of cardiac origin: results from a prospective multicentre study. Aust Dent J 2012; 57:355-8. [DOI: 10.1111/j.1834-7819.2012.01698.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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29
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Bereiter DA, Okamoto K. Neurobiology of estrogen status in deep craniofacial pain. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2011; 97:251-84. [PMID: 21708314 DOI: 10.1016/b978-0-12-385198-7.00010-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Pain in the temporomandibular joint (TMJ) region often occurs with no overt signs of injury or inflammation. Although the etiology of TMJ-related pain may involve multiple factors, one likely risk factor is female gender or estrogen status. Evidence is reviewed from human and animal studies, supporting the proposition that estrogen status acts peripherally or centrally to influence TMJ nociceptive processing. A new model termed the "TMJ pain matrix" is proposed as critical for the initial integration of TMJ-related sensory signals in the lower brainstem that is both modified by estrogen status, and closely linked to endogenous pain and autonomic control pathways.
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Affiliation(s)
- David A Bereiter
- Department of Diagnostic and Biological Sciences, University of Minnesota School of Dentistry, Minneapolis, MN 55455, USA
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30
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Yanagawa Y, Nishimura M, Ohkawara J, Hasegawa K, Yamane M. Acute myocardial infarction presenting with pharyngeal pain alone. J Emerg Med 2010; 43:e287-8. [PMID: 20634021 DOI: 10.1016/j.jemermed.2010.05.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2010] [Revised: 04/01/2010] [Accepted: 05/17/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Pharyngeal pain alone due to acute myocardial infarction is rare. CASE REPORT A 37-year-old man felt sudden pharyngeal pain. He was transferred to a medical facility under a misdiagnosis of pharyngitis. However, he was thereafter found to have acute myocardial infarction and thus was transferred to another hospital. An emergency coronary angiogram revealed complete occlusion of the right coronary artery and he underwent coronary angioplasty. The patient was later discharged ambulatory. CONCLUSION A misdiagnosis of acute myocardial infarction can lead to unfavorable outcomes; therefore, physicians or emergency medical technicians should be aware of this disease even when a patient complains of sudden pharyngeal pain alone.
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Affiliation(s)
- Youichi Yanagawa
- Department of Traumatology and Critical Care Medicine, National Defense Medical College, Tokorozawa, Saitama, Japan
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Kreiner M, Falace D, Michelis V, Okeson J, Isberg A. Quality Difference in Craniofacial Pain of Cardiac vs. Dental Origin. J Dent Res 2010; 89:965-9. [DOI: 10.1177/0022034510370820] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
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, i.e., 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.
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Affiliation(s)
- M. Kreiner
- Department of Oral and Maxillofacial Radiology, Umeå University, SE - 901 87 Umeå, Sweden
- Department of General and Oral Physiology, Universidad de la República, School of Dentistry, Montevideo, Uruguay
| | - D. Falace
- Orofacial Pain Center, University of Kentucky, College of Dentistry, Lexington, USA
| | - V. Michelis
- Department of Cardiology, Hospital de Clínicas, Montevideo, Uruguay
- Department of Cardiology, Hospital Central de las Fuerzas Armadas, Montevideo, Uruguay
| | - J.P. Okeson
- Orofacial Pain Center, University of Kentucky, College of Dentistry, Lexington, USA
| | - A. Isberg
- Department of Oral and Maxillofacial Radiology, Umeå University, SE - 901 87 Umeå, Sweden
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Türp J, Hugger A, Löst C, Nilges P, Schindler H, Staehle H. Vorschlag einer Klassifikation der Odontalgien. Schmerz 2009; 23:448-60. [DOI: 10.1007/s00482-009-0819-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sone M, Koizumi A, Tamiya E, Inoue K, Ebihara I, Koide H, Okazaki S, Kato Y, Suzuki J, Daida H. Angina Pectoris with Pharyngeal Pain Alone: A Case Report. Angiology 2008; 60:259-61. [DOI: 10.1177/0003319707311537] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Patients with pharyngeal pain are frequently encountered in the department of otorhinolaryngology. The pharyngeal pain is usually caused by an inflammation or a malignant disease. In some cases, anginal pain radiates to the pharynx. However, patients with angina pectoris who suffer from pharyngeal pain without chest pain are believed to be very rare. The patient was a 70-year-old man whose chief complaint was only pharyngeal pain on exertion. The pharyngeal pain was similar to acute pharyngitis with burning pain. Upon cardiac catheterization, no abnormality was found in the right coronary artery or in the circumflex artery, but 99% stenosis was found in the middle portion of the left anterior descending artery. There was no collateral circulation to the left anterior descending artery. Thus, percutaneous coronary intervention was performed, and the pharyngeal pain vanished.
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Affiliation(s)
| | - Akiko Koizumi
- Department of Cardiology (MS, AK, ET, KI), Tokyo, Japan
| | - Eiji Tamiya
- Department of Cardiology (MS, AK, ET, KI), Tokyo, Japan
| | - Kiyoshi Inoue
- Department of Cardiology (MS, AK, ET, KI), Tokyo, Japan
| | - Isao Ebihara
- Department of Medicine, Koto Hospital, Tokyo, Japan
| | - Hikaru Koide
- Department of Medicine, Koto Hospital, Tokyo, Japan
| | - Shinya Okazaki
- Department of Cardiology, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Yoshiteru Kato
- Department of Cardiology, Juntendo University School of Medicine (YK, JS, HD), Tokyo, Japan
| | - Jun Suzuki
- Department of Cardiology, Juntendo University School of Medicine (YK, JS, HD), Tokyo, Japan
| | - Hiroyuki Daida
- Department of Cardiology, Juntendo University School of Medicine (YK, JS, HD), Tokyo, Japan
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36
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Myers DE. Vagus nerve pain referred to the craniofacial region. A case report and literature review with implications for referred cardiac pain. Br Dent J 2008; 204:187-9. [DOI: 10.1038/bdj.2008.101] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2007] [Indexed: 11/09/2022]
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