Relationship between carotid artery calcification detected in dental panoramic images and hypertension and myocardial infarction

Carotid Artery Calcification Detected on Panoramic Radiography Is Significantly Related to Cerebrovascular Accident, Coronary Artery Disease, and Poor Oral Health: A Retrospective Cross-Sectional Study

Panoramic radiography imaging modality is widely used by dentists for diagnosing dental and jaw conditions. It can also detect carotid artery calcification (CAC), indicative of calcified atherosclerotic plaques in the carotid arteries. This cross-sectional retrospective study at the University of Tennessee Health Science Center investigated the link between CAC identified on panoramic radiograph (PR) and cerebrovascular accident (CVA), coronary artery disease (CAD), and poor oral health. Data from 314 CAC patients collected from 2014 to 2023 included age at diagnosis, gender, and clinical histories of hypertension, hyperlipidemia, diabetes mellitus, CVA, CAD, and the decay, missing, and filled permanent teeth (DMFT) index. These patients were age- and gender-matched with non-CAC patients for analysis. The findings revealed high prevalences of hypertension (86.2%), hyperlipidemia (57.6%), diabetes mellitus (30.7%), CVA (15.5%), and CAD (28.7%) amongst CAC patients and the average DMFT index was 26.6. A comparative analysis of 276 matched controls demonstrated significant differences in hypertension (85.9% vs. 57.6%), hyperlipidemia (58.3% vs. 33.7%), diabetes (32.6% vs. 22.1%), CVA history (14.9% vs. 5.1%), CAD (26.1% vs. 9.8%), and DMFT scores (26.3 vs. 23.7), all indicating strong associations between CAC and these health conditions. The adjusted analysis showed that hypertension (aOR: 3.20 [95% CI: 2.06-5.07]), hyperlipidemia (aOR: 1.70 [95% CI: 1.14-2.50]), CVA (aOR: 2.20 [95% CI: 1.13-4.30]), and CAD (aOR: 2.10 [95% CI: 1.28-3.60]) were significantly associated with CAC. Notably, only 41.7% of the patients received a medical consultation after CAC detection on PR. It is crucial for dentists to refer patients for further evaluation.

Benefit of Panoramic Radiography in the Detection of Carotid Calcifications: Clinical Case Reports and Review of the Literature

Atherosclerotic lesions in the common carotid artery are one of the most frequent causes of ischemic stroke. They are usually diagnosed by cardiologists and are managed following complementary examinations. In dental practice, panoramic radiograph is a basic examination frequently performed in first line. On this radiography, possible unilateral or bilateral opacities projecting to the latero-cervical regions can be visualized, raising suspicion of carotid calcifications. The aim of this study was to present, through three cases and a review of the literature, the benefit of PR in the diagnosis of carotid calcifications and the approaches to be followed in case of such suspicious images. This would contribute, in some cases, to an early diagnosis and management, thus avoiding the evolution towards cerebral vascular accidents.

A 5 years follow-up for ischemic cardiac outcomes in patients with carotid artery calcification on panoramic radiographs confirmed by doppler ultrasonography in Turkish population

OBJECTIVE

To evaluate the diagnostic accuracy of digital panoramic radiograph (DPR) for detection of carotid artery calcification (CAC) confirmed by Doppler Ultrasonography (DUSG) and to clarify the relationship between between CAC identified by DPR and cardiovascular events through a 5 year follow-up period.

METHODS

Of 3600 consecutive patients examined, 158 patients presented with CAC as detected by DPR. The final study group was composed of 96 patients who had CAC confirmed by DUSG or CT angiogram. The control group was composed of 62 patients who has normal DUSG. The end point of the study was the occurrence of any cardiovascular event.

RESULTS

72 (75%) of the 96 patients with CAC confirmed by DUSG (16 patients had significant stenosis) had bilateral and 24 (25%) had unilateral CAS as detected by DUSG. There was a low agreement between the examination results with a κ value of 0.488 (p < 0.005) for calcification. Study data revealed that smoking, chronic obstructive pulmonary disease (COPD), diabetes mellitus (DM) and diastolic hypertension were significantly more common in patients with CAC than the control group (p < 0.05). During the follow-up period, 13 subjects had myocardial infarction and 1 subject died; in the control group, 1 patient died after MI and 1 patient died of a non-cardiac event.

