P ain referred to the orofacial structures can be a diagnostic challenge for the dentist. In some instances, a patient may complaint of tooth pain that is completely unrelated to any dental source. This poses a diagnostic and therapeutic problem for the dentist. Myocardial ischemia pain most commonly radiates to the left arm, shoulder, neck and face. In rare instances angina pectoris may present as dental pain. When this occurs, an improper diagnostic frequently leads to unnecessary dental treatment or more significantly, a delay of proper treatment. This delay may result in the patient experiencing a myocardial infarction. It is the dentist responsibility to establish a proper diagnosis so that the treatment will be directed toward the source of pain and not to the site of pain.