Sir, we read with interest the article by Scully and Felix (BDJ 2006; 200: 75–83) on the causes of orofacial pain. We felt it underplayed the importance of jaw pain as a key trigger for consideration of the diagnosis of a temporal (or giant cell) arteritis. It was particularly pertinent as we had recently treated a case of temporal arteritis where jaw pain was the presenting feature.

The case involved an 81-year-old lady who had developed jaw pain four weeks before presentation and had had two teeth removed by her dentist. This failed to improve her symptoms and over the coming weeks two further teeth were removed without resolving her pain. It was not until she developed blurred vision in her left eye that she was referred to us.

When we saw her, in addition to her jaw pain, she also complained of scalp tenderness and extreme tenderness over the temporal region. On examination her vision was normal in the right eye but on the left was markedly reduced. Investigations showed a raised erythrocyte sedimentation rate (ESR) and an elevated c reactive protein (CRP). A diagnosis of temporal arteritis was made and she was started on intravenous methyl prednisolone. After starting the treatment her jaw pain finally improved. Unfortunately, the vision in her left eye will not recover.

Temporal arteritis is a condition that occurs mainly in the over 50s and whose incidence increases with age.1,3 Jaw claudication is commonly the presenting symptom, present in 48% of cases.4 Other key features include tongue pain, headache and scalp tenderness (especially when combing their hair), weight loss and general malaise. We have not found sweating or fever to be key features although they are described in the literature.2,3,4 The temporal artery is not always tender, although it frequently is, and in advanced cases the artery becomes pulseless.2,3

As stated by Scully and Felix untreated temporal arteritis can lead to loss of vision. This is usually unilateral, as in our case, but can become bilateral. In the worse case scenario, untreated temporal arteritis can lead to a stroke.3

It is vital then that dental practitioners are aware of the importance of jaw pain as a presenting feature of this condition which can have such devastating effects and refer if there is any doubt.