Orofacial Pain is often the First Sign of Cardiac Disorders and Myocardial Infarction

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Patients with orofacial pain most commonly have myofascial pain but it is always important to remember that orofacial pain is the most frequent first symptom of Cardiac pain.

This has been published in numerous locations including:
Craniofacial Pain as Sole Prodromal Symptom of Acute Myocardial Infarction. Conference Paper · July 2010 (Abstract below)
Conference: IADR General Session 2010 (Additional references below).

Differential Diagnosis is the key to treatment of orofacial pain but it is also important to note that the most common cause of Orofacial is referred myofascial pain. In the orofacial region this is common due to repetitive strain injuries to the masicatory muslces and related postural muscles of the head and neck.

The most common treatment for myofascial pain is the use of occlusal oral appliances to address the myofascial pain. A neuromuscular appliance may be the most successful occlusal appliance partially due to occlusal scheme and partially do to ULF-TENS muscle relaxation utilized in neuromuscular dentistry. The Myomonitor is the original ULF-TENS that is very efficient at relaxing all of the masticatory and facial muscles and has an added advantage of being a Sphenopalatine Ganglion Stimulator.

Many patients with TMD and Orofacial Pain have a high Axis
Two component which involves the Hypothalamus-Pituitary-Adrenal complex. The SPG stimulation tends to act as a reset to these important autonomic structures.

Internal Derangements of the TMJoints may or may not be present in patients with TMD. Internal derangements are the source of clicking, popping and locking commonly associated with TMJ disorders.

Many dentists and physicians fail to make the proper diagnosis if clicking anf popping of the joint is not present because they don’t understand the complex nature of these disorders.

This has been published in numerous locations including:
Craniofacial Pain as Sole Prodromal Symptom of Acute Myocardial Infarction. Conference Paper · July 2010 (Abstract below)
Conference: IADR General Session 2010

Craniofacial Pain as the Sole Sign of Prodromal Angina and Acute Coronary Syndrome: A Review and Report of a Rare Case
Iran Endod J. 2015 Fall; 10(4): 274–280.

Craniofacial Pain of Cardiac Marcelo Kreiner Origin
An Interdisciplinary Study
Umeå University Medical Dissertations
Full Test at: http://www.iesta.edu.uy/wp-content/uploads/2014/05/Craniofacial-Pain-of-Cardiac-Origin.pdf

Craniofacial Pain as Sole Prodromal Symptom of Acute Myocardial Infarction.
Abstract
OBJECTIVES: Recently, we revealed that craniofacial pain can be the sole symptom of an acute myocardial infarction. We hypothesized that this finding is also true for pre-infarction angina. METHODS: A total of 326 consecutive patients with verified cardiac ischemia comprised the study material. Those 150 patients, who experienced two or more acute cardiac ischemic episodes were selected and the latter two episodes were included in an intra-individual variability analysis. Acute myocardial infarction was experienced by 120 patients and was classified as having an abrupt onset or acute myocardial infarction with prodromal angina. Ischemia symptoms experienced within three months prior to the occurrence of an infarction were regarded as prodromal. Data was collected on demographic details, pain characteristics and risk factors. The McNemar’s and the Marginal Homogeneity tests were used to assess the differences in pain characteristics between intra-individual episodes. A multivariate logistic regression model was used to assess possible associations between risk factors, age, gender and the presence of craniofacial prodromal pain. Ethical approval was obtained and informed consent was obtained from each patient. RESULTS: Pain in craniofacial areas constituted the sole prodromal symptom of an acute myocardial infarction in 5% of patients. Women were more likely than men to experience craniofacial pain during their two ischemic episodes (p=0.004). The pain quality descriptors used, i.e. mainly pressure or burning, did not differ significantly between the two episodes (p=0.26). CONCLUSIONS: Craniofacial pain can be the only prodromal symptom of an acute myocardial infarction and thus easily misinterpreted, with the risk of fatal outcome. These data suggest a need of education of the general public and clinicians regarding craniofacial prodromal symptoms indicating myocardial infarction. ACKNOWLEDGMENTS: Funded by the Universidad de la Repblica, Uruguay, the Medical Faculty, Ume University, Sweden and the Swedish Dental Society.

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