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Giant cell arteritis (GCA) is a rare condition that causes inflammation of blood vessels. Early diagnosis and treatment is essential to prevent ischaemic complications, including blindness, tongue necrosis and stroke. GCA can present with orofacial symptoms, such as toothache and pain/difficulty in chewing, which may cause individuals with GCA to first present to the dentist. This has important patient safety and medicolegal implications. Dental practitioners should be alert to the possibility of GCA and should direct suspected cases to their general medical practitioner or a hospital specialist. Increased awareness of GCA should minimize the risk of blindness and stroke.
CPD/Clinical Relevance: Early recognition and treatment of GCA is key to prevent complications, such as blindness, tongue necrosis and stroke.
Article
Giant cell arteritis (GCA) is an inflammatory condition that can lead to orofacial symptoms, blindness and stroke.1 Though GCA is rare, all UK general dental practitioners (GDPs) should expect to see some cases during their career. The major feature of GCA is that some of the arteries in the head and neck, predominantly branches of the external carotid and subclavian arteries, become inflamed and narrowed/blocked, causing ischaemic damage (Table 1). Previous terms for GCA include ‘cranial arteritis’ and also ‘temporal arteritis’, because the superficial temporal artery is often affected. Inflammation of other arteries can cause severe problems for the patient: maxillary artery inflammation can cause oral pain, ulceration and necrosis; orbital involvement can cause blindness in one or both eyes, intracranial involvement can cause cerebrovascular accident (stroke). Depending on the vascular territories affected, it may present with different symptoms.
Early diagnosis of GCA is important because prompt treatment with steroids will minimize the risk of the catastrophic complications mentioned previously. It often presents in a non-specific manner with a gradual onset of headache and constitutional upset, including loss of appetite, weight loss, night sweats and/or fever. Around 45% of cases have significant orofacial symptoms, meaning that GCA patients may first present to their GDP.2
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