Angina Tooth Pain

Introduction

Have you ever gotten a toothache from physical exertion, and you found that taking rest immediately alleviated the pain?  Is your toothache still bothering you after multiple trips to the dentist? While a toothache is usually not a cause for alarm, there are times when it may indicate something more serious. 

What can cause tooth pain?

A toothache or tooth pain is caused when the nerves in the root of a tooth or surrounding a tooth are irritated. The common reasons for tooth pain are infection, decay, injury, gum disease, or the loss of a tooth. Pain sometimes originates from other areas such as the jaw, ears, or sinuses and radiates towards the oral cavity causing tooth pain. 

The signs and symptoms are:

• Irritation and inflammation of the gums and teeth
• A sudden and excruciating throbbing pain even on slight touch
• Tenderness around the tooth and gums
• Sensitivity brought on by either hot or cold temperatures
• An unusually intense pain, such as a burn or shock

Toothache of cardiac origin

It has been suggested that tooth pain can be an early indicator of heart disease. Due to the location of the vagus nerve, some heart diseases may cause dental pain. This nerve originates in the brain and travels down the side of your skull, through your jaw, and into your heart and other vital organs. 

What is angina pectoris?

Angina pectoris refers to pain or discomfort in the chest caused by a decrease in blood flow to the heart. This may indicate coronary heart disease when there is a block in blood flow due to the buildup of cholesterol and other substances in the coronary arteries which supply the heart.¹ Other causes may include irregular cardiac rhythms, heart failure, and anaemia (less frequent).² Most cases of angina are relieved quickly after taking rest or prescribed cardiac medication like nitroglycerin. 

Types of angina

Stable angina: The vast majority of cases of angina are stable angina. It appears with strenuous exercise and disappears after rest or the use of angina medication. It typically lasts for 3-5 minutes. 

Unstable angina: occurs without warning and while at rest. Usually, it's very intense and it lasts for at least 20 minutes. The angina discomfort rapidly worsens and happens with little physical effort. Urgent care is needed for unstable angina, as it may signal a heart attack.

Variant angina (Prinzmetal angina): It is not caused by clogged arteries in the heart but rather by a temporary reduction in blood flow to the heart due to an arterial spasm. It often occurs while sleeping and during the night, in cyclical patterns. Anti-anginal drugs might help with the discomfort.

Refractory angina: Frequent angina attacks persist despite the use of medicines and lifestyle modifications.

Signs and symptoms

Angina chest discomfort is frequently reported as squeezing, pressure, heaviness, tightness, or pain, and may feel like a heavy weight resting on the chest.²,³ 

Other symptoms may include:

• Sharp chest pain
• Pain radiating towards the left arm, shoulder, neck and jaw
• Dizziness
• Fatigue
• Nausea
• Sweating

Angina can be different in men and women. Although chest pain is a typical symptom of angina in women, there are a few less frequent symptoms (especially in women) such as:

• Breathing problems 
• Stabbing pain 
• Stomach ache

How does angina pectoris cause toothache?

In rare cases, angina pectoris can cause symptoms similar to tooth pain. When the arteries leading to the heart get constricted, it can generate a sharp pain in the chest that radiates to the left side of the jaw, giving the impression of toothache. Generally, tooth pain of cardiac origin appears as heaviness, tightness, and throbbing, radiating to the neck and left side of the mandible (jaw). Sometimes the pain may be felt near the ears.⁴ Improper diagnosis (misdiagnosis) of the condition can result in the administration of the wrong treatment. This delay in finding the cause of tooth pain to be angina may cause the patient to experience an acute myocardial infarction or heart attack.

Ludwig’s angina and tooth pain

Ludwig's angina is caused by a bacterial infection known as cellulitis (which causes redness, swelling and pain) that manifests itself in the neck and the floor of the mouth. It usually begins with an infection in the second or third lower molar (abscessed tooth). Oral microorganisms are usually involved in the infections that cause the disease. This rare form of cellulitis can rapidly develop, producing life-threatening disease and the potential obstruction of the airways .⁵ 

Symptoms include:

• Tooth pain
• Difficulty with speech
• Shivering or high temperature
• Pain in the neck and jaw
• Protruding tongue
• Swelling in the jaw, tongue, face and neck
• Pain or tenderness under the tongue

When to call a doctor

If you are having problems breathing or swallowing, this is a medical emergency. 

Contact your doctor if you experience:

• Cold and fever 
• Jaw, cheek, or neck swelling or pain
• Tooth pain 
• Jaw pain associated with chest pain
• No other dental causes seen which can cause tooth pain
• Sudden onset of pain with mild to severe intensity
• Tooth pain on performing physical activity
• No relief from toothache despite medication or mandibular anaesthesia

Summary

Toothaches can be incredibly painful, but as long as they are treated, the discomfort is temporary. It is typically caused by tooth infections and, if left untreated, can progress into life-threatening conditions. A toothache may be an early indicator of heart disease. There is a small risk of heart disease if you experience an unexplained toothache that intensifies after physical activity and reduces after rest. This does not mean that everyone with a toothache is at risk of  a heart attack. If there is also chest discomfort, dizziness, or sweating in addition to toothache, the patient needs immediate medical assistance.