Background <p>Giant cell arteritis (GCA) is a rare systemic vasculitis that primarily affects medium-sized and large arteries and frequently involves the extracranial branches of the carotid artery, including the temporal artery. Orofacial symptoms may occur that clinically resemble temporomandibular disorders (TMD) or other dental conditions and thus represent a particular diagnostic challenge in dental practice. Data on orofacial manifestations and diagnostic pathways in biopsy-confirmed GCA from a dental perspective remain limited. The aim of the present study was to analyze orofacial symptoms, diagnostic pathways, and factors that may contribute to delayed diagnosis.</p> Methods <p>This retrospective descriptive single-center case series included six patients with biopsy-confirmed GCA treated at a tertiary outpatient clinic for rare systemic inflammatory diseases. Medical records were systematically reviewed, and missing information was supplemented through patient interviews conducted by telephone or in person using a predefined interview guide. These interviews were used to reconstruct symptom onset, orofacial manifestations, warning signs, and diagnostic pathways. The findings were analyzed descriptively and summarized in tabular and narrative form.</p> Results <p>All six patients exhibited orofacial manifestations. Dental consultation formed part of the diagnostic pathway in five cases and represented the first professional point of contact in three. Load-related chewing complaints consistent with jaw claudication were documented in four cases, while atypical orofacial presentations were also observed. Elevated C-reactive protein (CRP) and fatigue/malaise were present in all patients; headache or temporal pain and visual symptoms occurred in five cases each. Time to diagnosis ranged from approximately 4 weeks to 5 months.</p> Conclusion <p>Orofacial symptoms may represent a clinically relevant component of GCA presentation, and dental care may be involved early in the diagnostic pathway. In patients older than 50 years, atypical, progressive, or treatment-resistant orofacial symptoms, particularly when accompanied by cranial or systemic warning signs or visual impairment, may indicate a non-dental cause and warrant further medical evaluation.</p> Trial registration <p>Not applicable. This retrospective descriptive case series was not registered in a public clinical trial registry.</p>