What is it?
Giant cell arteritis is an inflammatory condition affecting the wall of medium and large arteries. Because it most often affects the artery running through the temple, it is also known as temporal arteritis. It is seen almost entirely over the age of fifty, and it becomes more common as age advances.
The inflammation thickens the vessel wall and the blood flow passing through it narrows. Tissue whose blood supply has dropped hurts while it works. Because the chewing muscles need more blood while they are working, they tire after a few mouthfuls, they hurt, and they settle when you pause. This is called jaw claudication and it is one of the early signs of the condition.
Here is the point that concerns a dental clinic: you may come to a dentist thinking this is a jaw joint or a tooth problem. If the branches of the same vessel network that supply the optic nerve are affected, loss of sight can develop, and that loss often does not come back. For that reason no days are lost when the picture raises suspicion.
Signs
You will not necessarily have all of these at once.
Why does it happen?
- 01
The immune system turning on the vessel wall
Immune cells gather in the vessel wall and create inflammation there. The wall thickens and the space inside the vessel narrows. The symptoms of the condition are the result of that narrowing.
- 02
Older age
The condition is very rare under the age of fifty and is most common around the age of seventy. That is why the same pain at the temple is not weighed the same way in a young patient and in an older one.
- 03
Occurring together with polymyalgia rheumatica
Stiffness and pain around the shoulders and hips that is marked in the mornings is often seen in the same person as this condition. If you have symptoms like these, tell your doctor about them separately.
- 04
Predisposition and environmental factors
The exact cause of the condition is not known. A genetic predisposition and certain environmental triggers are thought to play a part together. It is not the result of anything you have done wrong.
How does it progress?
- 1
General symptoms
Tiredness, loss of appetite, weight loss, a mild fever and night sweats can carry on for weeks. At this stage the picture does not look specific to the condition.
- 2
Head and jaw findings
A new kind of pain at the temple, tenderness of the scalp when you comb your hair and the jaw tiring while you chew are added. The vessel at the temple may feel tender and thickened.
- 3
A warning from the eye
There may be brief loss of sight in one eye, blurring or double vision. Even if it has passed, this finding is not to be expected; assessment is needed the same day.
- 4
Permanent loss of sight
If assessment is delayed, the blood supply to the optic nerve can be disturbed, and the loss of sight that follows is not expected to come back. The point of coming early is to keep things from reaching this stage.
How is it treated?
For this condition the place to go is a rheumatology clinic. If no appointment can be found for the same day, go to an emergency department. The assessment is not put off to the following week. If you have any symptom to do with your sight, go to an emergency department without delay. Giant cell arteritis is not diagnosed in dentistry and it is not treated in dentistry.
What to expect there is blood tests showing the level of inflammation, an ultrasound examination of the artery at the temple and, where needed, an examination of a small piece taken from the vessel. If the suspicion is strong, treatment to suppress the inflammation may be started before the work-up is complete. Requesting these tests, reading them and starting treatment rest with the doctor in charge.
The dentist's role is to notice and to refer. Pain at the temple that has newly started over the age of fifty, together with the jaw tiring while chewing, is not a picture to be handled like ordinary chewing muscle pain and watched with a night guard. If these findings are seen together at the examination, you are referred to the relevant department the same day.
- Sudden or brief loss of sight, blurring or double vision in one eye
- An unusual pain at the temple starting for the first time over the age of fifty
- Feeling a tender, thickened vessel at the temple that hurts when touched
- Fever, tiredness or weight loss along with the jaw tiring while you chew
How is it prevented?
- This condition cannot be prevented; protection comes from recognising the sign early and going for help without delay.
- Do not treat a headache or pain at the temple that starts for the first time after the age of fifty as something ordinary.
- Note it and tell your doctor if your jaw tires while you chew and settles when you pause.
- Report any disturbance of your sight the same day, even if it was brief and has passed.
Frequently asked questions
- My jaw tires when I chew, is that always a serious condition?
- No. The most common reason for tiring while chewing is the chewing muscles being overworked, and that picture is a quiet one. But over the age of fifty, if it has newly started and comes with pain at the temple, tiredness or a symptom affecting your sight, assessment is needed the same day. The examination and blood tests are what tell them apart.
- What is the difference between my temple pain and a tension-type headache?
- Tension-type pain is usually on both sides, has been familiar for years and gives a dull tightness. In giant cell arteritis the pain starts newly, is most often one-sided, the scalp may be sensitive to touch, and the jaw may tire while you chew. That combination is assessed without waiting.
- Can a dentist request tests for this condition?
- No. Requesting these tests and starting treatment on the result rests with the doctor in charge. The dentist's job is to notice the finding and to pass it on clearly to you and to the department you are referred to. That is why the questions about your age, your sight and your general health at the examination are not merely a formality.
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.