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

A selection of abstracts of clinically relevant papers from other journals. The abstracts on this page have been chosen and edited by John R. Radford.

Abstract

Despite frequent claims to the contrary, there is little evidence that dental pain could be the only symptom for cardiac insufficiency.

Main

Jalali N, Vilke GM et al. J Emerg Med 2014; 10.1016/j.jemermed.2013.11.071

'...should emergency physicians consider the possibility of myocardial infarction in patients who present solely with dental pain?' Such a question is even more pertinent for dentists. In this systematic review, 18 studies met the criteria. Two were prospective cohort studies, one recruiting 186 participants and the other 474. The methodology of only one of these cohort studies was judged robust. It was reported that as few as 1 in 20 patients with cardiac insufficiency had solely a symptom involving the orofacial region, and this was usually confined to the upper throat. Rarely was the symptom described as pain but instead as 'pressure' or 'burning'. Of the case reports, only three identified orofacial pain as the sole symptom of cardiac insufficiency. Symptoms such as pain on exercise, nausea, shortness of breath or diaphoresis (profuse sweating) require investigation.