Gerald S. Fine, D.D.S.
Oral and Maxillofacial Surgery
It was a Thursday afternoon and my next patient was an 86 year old woman with a history of headaches and severe pain radiating to the ear when she ate. My initial oral examination was unremarkable. The patient presented with an ill fitting full upper and a partial lower denture as well as several carious and periodontally involved anterior lower teeth. She had lost her spouse a year ago and was anxious and depressed.
Past Medical History: My patient was being seen and treated by her physician for thyroid disease, hypertension, and anxiety/depression.
Differential Diagnosis: Upon examination I considered an ill fitting denture and/or temporomandibular disorder (T.M.D.) as most likely explanations for her symptoms.
When I discussed my findings with my patient she added additional information. Her chin was numb. Numbness could not be explained by either T.M.D. or by an ill fitting upper denture. What had I missed I wondered? My panoramic x-ray didn't show any significant dental issues. There were no cysts or lesions near the mental foramen. Her dental symptoms could not be explained by my clinical or radiographic findings. Perhaps it was not a dental issue. I called her primary care physician and discussed my concern that our mutual patient may have Temporal Arteritis. I sent our patient to the Quest lab. down the street. The elevated sedimentation rate lab result was indicative of temporal arteritis. A later obtained biopsy confirmed the diagnosis.
Temporal Arteritis is not an uncommon problem among the elderly but can be difficult to diagnose. It manifests itself with various signs and symptoms including mouth and head pain. It is a vasculitis found in women three times more frequently than in men. It most commonly affects the lingual, ophthalmic, temporal, and facial superficial scalp arteries. Blindness can result if it affects the ophthalmic artery.
Sixty per cent of patients report headaches severe enough to seek medical attention. Many patients initially seek treatment from their dentist because they are demonstrating pain that increases with vigorous chewing. This distinguishing feature is indicative of Temporal Arteritis. Patients may also have a toothache, tongue infarction, cough, and chin numbness.
Patients who have clinical symptoms that are not readily explained by their oral and physical findings may have Temporal Arteritis and should be referred to a physician.
Gerald S. Fine, D.D.S.
Practice limited to oral & maxillofacial surgery