Bilateral temporomandibular joint pain as the first and only symptom of ischemic cardiac disease: a case report.

Pain of ischemic and non-ischemic cardiac disease can be referred to the craniofacial region. Also, in 6% of patients, craniofacial pain can be the first and only and symptom of cardiac ischemia. Missed diagnoses of these cases may lead to unnecessary dental treatment and a significant number of deaths in patients with atypical symptoms of coronary disease. Therefore the aim of this report, was to present a 48-year-old man with a chief compliant of severe bilateral pain in the temporomandibular joint who was referred to us for evaluation of a suspected temporomandibular disorder. Clinical and radiological examinations we did not find any origin for his pain. The patient was referred for cardiological evaluation (exercise test, electrocardiography, laboratory tests and coronary angiography) and was diagnosed with angina pectoris. The patient had no previous history of heart disease or chest pain. In conclusion, awareness of this symptomatology can be useful for diagnosis of coronary insufficiency and timely treatment. Therefore, cardiac disease should be considered in the differential diagnosis of orofacial pain.