Pain & Sensitivity

Can jaw pain come from the heart?

Dental pain gets worse when you bite; heart-related pain gets worse when you walk

In the great majority of people with jaw pain, the problem is in the mouth. But when the blood supply to the heart falls short, the discomfort does not always stay in the chest; sometimes it is felt only in the jaw, the neck or the arm, and the patient goes to a dentist first. What separates the two pictures is not where the pain is, but what brings it on and what makes it go.

Short answer

It can. Heart-related discomfort spreads from behind the breastbone to the neck, the shoulder, the inner side of the arm and the jaw; the NHS writes that in a heart attack the pain can spread to the arm, the neck and the jaw. What sets it apart is not where the pain is but what triggers it: heart-related pain comes on with exertion, goes with rest, and cannot be reproduced by any tooth. If sweating, nausea or breathlessness go with it, call 112.

What sets it apart: Not where the pain is, but that it comes with exertion and goes with rest
Where heart-related pain spreads: Chest, neck, shoulder, the inner side of the arm, jaw, teeth
Emergency signs: Sweating, nausea, breathlessness, pressure in the chest
If there is any doubt: Call 112; the patient does not drive themselves

Why heart-related pain is felt in the jaw

The fibres that carry sensation from the heart end at the same levels in the spinal cord as the fibres carrying sensation from the neck and the arm. The signal that travels up to the brain does not have "heart" written on it; the brain can read the input as though it were coming from a neighbouring area. This is called referred pain, and we meet the same mechanism in dentistry: pain from a lower molar goes to the ear, and discomfort from the heart goes to the jaw.

MSD Manuals lists where heart-related discomfort can be felt as follows: either shoulder, the inner side of either arm, the back, the throat, the jaw and the teeth. It is the "teeth" at the end of that list that gives this page its reason to exist.

The NHS lists these symptoms for a heart attack: pain in the chest that feels like being squeezed or pressed and can spread to the arm, the neck or the jaw; breathlessness; nausea or vomiting; a feeling of indigestion with burning in the chest; sweating; and skin that is pale, bluish or greyish. The same body says that an ambulance should be called for these symptoms. In Turkey the number to call is 112.

When the blood supply to the heart falls short on exertion, it is called angina, and that picture has a signature of its own. The NHS describes angina as sudden pain in the chest, the neck, the shoulders, the jaw or the arms; the pain feels like tightness, pressure or a dull ache, and it can leave the person feeling sick, short of breath, dizzy or sweaty. It is usually brought on by movement, stress, emotional strain or cold weather. Its most distinctive feature is how long it lasts: attacks mostly last less than 10 minutes and are stopped by a few minutes of rest or by the person's own angina medication.

The absence of chest pain is not enough to rule the heart out. MSD Manuals writes that between a quarter and a third of people having a heart attack have no chest pain, and that in up to one in five the symptoms are either very mild or not present at all; this silent picture may only be noticed on an ECG taken later. A silent course is particularly common in people with diabetes. In older people the symptoms can come to the fore as breathlessness, or can resemble a stomach upset.

In women the presentation is often different. MSD Manuals notes that women often present with symptoms described as atypical, which are harder to recognise as coming from the heart; in angina, a burning feeling or tenderness in the back, the shoulders, the arms or the jaw is more common in women. That is why "my chest does not hurt, so it is not my heart" is not a safe way to rule it out.

A widespread belief insists that the pain has to be on the left. The sources do not support that: MSD Manuals writes that the discomfort can be felt in either shoulder and on the inner side of either arm. Pain felt in the right jaw does not take the heart off the list.

The distinctive feature of pain coming from a tooth is that it can be reproduced. A mouthful of cold water, biting with that tooth, or the dentist tapping the tooth lightly sets the same pain off again, and the pain sits on a single tooth. Heart-related discomfort has no such trigger: the patient cannot point to it with one finger, describes a wide area with the flat of the hand, and the pain comes on not with chewing but with walking up a hill.

Which signs point to a tooth, and which to the heart

The two lists below are the signs we look at during an examination. The ones in the first say that the source is in the mouth. If even one of the ones in the second list is present, the next step is not dental treatment but an assessment of the heart.

