Relationship between calcified carotid atheromas in digital panoramic radiographs and underlying systemic diseases in implant patients

Association of high cardiovascular risk and diabetes with calcified carotid artery atheromas depicted on panoramic radiographs

OBJECTIVE

To evaluate whether estimates of risk of future cardiovascular events and death and established or unknown diabetes are significantly associated with calcified carotid artery atheromas (CCAAs) on panoramic radiographs (PRs). The main focus was on men and women without previous myocardial infarction (MI).

METHODS

The PAROKRANK (Periodontitis and its Relation to Coronary Artery Disease) study included patients with a first MI and matched control subjects. In this substudy, 738 patients (138 women) and 744 control subjects (144 women) with available PRs were assessed for CCAA. Cardiovascular risk estimates were determined according to the Framingham Risk Score (FRS) and Systematic COronary Risk Evaluation (SCORE). Established and previously unknown diabetes was also determined.

RESULTS

CCAA was detected on PRs in 206 control subjects (28%) and 251 patients (34%). FRS was significantly associated with CCAA among control subjects (P = .04) and patients (P = .001). SCORE was associated with CCAA among control subjects (P < .01) but not patients (P = .07). Among men, FRS and SCORE were associated with CCAA in both control subjects and patients. Diabetes was not significantly associated with CCAA after adjustments.

CONCLUSIONS

Elevated cardiovascular risk scores were associated with CCAA on PRs among control subjects. Diabetes was not independently associated with CCAA, possibly owing to selection bias.

Relationship between the prevalence of soft tissue radiopacities on panoramic radiographs and medical conditions

BACKGROUND

This study aimed to describe radiographic characteristics and the prevalence of selected anatomical structures and soft tissue radiopacities on panoramic radiographs and their relationship to medical conditions.

METHODS

A retrospective cross-sectional study was conducted with 814 consecutive patients aged 35-88 years and their panoramic radiographs. Soft tissue calcifications found in the mandibular angle area were recorded according to gender, age, and bilaterally. Patient medical records were reviewed for atherogenic risk factors including hypertension, diabetes, dyslipidemia, chronic renal disease, menopause, drug usage and any other systemic condition. Data were analyzed with the χ² test and Fisher's Exact test; P<0.05 was considered statistically significant.

RESULTS

Among the 814 patients, a total of 74 (9.1%) calcified carotid artery atheromas (CCAA) were identified, of which 34 (4.17%), 40 (3.19%), and 14 (1.7%) were right, left, and bilateral, respectively. Orthopantomographic examination revealed triticeous cartilage (7.3%) in the cervical bifurcation region, asymptomatic styloid process elongation 192 (23.5%), tonsilloliths 27 (3.3%), sialoliths 37 (4.5%), calcified lymph nodes 46 (5.7%), impacted roots 109 (13.4%), and foreign radiopaque materials 23 (%2.8). There was a significant age and gender difference between type II diabetes and CCAA. A positive correlation was found between styloid process elongation and temporomandibular joint disorders and antidepressant use.

CONCLUSIONS

Soft tissue radiopacities can be a validated risk indicator of cardiovascular events or misdiagnosed pain. Dental practitioners must be aware of these atypical findings as they may be related to serious disease states and may require referral for further investigation.