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Jaw Pain: Myocardial


What is it?
A myocardial infarction
(also known as a heart
attack), refers to the
sudden damage and or
death in multiple possible
areas of varying quatity of
the heart muscle

What are the causes?

A myocardial infarction (MI) occurs when
there is a sudden blockage of a coronary
Blockages can be caused by plaque
Plaque is a substance made up of fat,
cholesterol, and other cellular waste products

Coronary arteries are located all over the

heart and supply the heart musculature
with the necessary blood and oxygen that it
needs to function properly

Whos at risk?
High blood pressure
High cholesterol
High triglyerides
Diabetes- high blood sugar levels
Increased age
Family history of heart disease
Poor diet and nutrition (diets high in saturated fats, trans fats,
Other factors: stress, lac of exercise, illegal drugs (cocaine,
amphetamines), etc.

Pressure and/or burning sensation provoked by
physical activity and relieved by rest
Chest pain radiating to shoulder, neck, arms,
craniofacial and jaw
Craniofacial/jaw pain may be the only symptom in 6% of
the population (Danesh-Sani, 2012)

Jaw pain can occur bilaterally

Other symptoms include: Sleep disturbances,
anxiety, nausea, sweating, increase heart rate,
dizziness, vomiting, cough

Gender Differences In
Symptoms vary from person to person in type
and severity; chest pain is the most
commonly reported symptom in each gender
Females (more likely than Males) to have:

Jaw pain
Shortness of breath
Back pain

Jaw pain in MI
Danesh-Sani, 2012
This study found that 15.5% of people having
a heart attack had right mandible pain, 14.6%
had left mandible pain, 7.8% had right
TMJ/Ear region pain, and 9.0% had left TMJ/Ear
region pain
No patients had pain in either side of the

Differential diagnosis: throbbing/aching tends to
help diagnosis and differiante dental pathologypressure/burning lead to a more concrete diagnosis
of cardiac origin
Angiogram with coronary catheterization
If patient is previously prescribed nitroglycerin and
has taken it when first sign of angina occurs with no
success in pain monitoring, a second dose (post 5
min) should be prescribed. If no response to the
second dose it can be inferred that a possible MI is
occurring and it is a medical emergency

Coronary artery bypass graft (CABG)
Medications: blood thinners (aspirin),
thrombolytics, antiplatelet drugs,
nitroglycerin, beta-blockers, ACE inhibitors,
pain relievers

Prognosis: Outcomes & Long

Term Effects
Mortality rates increase if chest pain isnt the chief
compliant in a MI, so clinicians need to be extremely
mindful when a client presents with just jaw pain!
Prognosis is dependent on damage, duration it took to
treat damage (i.e. time to the hospital),
Long term management includes: modifying diet
(increasing whole grains, fruits, vegetables, lean proteins
and decreasing sugar, saturated fat, trans fat, cholesterol)
Smoking cessation
Cardiac Rehab (physical therapy)
Increasing physical activity and exercise

Lets Test Your


True or False:
Mortality rate decreases if a patient
presents with jaw pain as the primary
compliant while having an undiagnosed
myocardial infarction.

FALSE, mortality rate increases! Why?

There are increased odds of misdiagnosing

the MI

True or False:
Women are more likely experience jaw
pain during a myocardial than men

TRUE! Women tend to have different

symptoms than men, and jaw pain is
attributed to women in reference to MI more
than men.

True or False:
A patient comes into the physical therapy with
complaints of jaw pain for the past 24 hours. When
you ask the patient to describe their pain, they say it
feels like pressure and a burning sensation. The
patient also states it is not brought on by any
mechanical motions in particular. The patient
exhibits normal range of motion and strength in the
jaw. You notice as youre evaluating the patient
begins to sweat and tells you they feel like headed.
CALL 911.

TRUE! The patient is experiencing symptoms that could

potentially be evidence of a myocardial infarction. Call 911
right away!

Attar H, Attar N. Dental Pathology Overlapping With Cardiac Origin Of Jaw Pain Leading To
Myocardial Infarction: A Case Report.Internet Journal Of Emergency Medicine[serial
online]. January 2011;7(1):1-1 1p. Available from: CINAHL Plus with Full Text, Ipswich, MA.
Accessed June 28, 2016.

Danesh-Sani S, Danesh-Sani S, Zia R, Faghihi S. Incidence of craniofacial pain of cardiac

origin: results from a prospective multicentre study.Australian Dental Journal[serial
online]. September 2012;57(3):355-358 4p. Available from: CINAHL Plus with Full Text,
Ipswich, MA. Accessed June 28, 2016.

Lpez-Lpez, J., Adserias-Garriga, M. J., Garcia-Vicente, L., Jan-Salas, E., ChimenosKstner, E., & Pereferrer-Kleine, D. (2012). Orofacial pain of cardiac origin, serial of
clinical cases. Medicina Oral, Patologa Oral Y Ciruga Bucal, 17(4), e633e637.

Sandler N, Ziccardi V. Differential diagnosis of jaw pain in the elderly.Journal Of The

American Dental Association (JADA)[serial online]. September 1995;126(9):1263.
Available from: Academic Search Complete, Ipswich, MA. Accessed June 28, 2016.