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Suggest Treatment For Severe Jaw Pain In Elderly Person
Question: I am a 58 yr old female. On 12/30/10 I survived the widow maker and had one stent placed in my LAD. Last Echo showed my EF is 55-60% and my last stress test showed more improvement. Was told by my Dr that I have recovered all my heart muscle and that I was a "Miracle." Main symptom was jaw pain. Now to the present. I fell face first in a parking lot (luckily did not hit face.) I caught myself with my arms. Lately I have been experiencing jaw pain that seems to remain in the joint where the upper and lower jaw connect. Sometimes I feel it in my upper and lower front teeth. It comes and goes but has been going on for almost 4 weeks now. Any jaw pain makes me panic to some point but I have no other symptoms at all. All in all, I feel really good. In your professional opinion, is this heart related or fall related and if fall related, how much longer should I expect it to last? Should I follow up with my cardiologist just to be sure? I currently take 1 325mg of aspirin a day, omega 3, hydrochlorot, carvedilol, omeprazole, metformin, Trulicity, and multivitamin. I quit smoking the day of my heart attack and exercise much more than I did prior to my heart attack. I just like to be proactive rather than reactive. Thank you so much for your time.
Brief Answer:
I would recommend as follows:
Detailed Answer:
Hello!
I carefully passed through your question and reviewed all your uploaded test reports and would with your doctor on the fact that your past medical history has been favorable with an improvement of your heart function.
Regarding the jaw pain it seems to be related to the trauma you have had.
I would like to know more about the jaw pain:
a- Is it related to mouth opening or chewing?
b- Is it related to physical activity?
c- Do you feel any cracking (a click sound) during mastication?
If the pain is triggered by mastication or mouth opening and not associated to physical activity (especially if you can feel the click sound) this would indicate a mandibular pain related to the bone or the joint.
Although your previously performed nuclear perfusional cardiac stress test has resulted without any new evidence of cardiac ischemia (revealing only the prior myocardial infarction damage, it is necessary to always be careful and alert, because your coronary angiography during LAD stenting has also revealed a right coronary artery lesion, which may be a potential source of newly occurring cardiac ischemia with subsequent chest or neck, jaw, etc. pain.
That's why I recommend you to consider a new medical consultation including a physical examination and some tests:
- a resting ECG
- cardiac enzymes
- a cardiac ultrasound.
If suspicions of cardiac ischemia are raised, a new nuclear perfusional cardiac stress test would be needed.
Hope to have been helpful!
Feel free to ask me again whenever you need!
Kind regards,
Dr. Iliri
I would recommend as follows:
Detailed Answer:
Hello!
I carefully passed through your question and reviewed all your uploaded test reports and would with your doctor on the fact that your past medical history has been favorable with an improvement of your heart function.
Regarding the jaw pain it seems to be related to the trauma you have had.
I would like to know more about the jaw pain:
a- Is it related to mouth opening or chewing?
b- Is it related to physical activity?
c- Do you feel any cracking (a click sound) during mastication?
If the pain is triggered by mastication or mouth opening and not associated to physical activity (especially if you can feel the click sound) this would indicate a mandibular pain related to the bone or the joint.
Although your previously performed nuclear perfusional cardiac stress test has resulted without any new evidence of cardiac ischemia (revealing only the prior myocardial infarction damage, it is necessary to always be careful and alert, because your coronary angiography during LAD stenting has also revealed a right coronary artery lesion, which may be a potential source of newly occurring cardiac ischemia with subsequent chest or neck, jaw, etc. pain.
That's why I recommend you to consider a new medical consultation including a physical examination and some tests:
- a resting ECG
- cardiac enzymes
- a cardiac ultrasound.
If suspicions of cardiac ischemia are raised, a new nuclear perfusional cardiac stress test would be needed.
Hope to have been helpful!
Feel free to ask me again whenever you need!
Kind regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you so much for your quick response. As for the jaw pain, it seems to come and go and I have been unable to pinpoint if it during eating, talking, etc. I have had clicking and popping and still do. I was told I have TMJ. This is what makes this hard to keep from worrying.
What is stage 1 systolic dysfunction? What was meant by LVEDPF 40 mean in regards to my stent when it was checked in 2012? I too was concerned about them stating my RCA was heavily plaqued but they have not mentioned doing anything. What is your take on my lipase level of 95 and MCV decrease, as well as abnormal liver function? Would you recommend me going ahead and getting an appointment with my cardiologist? All in all, what would you say about my long term prognosis?