When it fits

If it starts with cold, heat or something sweetPain that starts like a knife with a mouthful of cold water and carries on after the glass has been put down comes from the pulp inside the tooth. Heart-related discomfort is not set off by a cold drink.
If pressing on a single tooth repeats the same painIf the pain repeats exactly when the dentist taps the tooth lightly, or when you bite something with that tooth, the address has been found. Being able to point to the pain on a single tooth with a fingertip is a feature of pictures that come from a tooth.
If it gets worse when you lie down at nightThrobbing that increases when you lie down and wakes you from sleep describes pressure inside the tooth. Angina comes with movement and goes with rest, which is exactly the opposite behaviour.
If there is swelling, a bad taste or discharge at the gumA blister on the gum on the painful side, a bad taste in the mouth or discharge shows that inflammation at the root tip has found a way out. These findings are not seen in a heart-related picture.

When it doesn't

If the pain comes with exertion and goes with restJaw pain that starts while you are climbing stairs, walking uphill or speeding up in the cold, and stops a few minutes after you sit down, is not how a tooth behaves. The NHS writes that angina attacks mostly last less than 10 minutes and are stopped by rest or by angina medication.
If pressure in the chest or pain in the arm or neck goes with itIf a feeling of tightness in the chest, pain running down the inner side of the arm, or neck or back pain is added to the jaw pain, the picture has left the field of dentistry.
If there is cold sweating, nausea or breathlessnessThese three are a stronger warning than the pain itself. If there is cold sweating that comes from nowhere, nausea, not being able to catch your breath, or pallor of the skin, where the pain is becomes secondary.
If no tooth reproduces the pain and the X-ray is clearIf the cold test, the bite test and tapping the tooth fail to repeat the pain in any tooth, and the X-ray shows no decay, no inflammation at the root tip and no crack, there is no reason left to assume that the source is in the mouth.

How we tell the source apart

The sequence below is not treatment; it is the order in which the address is found. Dental treatment carried out in a heart-related picture neither takes the pain away nor spares a procedure that cannot be undone; that is why we do not touch a tooth that has not been tested.

1
We test the pain against exertion
The first thing we ask is this: does the pain start while you are climbing stairs, walking uphill or speeding up in the cold? Does it go within a few minutes once you sit down? Jaw pain that answers yes to both is not coming from a tooth, and is taken to be coming from the heart until that is disproved.
2
We ask about the accompanying symptoms one by one
Pressure in the chest, pain running to the inner side of the arm or to the neck, cold sweating, nausea, breathlessness, sudden weakness. In women we also ask about a burning feeling or tenderness in the back, the shoulders, the arms or the jaw; MSD Manuals notes that this presentation is more common in women.
3
We test the teeth one by one
With the cold test, light tapping on the tooth and a bite test, we try to reproduce the pain. We test not only the tooth you point to, but its neighbours and the teeth in the opposite jaw as well. If none of them repeats the pain, that is one of the strongest findings that the source is not in a tooth.
4
An X-ray, and a CBCT scan if needed
A panoramic X-ray shows how deep the decay is, inflammation at the root tip and the position of a buried tooth. Where a root fracture is suspected, we take a CBCT scan. Clear imaging is not enough on its own, but it narrows the dental causes markedly.
5
The moment the heart comes under suspicion, we stop the procedure
If the pain started in the chair, or if these signs appear during the examination, the procedure is not carried on with: the patient is sat upright, 112 is called, and the patient is not sent off in their own car. Bring a list of the medicines you take to your appointment, and any ECG you have had before; those two documents speed the distinction up.
6
If the heart is not suspected and the address is still unclear, we use an anaesthetic test
Most pain that comes from a tooth stops when the area is numbed with a local anaesthetic. But this test does not decide it on its own: an inferior alveolar block is known to fail in inflamed lower molars, with the pain carrying on even though the patient's lip is numb, and the failure rate reported for this block in the literature ranges from 30% to 80%. So pain that carries on despite the numbness is not taken as proof that the source is not in that area; it is weighed up together with the other findings and gains one more step before moving to a procedure that cannot be undone.

