Toothache that wasn't: How a dentist spotted a heart attack

Dr Krunal Thakker

A few years ago, a 57-year-old male patient walked into my dental clinic complaining of a dull, nagging pain in his lower left molar. What I didn’t know then was that his ‘toothache’ had nothing to do with his teeth.

For the past two days, he said he’d been feeling a strange discomfort in his lower jaw — not sharp or electric like a typical dental issue, but a gnawing throb that worsened when he climbed stairs or went for a walk. Oddly, there was no swelling. No sensitivity to hot or cold.

I picked up my mouth mirror and examined his teeth under the bright glare of the overhead lamp. Every molar stood strong and clean. The X-rays were equally uneventful — no decay, no infection, no gum disease. He had no chronic medical history, wasn’t on any medication and appeared — at least on paper — to be healthy. But something didn’t compute.
After a while, I noticed that he looked pale and that beads of sweat had begun to dot his forehead even though the air conditioner in my clinic was at its lowest temperature setting. When I asked a few more questions, he mentioned that he’d also been experiencing shortness of breath during walks. That’s when my instincts kicked in: Was I missing something critical?
Then it struck me — ‘referred pain’. Pain from an impending heart attack doesn’t always begin in the chest. In fact, especially in older adults, it can manifest as jaw pain — typically on the lower left side. Cardiac issues can present as pain radiating to the chest, arms, neck, face, jaws and even the teeth. I had seen it in medical textbooks, heard about it at conferences — but now, was it sitting right in front of me? I felt a jolt of urgency.

“Please visit the nearest hospital right away and see a cardiologist,” I told him. Thankfully, he listened. That decision saved his life.

At the hospital, tests confirmed that he was in the early stages of a heart attack. The pain he thought was in his tooth was actually his heart crying out for help. He was admitted, given prompt medical treatment and stabilised. The doctors later told him that waiting even one more day could have led to tragic consequences.

On the surface, the idea of jaw pain as an alarm bell for a heart attack may seem bizarre. But research proves otherwise. An American study found that in some cases, reduced blood flow to the heart due to clogged arteries can cause referred pain — sometimes felt in the jaw, neck or even ears. It often mimics a dental issue so convincingly that both patients and doctors can miss the red flag.

We’re often trained to think of tooth pain as purely dental. But it may not always be about the teeth. Sometimes, it’s about seeing the whole person.

To be sure, not every toothache or jaw pain signals a heart attack. But in patients with a history of heart or coronary disease — especially when the toothache comes with symptoms like jaw pain, headache, shortness of breath or sweating — we must widen our lens.

This case reminded me that being a good clinician means looking beyond the obvious. As healthcare professionals, we must listen not just with our instruments but with our intuition.

The body doesn’t always scream. Sometimes, it whispers through the wrong door. And it’s our job to hear it.

Dr Thakker is a Mumbai-based dentist. He spoke to Sharmila Ganesan Ram