Sir, giant cell arteritis (GCA) is a condition which may result in blindness in one or both eyes, may result in a cerebrovascular accident, and which may be initially presented to the dentist. In two recent medico-legal cases in which a dentist was the first port of call for jaw pain, both patients went on to lose vision when early intervention with systemic glucocorticoids (steroids) may have prevented permanent vision loss. There have been previous case reports describing GCA following presentation to the dentist with jaw or facial pain.1,2

The temporalis and the masseter are the main muscles of mastication. These are nourished by branches of the superficial temporal and the maxillary artery. Inflammation of those arteries causing narrowing of the lumen will result in the typical claudicant pain experienced by those suffering with GCA. Blindness occurs because of inflammation and narrowing or occlusion of the ophthalmic artery or its branches. In a recent British study of clinical features of GCA, 143/318 (45%) had pain or difficulty in chewing and 59/318 (19%) had complained of a toothache. This may mean that potentially half of those with GCA may seek the attention of their GDP.3

Although commonly presenting with symptoms that may be confused with local oral or dental issues, GCA is a rare condition with an annual incidence of 2.2/10,000 in the UK, which may add to the problem of early recognition.4 In addition, dental practices may have established referral pathways with the maxillofacial surgery department, but not with the ophthalmology or rheumatology departments, further complicating the process of referral to secondary care. We believe that GCA should be a topic in continuing professional development programmes for dental practitioners to assist early diagnosis of this potentially devastating disease.