What is stage 1 systolic dysfunction? What was meant by LVEDPF 40 mean in regards to my stent when it was checked in 2012? I too was concerned about them stating my RCA was heavily plaqued but they have not mentioned doing anything. What is your take on my lipase level of 95 and MCV decrease, as well as abnormal liver function? Would you recommend me going ahead and getting an appointment with my cardiologist? All in all, what would you say about my long term prognosis?
Brief Answer:
I would explain as follows:
Detailed Answer:
Hello again!
Thank you for the additional information!
In my opinion, your symptoms are typical of temporo-mandibulary joint pain, and the situation does not seem to be really concerning.
Let me answer to your questions:
- Stage 1 diastolic dysfunction (as mentioned on your doctor report) or ventricular relaxation dysfunction indicates that the left ventricular chamber doesn't relax appropriately, showing an increased stiffness toward blood inflow reaching the ventricle during diastole. This process implies energy requirement and is impaired when the cardiac structure has suffered alterations such as myocardial ischemia or infarction or myocardial hypertrophy.
But you shouldn't worry about this finding as it is only a mild alteration and usually reversible.
-LVEDP stands for left ventricular end diastolic pressure which is the traditional marker for investigating systolic and diastolic function. A value of 40mm Hg is abnormally high, but your cardiac conditions have tremendously improved since the 2012 echo profile.
-Regarding your RCA lesion I would explain that there are two reasons why the doctors has not utilized any invasive treatment.
a) It may be a chronic lesion and insufficient collateral blood flow may have developed, leading to restoration of blood flow distal from a coronary obstruction.
b) RCA may be with a very low caliber and that way supplying not a great myocardial territory.
- Your MCV was 82 Fl, which is within the normal ranges. Your lipase level is a little above the normal ranges, but I would recommend performing an abdominal ultrasound to examine your pancreas and liver, and repeat these tests every 6 months. It is also important losing some pounds, because obesity is a risk factor for pancreas injury and thus increased levels of lipase. I would not recommend eating spicy and fatty foods and alcohol as they may increase those levels further.
- As, I explained your symptoms seem to be quite typical of Temporo-mandibular joint. But, to be sure that everything is OK, I would recommend performing a resting ECG and cardiac enzyme levels, just to be sure that it is not cardiac ischemia.
Hope to have clarified some of your uncertainties!
Wishing all the best,
Dr. Iliri
I would explain as follows:
Detailed Answer:
Hello again!
Thank you for the additional information!
In my opinion, your symptoms are typical of temporo-mandibulary joint pain, and the situation does not seem to be really concerning.
Let me answer to your questions:
- Stage 1 diastolic dysfunction (as mentioned on your doctor report) or ventricular relaxation dysfunction indicates that the left ventricular chamber doesn't relax appropriately, showing an increased stiffness toward blood inflow reaching the ventricle during diastole. This process implies energy requirement and is impaired when the cardiac structure has suffered alterations such as myocardial ischemia or infarction or myocardial hypertrophy.
But you shouldn't worry about this finding as it is only a mild alteration and usually reversible.
-LVEDP stands for left ventricular end diastolic pressure which is the traditional marker for investigating systolic and diastolic function. A value of 40mm Hg is abnormally high, but your cardiac conditions have tremendously improved since the 2012 echo profile.
-Regarding your RCA lesion I would explain that there are two reasons why the doctors has not utilized any invasive treatment.
a) It may be a chronic lesion and insufficient collateral blood flow may have developed, leading to restoration of blood flow distal from a coronary obstruction.
b) RCA may be with a very low caliber and that way supplying not a great myocardial territory.
- Your MCV was 82 Fl, which is within the normal ranges. Your lipase level is a little above the normal ranges, but I would recommend performing an abdominal ultrasound to examine your pancreas and liver, and repeat these tests every 6 months. It is also important losing some pounds, because obesity is a risk factor for pancreas injury and thus increased levels of lipase. I would not recommend eating spicy and fatty foods and alcohol as they may increase those levels further.
- As, I explained your symptoms seem to be quite typical of Temporo-mandibular joint. But, to be sure that everything is OK, I would recommend performing a resting ECG and cardiac enzyme levels, just to be sure that it is not cardiac ischemia.
Hope to have clarified some of your uncertainties!
