Case Report: A case of toothache of cardiac origin with a long-term clinical course

TL;DR

A 76-year-old woman's toothache was actually caused by heart issues, highlighting the importance of considering cardiac origins for unexplained dental pain.

Contribution

This case report emphasizes the need for cross-disciplinary awareness to avoid misdiagnosis of cardiac-origin toothache.

Findings

Persistent tooth pain and chest discomfort were ultimately linked to severe coronary artery stenosis and a left ventricular thrombus.

Symptoms resolved completely after cardiac intervention, confirming the cardiac origin of the toothache.

The case underscores the risk of delayed cardiac treatment due to misdiagnosis as a dental condition.

Abstract

Toothache of cardiac origin is a rare but significant form of referred pain originating from cardiac pathology such as angina pectoris. Although jaw and throat discomfort are known referred pain sites, toothache alone is an uncommon presentation. Misdiagnosis often leads to unnecessary dental interventions and delays in appropriate cardiac treatment, highlighting the need for greater awareness among both dentists and internists.

A 76-year-old woman presented with persistent pain in the gingiva around teeth #33 and #34, accompanied by sharp chest discomfort which would subside in about 5–6 min. Extensive dental examinations, including extractions, failed to resolve her symptoms. Initial cardiac evaluations—electrocardiogram, Holter monitoring, echocardiography, and chest computed tomography—were unremarkable. Consequently, she was diagnosed with atypical odontalgia and prescribed antidepressants, but these proved ineffective. However, over several months, the toothache worsened upon exertion, accompanied by chest pain unresponsive to standard analgesics. A specialized cardiac imaging center finally detected severe stenosis (90%–99%) of the left anterior descending artery and Right Coronary Artery, as well as a left ventricular thrombus. Coronary angiography confirmed unstable angina, and the patient underwent a Dor procedure to remove the thrombus alongside coronary artery bypass grafting. Following surgery, her toothache and chest pain completely resolved.

This case features a protracted course from symptom onset to definitive treatment. In older patients reporting persistent tooth or gingival pain with intermittent chest discomfort—especially when symptoms are exertional and dental findings are negative—clinicians should consider a cardiac origin and expedite cardiologic imaging to avert hazardous delays. Systematic accumulation of cases and cross-disciplinary research are essential to establish actionable diagnostic guidance and move beyond anecdotal evidence.

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