Differential diagnosis of jaw pain in the elderly

Orofacial Pain with Cardiac Origin of Coronary Artery Disease: A Case Report and Literature Review

When diagnosing orofacial pain, clinicians should also consider non-odontogenic origin and systemic diseases as possible etiological factors, along with odontogenic origin. This case report aimed to provide information for early detection of orofacial pain of cardiac origin by dentists, when pain due to coronary artery disease is the only presenting symptom. A 60-year-old male patient with unexplained isolated bilateral jaw pain that had persisted for the past 5 years was referred to a dentist by an anesthesiologist who suspected temporomandibular joint disorder. In oral examination, no specific pathological changes were observed in the oral cavity, including teeth, surrounding alveolar bone, and buccal mucosa. Magnetic resonance imaging and conventional radiography showed no pathological destruction or abnormalities of bone and soft tissue in the temporomandibular joint region. However, pain was precipitated by ordinary daily activities, and the pain alleviating factor was rest. Eventually, the patient was referred to a cardiologist for further evaluation since his pain was induced by physical activity. Coronary artery disease (CAD) was diagnosed using coronary computed tomography angiography, and the pain was considered to be angina pectoris. Percutaneous coronary intervention was successfully done for the patient, after which his orofacial symptoms disappeared. To conclude, isolated craniofacial pain of cardiac origin may lead to patients seeking dental care or visiting orofacial pain clinics. In these settings, dentists and orofacial pain specialists may contribute to the diagnosis of CAD and refer patients for cardiac evaluation and appropriate management.

Giant Cell Arteritis: A Case-Based Narrative Review of the Literature

Purpose of Review

Giant cell arteritis (GCA) is a chronic, inflammatory condition, primarily affecting the medium and larger arteries. The purpose of this narrative review is to describe GCA in the context of headache and facial pain, based on a case and the available current literature. Understanding the etiology, pathophysiology, the associated conditions, and the differential diagnoses is important in managing GCA.

Recent Findings

In a patient presenting with unilateral facial/head pain with disturbances of vision, GCA should be considered in the differential diagnosis. There is an association of GCA with several comorbid conditions, and infections including coronavirus-19 (COVID-19) infection. Management of GCA primarily depends upon the identification of the affected artery and prompt treatment. Permanent visual loss and other serious complications are associated with GCA.

Summary

GCA is characterized by robust inflammation of large- and medium-sized arteries and marked elevation of systemic mediators of inflammation. An interdisciplinary approach of management involving the pertinent specialties is strongly recommended.

The Appearance of The Infraorbital Canal and Infraorbital Ethmoid (Haller's) Cells on Panoramic Radiography of Edentulous Patients

Objectives. The aim of the study is to detect the prevalence and the characteristics of infraorbital canal and Haller's cells on panoramic radiography of edentulous patients. Methods. The study group comprised 291 panoramic radiographs of edentulous patients. Radiographs were interpreted for the visibility and characteristics of infraorbital canal and Haller's cells. For classification of infraorbital canal, a method based on the image characteristics of the border of the canal (Types I, II, and III) was used. Haller's cells were grouped according to the number and the shape of loculations. Results. Infraorbital canal was observed in 246 (84.6%) radiographs. The most prevalent of the observed canals were Type III for both sides (39.9 % for right and 32.3% for left side). The visibility of Haller's cells was 23.7%. The frequencies of Haller's cells' visibility were approximately equal for both genders. There is no significant difference between genders for the visibility of infraorbital canal and Haller's cells. Conclusions. The surgeons, implantologists, and radiologists should take into consideration infraorbital canal and Haller's cell for planning implant surgery of maxillary anterior region and undefined orofacial pain for edentulous patients.

Giant cell arteritis

Giant cell arteritis has been considered an enigmatic disease. It is characterised by chronic granulomatous inflammation of the walls of large and medium-sized arteries. The process has a predilection for the extradural cranial arteries, which include the ophthalmic and the posterior ciliary arteries. It is a multi-symptom disease of older individuals and patients often present with challenging issues and diagnostic dilemmas. We review the literature and latest protocols for the diagnosis and management of giant cell arteritis.

Oral symptoms and signs in elderly patients with type 2 diabetes mellitus. A focus on diabetic neuropathy

OBJECTIVE

We investigated oral disorders and compared the findings with the occurrence of neuropathy in type 2 diabetes mellitus.

STUDY DESIGN

Mucosal diseases, tooth loss, and temporomandibular joint dysfunction were examined in 45 patients with long-term type 2 diabetes mellitus and in 77 control subjects. The occurrence of neuropathy was evaluated by neurophysiologic tests.

RESULTS

Of patients with diabetes, 56% suffered from dry mouth and 18% from glossodynia; of controls, correspondingly, 36% and 7% (P <.05); 2 or more mucosal lesions were detected in 42% and 20%, respectively (P =. 008). Temporomandibular joint dysfunction was found in 27% of subjects with diabetes and in 16% of control subjects. Peripheral neuropathy was present in 42% of patients with diabetes and in none of the controls (P <.01), and autonomic parasympathetic neuropathy in 54% and 31%, respectively (P =.02). Peripheral and autonomic parasympathetic neuropathies were independent risk factors for tooth loss and temporomandibular dysfunction.

CONCLUSIONS

Diabetic neuropathy was found to be associated with tooth loss and temporomandibular joint dysfunction.