Wishing all the best,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you again Dr. XXXXXXX
Over the weekend I really tried to pay attention to things and what seems to trigger the pain. Since I fell, (again I did not hit my head, but did fall hard) I have headaches which start at the base of my neck and move toward my forehead and when this happens, it seems my upper jaw and where the upper and Lower jaw meet seem to hurt. It sometime affects what feels like the front teeth upper and lower. Yesterday I played with my two granddaughters a lot and this morning woke with the headache and some jaw pain. The pain does not throb or radiate anywhere else. Could I have gotten whiplash from my fall or something like that and could that too cause this in my jaw? I do plan on following up with my cardiologist as you recommended, but wanted to share this also. Prior to playing with the kids, I did laundry and cleaned house with no issues. One last thing, what is you opinion on my long term prognosis as I really want to watch my grandchildren grow up. Thank you so very much for your valuable time and input.
Over the weekend I really tried to pay attention to things and what seems to trigger the pain. Since I fell, (again I did not hit my head, but did fall hard) I have headaches which start at the base of my neck and move toward my forehead and when this happens, it seems my upper jaw and where the upper and Lower jaw meet seem to hurt. It sometime affects what feels like the front teeth upper and lower. Yesterday I played with my two granddaughters a lot and this morning woke with the headache and some jaw pain. The pain does not throb or radiate anywhere else. Could I have gotten whiplash from my fall or something like that and could that too cause this in my jaw? I do plan on following up with my cardiologist as you recommended, but wanted to share this also. Prior to playing with the kids, I did laundry and cleaned house with no issues. One last thing, what is you opinion on my long term prognosis as I really want to watch my grandchildren grow up. Thank you so very much for your valuable time and input.
Brief Answer:
My opinions as follows:
Detailed Answer:
Hello again dear,
Based on your symptoms, I would conclude that a whiplash injury can not be excluded.
I don't think that your symptoms are related to cardiac ischemia. So relax and do not worry about it.
I would recommend consulting with your doctor and performing a cervical spine X ray study to examine your heart cervical column.
A cervical collar may be needed.
I think that you will recover gradually in the next days, because, as you are able to perform a lot of physical activity (as laundry and house cleaning), the situation does not seem to be concerning.
I would recommend trying acetaminophen or ibuprofen for the pain.
Regarding your long term prognosis, after reviewing all your tests, I would explain that if you continue on a healthy lifestyles (healthy diet, a lot of physical activity, loose some pounds), you will be able to live a long life and enjoy your grandchildren while growing up.
It would be also necessary performing periodically scheduled follow ups (every 6-12 months) by your cardiologist (with resting ECG, cardiac ultrasound, blood work and cardiac stress test).
Hope you will find this answer helpful!
Wishing good health,
Dr. Iliri
My opinions as follows:
Detailed Answer:
Hello again dear,
Based on your symptoms, I would conclude that a whiplash injury can not be excluded.
I don't think that your symptoms are related to cardiac ischemia. So relax and do not worry about it.
I would recommend consulting with your doctor and performing a cervical spine X ray study to examine your heart cervical column.
A cervical collar may be needed.
I think that you will recover gradually in the next days, because, as you are able to perform a lot of physical activity (as laundry and house cleaning), the situation does not seem to be concerning.
I would recommend trying acetaminophen or ibuprofen for the pain.
Regarding your long term prognosis, after reviewing all your tests, I would explain that if you continue on a healthy lifestyles (healthy diet, a lot of physical activity, loose some pounds), you will be able to live a long life and enjoy your grandchildren while growing up.
It would be also necessary performing periodically scheduled follow ups (every 6-12 months) by your cardiologist (with resting ECG, cardiac ultrasound, blood work and cardiac stress test).
Hope you will find this answer helpful!
Wishing good health,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you again for everything! Oh have been amazing and I feel much better. I hope if the need arises I will get you again.
Brief Answer:
You are welcome!
Detailed Answer:
I am glad to have been helpful to you!
I would be happy to answer to all of your questions or review your future tests.
You can ask me directly on my personal link as follows:
http://doctor.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=69765
Best wishes,
Dr. Iliri
You are welcome!
Detailed Answer:
I am glad to have been helpful to you!
I would be happy to answer to all of your questions or review your future tests.
You can ask me directly on my personal link as follows:
http://doctor.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=69765
Best wishes,
Dr. Iliri
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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