What is done, depending on the source

There is no single treatment for this complaint; the work to be done depends on the source of the pain. Below are the answers to the pictures on this page.

If the heart is suspected: emergency assessment

What has to be done is to put the dental treatment off and send the patient for emergency assessment. There, an ECG, an examination and blood tests establish the state of the heart. The dentist's job is not to make the diagnosis but to recognise the picture and send it to the right place.

If angina has been diagnosed: talk to the cardiac team first

Once the diagnosis has been made, the timing and the scope of dental treatment are set together with the doctor looking after your heart. If you are on blood thinners, if you have had a cardiac procedure recently or if your medicines have just been changed, tell your dentist yourself; carrying the list of your medicines with you is the most practical way.

The jaw joint and clenching

Where the pain changes as you open and close your mouth, comes with a tired jaw in the morning and goes with rest, the source is the joint and the chewing muscles. Here the treatment is to take the load off the joint: a night guard, a soft diet for a while and jaw exercises.

If it turns out to be dental: treatment aimed at the cause

A filling for deep decay, root canal treatment for an inflamed pulp, cleaning or removal for a partly erupted wisdom tooth. Once the address of the pain has been found, the treatment comes down to a single tooth and the result usually comes quickly.

If the pain ends in the loss of a tooth

Where a single tooth is lost, a single-tooth implant goes in its place, and the right route is to make that decision with your own dentist. If the tooth loss extends to more than one tooth, this is our area: if you have a panoramic X-ray or a CBCT scan, send it through the form; the dentist who will carry out the treatment reads the image, and we write to you within 24 hours. This is a preliminary assessment; the final decision is made after an examination and a CBCT scan.

Mistakes commonly made in this distinction

We set these out so that you can ask the right questions, whichever dentist you go to. If a dentist does not explain them unprompted, ask.

A sound tooth is taken out in heart-related pain

The tooth the patient keeps pointing to can be opened up, or taken out, without being tested. The pain stays where it was, the tooth does not come back, and the real diagnosis is delayed. If an assessment recommends extraction without a cold test, without an X-ray and without asking about accompanying symptoms, ask for a second opinion.

Pain going with a painkiller does not clear the tooth

A painkiller changes not the source of the pain but how it is perceived. Both dental and heart-related pain can settle for a while with medication. What means something is not what makes the pain go, but what brings it on.

Ruling the heart out because there is no chest pain

MSD Manuals writes that between a quarter and a third of people having a heart attack have no chest pain. A silent course is more common in people with diabetes and in older people. The absence of chest pain is not a criterion for ruling anything out.

The rule that "if it is not on the left, it is not the heart"

The sources say that the discomfort can be felt in either shoulder, on the inner side of either arm, in the back, the throat or the jaw. Ruling something out by which side it is on can miss a real picture.

Driving yourself to hospital

If there is any doubt, the right course is to call an ambulance. A patient who gets worse at the wheel is a danger both to themselves and to everyone else on the road; when 112 is called, the assessment starts on the way.

What to expect afterwards

The sequence below describes what happens when the pain turns out to be heart-related, and what follows on the dental side.

The first hours at A&E
At A&E an ECG is taken, an examination is carried out and blood tests are requested if they are needed. No decision about dental treatment is made at this stage; the priority is to establish the state of the heart.
The first days after the diagnosis
If treatment has started on the cardiac side, your medication may change. If the jaw pain eases along with the heart treatment, the heart is confirmed as the source. If the pain carries on in the same way, you go back to the dental assessment.
The timing of the dental treatment
When elective dental procedures are carried out is set according to the opinion of the cardiologist looking after you. If you are on blood thinners, do not stop the medication on your own; how to proceed with which procedure is a decision the two doctors take together.
If the source turns out to be a tooth
After a filling or root canal treatment, the throbbing that goes to the jaw and the ear eases markedly within the first day. Tenderness felt on biting lasts a few days longer and then dies down on its own.

