What is it?
When the heart muscle is not getting enough blood, the pain that follows is not always felt in the chest. The signal from the heart meets the nerve pathways coming from the face and jaw at the same level in the spinal cord; the brain may not be able to tell where the pain is coming from. That is why the pain is felt in the lower jaw, the neck, the arm or the back.
This pain has features that set it apart from toothache. You cannot point to one particular tooth, it is spread out, and it can be on both sides. It does not come on with hot, cold or chewing; it starts with exertion such as walking, climbing stairs or lifting something heavy, and eases after a few minutes of rest. Sweating, nausea, breathlessness and feeling weak can come with it.
In women, in people with diabetes and at older ages, a heart attack can run its course without typical chest pain; the first place someone turns may be the dentist. So where jaw pain comes on with exertion and the examination of the mouth does not explain it, a cause in the heart is treated as the priority until it has been ruled out.
Signs
You will not necessarily have all of these at once.
Why does it happen?
- 01
Narrowing in the heart's arteries
Narrowing of the vessels that feed the heart means the extra oxygen needed during exertion cannot be supplied. The pain comes with effort and goes with rest; this picture is called stable angina.
- 02
A sudden blockage of an artery
A clot forming on top of a narrowed artery can cut off the flow completely. This time the pain does not go with rest, it builds, and the heart muscle begins to be damaged within minutes.
- 03
Pain being felt in the wrong place
The nerve signal from the heart and the signal from the lower jaw gather in the same region of the spinal cord. Because of this shared route the brain cannot tell the source apart, and places the pain in the jaw, the arm or the neck.
- 04
The background that raises the risk
High blood pressure, diabetes, high cholesterol, smoking and a family history of early heart disease all raise the likelihood. Where this background is present, jaw pain that comes on with exertion is treated with suspicion sooner.
How does it progress?
- With exertion
Pain that starts when you walk and goes when you rest
The pain appears at a particular level of effort, goes after a few minutes of rest, and comes back in the same way each time. This pattern brings a cause in the heart to mind and calls for a planned cardiology assessment.
- Changing
Pain that comes with less effort and takes longer to go
If the same pain starts coming on with lighter exertion and lasting longer, the picture has become unstable. You do not wait your turn for an appointment; assessment is needed the same day.
- At rest
Pain that comes at rest and does not go
If the pain starts with no effort at all, goes on for more than twenty minutes, or comes with sweating, nausea and breathlessness, it is an emergency. Do not wait; call 112.
How is it treated?
In this picture the dentist's job is not to treat but to recognise and refer. Once it is clear that the pain comes with exertion and goes with rest, and the examination of the mouth gives no finding that explains it, the planned dental procedure is postponed. The clinic's role here is limited to noticing it and sending you to the right place.
If the pain is going on at that moment, has lasted more than twenty minutes, or comes with sweating, nausea and breathlessness, call 112; do not set off in your own car. At the emergency department an ECG and blood tests are done within the first few minutes. Even if the pain has passed, the cardiology assessment is not put off.
In cardiology the decision is reached with an exercise test, an echocardiogram and, where needed, an angiogram; treatment may be medication, a stent or surgery. If the heart assessment shows no problem, a cause in the tooth, in the chewing muscles or in the jaw joint is looked at again. That is the order, not the other way round.
- Jaw or chest pain lasting more than twenty minutes that does not go with rest
- Cold sweating, nausea and breathlessness coming with the pain
- Pain spreading to the arm, the neck, the back or the upper abdomen
- Feeling faint, palpitations and sudden weakness
How is it prevented?
- Do not treat jaw pain that comes on with exertion as toothache and put it off; if the examination of your mouth does not explain it, a cardiology assessment is needed.
- Keep up regular checks of your blood pressure, your blood sugar and your cholesterol; these three are the best known background to heart and artery disease.
- Stopping smoking is one of the first steps that lowers the risk of a blocked artery.
- Tell your dentist about any heart condition you have and the medicines you take at every appointment; the plan for your procedure is built around them.
Frequently asked questions
- If the pain is coming from my heart, why is my tooth sensitive?
- In pain that comes from the heart the teeth are usually normal. Even where sensitivity is felt, you cannot point to a single tooth, and cold, heat or chewing do not clearly change the pain. In pain that comes from a tooth, the link with a trigger is obvious.
- The pain has gone, should I still see a doctor?
- Yes. Pain that comes with exertion and goes with rest can be the warning sign of a narrowed artery. The fact that the pain has passed does not show that the cause has gone; the assessment should not be put off, and a cardiology appointment should be arranged within a short time.
- What happens if this pain starts during dental treatment?
- The procedure is stopped, your condition is assessed and, if needed, 112 is called. Giving a painkiller and carrying on with the procedure is not right; in this picture, time lost is expected to turn into permanent damage to the heart muscle.
This content is for general information and does not replace an in-person examination. Symptoms overlap between conditions, and a diagnosis can only be made clinically.