A 65-year-old woman presents with a throbbing pain affecting her left temple. The headache began about a week ago and is accompanied by pain in the muscles around her jaw joint on eating. She has no previous history of facial pain or headache. Intraoral examination is unremarkable. There is no evidence of dental pathology or parafunctional habits.

The recent onset of unilateral pain of this nature in this site without any previous history should immediately raise the possibility of giant-cell arteritis. The patient is in the right age group (usually = 50 years). The accompanying pain in the muscles of mastication on chewing could represent temporomandibular joint dysfunction but is entirely consistent with giant-cell arteritis.

RESEARCH

Giant-cell arteritis (GCA), also known as temporal arteritis or Horton’s arteritis, is a systemic vasculitis that primarily affects large and medium-sized vessels, particularly the extracranial branches of the carotid arteries (Calvo-Romero, 2003). It is most commonly observed in individuals over the age of 50 (Joseph et al., 2019). GCA is characterized by inflammation of the blood vessels, which can lead to various symptoms and complications (Shenoy et al., 2023).

The diagnosis of GCA can be challenging, and early recognition is crucial to prevent serious complications such as blindness, stroke, and necrosis of the lips and tongue (Gualtierotti et al., 2018). The diagnosis of GCA is typically based on a combination of clinical features, laboratory tests, and imaging studies (Liedtke et al., 2023). The gold standard for diagnosis is a temporal artery biopsy, which reveals histologic evidence of arteritis (Bengtsson & Malmvall, 1981). However, it is important to note that giant cells are not required in the histopathological diagnostic criteria for GCA (Armstrong et al., 2008).

The symptoms of GCA can vary but commonly include severe temporal headaches, low-grade fever, malaise, depression, weight loss, and visual changes (Gualtierotti et al., 2018). Patients may also experience dental pain, dysphagia, dysarthria, chronic cough, and, rarely, necrosis of the lips and tongue (Gualtierotti et al., 2018). In some cases, GCA can present with orofacial symptoms such as toothache and pain/difficulty in chewing, which may lead patients to seek dental care initially (Shenoy et al., 2023).

Dentists play a crucial role in the early recognition and referral of patients with suspected GCA. Increased awareness of GCA among dental practitioners can minimize the risk of serious complications such as blindness and stroke (Shenoy et al., 2023). Dental practitioners should be alert to the possibility of GCA and should direct suspected cases to their general medical practitioner or a hospital specialist (Shenoy et al., 2023).

The management of GCA typically involves high-dose steroid treatment (Calvo-Romero, 2003). Early initiation of treatment is essential to prevent complications and improve outcomes (Lee et al., 2011). However, many questions about the diagnosis, treatment, and optimal patient follow-up of GCA remain unanswered (Iudici et al., 2023). International guidelines exist, but some aspects are based mainly on low-quality data or expert opinion (Iudici et al., 2023). The management of GCA patients can also be influenced by factors such as the care setting, physician’s experience, or resource availability (Iudici et al., 2023).

In conclusion, GCA is a systemic vasculitis that primarily affects large and medium-sized vessels. It can present with a wide range of symptoms, including orofacial symptoms such as dental pain and difficulty in chewing. Early recognition and referral of suspected cases are crucial to prevent serious complications. Dentists play an important role in the early detection of GCA and should be aware of the signs and symptoms associated with the condition. Further research is needed to improve the diagnosis, treatment, and management of GCA patients.

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