Don't wait if

If there is pressure in the chest, breathlessness or cold sweating. If any of these goes with the jaw pain, do not wait for an appointment, call 112. Time lost in this picture is not won back.
If the pain comes with exertion and goes with rest. This behaviour is not seen in pain that comes from a tooth. See a doctor the same day and say clearly that the pain starts when you walk.
If you have been diagnosed with angina before and your pain has changed. Pain that is more severe than before, comes more often, lasts longer or appears while you are resting needs emergency assessment.
If you have had dental treatment but the pain carries on in the same way. If the pain in the treated tooth carries on, the diagnosis should be looked at again. Before a second procedure is done on the same tooth, the question of whether the source really is there should be asked.

What determines the cost

We do not give a single figure on this page, because until the source is found the work to be done is not clear either: the same complaint ends with a single-session filling in one patient, with a night guard in a second and, in a third, on the cardiology side with no dental treatment at all. On the dental side, these are the items that determine the price:

The source of the pain: A filling, root canal treatment, an extraction and a night guard are entirely different procedures. A figure given before the source has been found is bound to change at the clinic.
How far the imaging goes: In some pictures a panoramic X-ray is enough. Where a root fracture or a buried tooth is suspected, a CBCT scan is needed.
How many teeth will be treated: A plan built around a single tooth and a plan covering several teeth are worked out separately. In patients who come with widespread tooth loss, the picture usually goes beyond a single tooth.
Your general state of health: In patients with a cardiac diagnosis, the plan takes shape according to the medicines they take and the opinion of the doctor looking after them. That can change the number of procedures and the pattern of appointments.

Frequently asked questions

Can jaw pain be a sign of a heart attack?

It can. The NHS writes that in a heart attack chest pain can spread to the arm, the neck and the jaw; MSD Manuals lists the discomfort as something that can be felt in the shoulder, on the inner side of the arm, in the back, the throat, the jaw and the teeth. Even so, the most common cause of jaw pain on its own is still a picture coming from the teeth or the jaw joint; what decides it is what brings the pain on and what makes it go.

What does heart-related jaw pain feel like, and where does it hurt?

Usually as a pressure or a dull ache that does not sit on a single tooth, is felt over a wide area and is described with the flat of the hand. It can spread across the whole of the lower jaw, to the neck or to the throat. It is not set off by cold water, by something sweet or by biting; it comes with movement and goes with rest.

Does pain that goes to the jaw only happen on the left?

No. The sources do not support that common belief. MSD Manuals writes that the discomfort can be felt in either shoulder, on the inner side of either arm, in the back, the throat, the jaw or the teeth. Being on the right does not take the heart off the list.

How long does heart-related jaw pain last?

The NHS states that angina attacks mostly last less than 10 minutes and are stopped by a few minutes of rest or by the person's own angina medication. Pain that does not go despite rest and keeps getting worse needs emergency assessment.

My chest does not hurt at all, only my jaw. Could it be my heart?

It could. MSD Manuals writes that between a quarter and a third of people having a heart attack have no chest pain, and that in up to one in five the symptoms are very mild or not present at all. A silent course is particularly common in people with diabetes. The absence of chest pain is not a safe way to rule it out.

Are the symptoms different in women?

Often, yes. MSD Manuals notes that women often present with symptoms described as atypical, which are harder to recognise as coming from the heart; in angina, a burning feeling or tenderness in the back, the shoulders, the arms or the jaw is more common in women. That is why "there is no classic chest pain" can be a misleading assessment in women.

Can a dentist tell whether the pain is coming from the heart?

They cannot make the diagnosis, but they can tell it apart. If the cold test, the bite test and tapping the tooth fail to reproduce the pain in any tooth, if the X-ray is clear and if the pain comes with exertion and goes with rest, it can be said that the source is not in the mouth. If the heart is not suspected, numbing the area can help, but it is not proof on its own: an inferior alveolar block is often reported to fail in inflamed lower molars, with the pain carrying on even though the lip is numb. If the heart is suspected, no test is waited for; the patient is sent straight for emergency assessment.

When should I call 112?

Straight away, if pressure or tightness in the chest, pain running down the inner side of the arm, breathlessness, cold sweating, nausea, sudden weakness or pallor of the skin goes with the jaw pain. Also if you have been diagnosed with angina before and your pain is more severe, more frequent or longer than before, or comes while you are resting. Do not set off in your own car.

Sources

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Next step

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