CONCLUSION

Patients with CAC detectable by DPR concomitant with COPD, DM, smoking or diastolic hypertension are more likely to suffer from vascular events. Therefore, patients with detectable carotid plaque in DPR require referral to a cardiovascular surgery clinic for further investigations.

Prevalence of Carotid Artery Calcification Detected on Panoramic Radiographs of Patients with a History of Hypertension or Myocardial Infarction

Background:

Atherosclerosis is characterized by the deposition of lipids on the internal walls of blood vessels, damaging various tissues of the body by complete or partial occlusion of the vessels. Sometimes the calcified plaques in the carotid artery can be detected on panoramic radiographs, helping the practitioners decrease the risk of Cerebrovascular Accident (CAV).

Objective:

This study aimed to assess the frequency of Carotid Artery Calcification (CAC) detected in panoramic radiographs of patients with hypertension or myocardial infarction.

Methods:

A total of 400 panoramic radiographs of patients >40 years of age were evaluated. The images belonged to patients with a history of hypertension or myocardial infarction and healthy individuals referred from the AL Zahra Cardiology Department to Isfahan School of Dentistry and a private oral and maxillofacial imaging center. All the images were evaluated for the presence of CAC. Data were analyzed with SPSS 19, using the Chi-squared test, Fisher's exact test, t-test and ANOVA (α=0.05).

Results:

The prevalence rate of CAC was 4%. According to the results, there was a significant relationship between CAC and hypertension (P=0.003), with no significant relationship between the prevalence of these lesions, stage of hypertension and myocardial infarction.

Conclusion:

According to the results, the prevalence of CAC on panoramic radiographs was significant; therefore, it seems that the detection of CAC on panoramic radiographs of patients must be considered by dentists.

Carotid Artery Calcification: A Digital Panoramic-Based Study

Objective: The aim of this study was to estimate the incidence of carotid artery calcification (CAC) in a sample of Lebanese population using digital panoramic radiographs. Materials and Methods: Panoramic radiographs of 500 patients (281 females and 219 males), aged between 18 and 88 years (mean: 47.9 years), were assessed for CAC. Data collected were analyzed statistically using IBM^® SPSS^® for Windows version 20.0 (SPSS, Chicago, IL, USA). Results: CAC were found in 34 cases (6.8%), among them, 23 females (8.18%) and 11 males (5.02%). Six of all the calcifications were on the right side, against six on the left side, and 22 on both sides. The mean age of patients affected with CAC was 60.9 years (ranging from 18 to 88 years). Chi-square test showed no statistical significance between gender and CAC, while Spearman correlation analysis showed positive low correlation with age (r = 0.179). Conclusion: CAC can be found on routine panoramic radiographs taken in dental clinics; dentists should automatically refer the patients in question for specialized medical evaluation.

Assessment of carotid calcifications on digital panoramic radiographs: Retrospective analysis and review of the literature

OBJECTIVES

To assess the validity of digital panoramic radiographs as an effective means of diagnosis for atherosclerosis and as a potential aid in the early detection of the disease.

STUDY DESIGN

We reviewed 2014 digital panoramic radiographs taken throughout 2012 and 2013 to identify the presence of calcified atherosclerotic plaques of both female and male patients all aged over 18 years. In addition the medical records of these patients were reviewed in order to establish if there were any predisposing risk factors for atherosclerosis. Statistical analysis was performed to identify any possible link between radiographic atherosclerotic plaques and predisposing risk factors for atherosclerosis using univariate and multivariate models. Statistical significance criteria was defined as P<0.05.

RESULTS

Out of 2014 patients (1149 female and 865 male), 191 (9.5%) were determined to have calcified atherosclerotic plaques on panoramic radiography. There was a statistically significant relationship between the presence of calcified atherosclerotic plaques and the established risk factors of atherosclerosis such as gender (OR=2.39, P<0.001), age (OR=1.5, P<0.001), stroke (OR=5.38, P<0.001) and hypertension (OR=2.11, P<0.001).

CONCLUSION

To our knowledge this is the largest study investigating atherosclerotic plaques on digital panoramic radiographs ever carried out in Portugal. Dental practitioners need to be aware of these incidental findings and to consider referring these patients for further investigations to confirm diagnosis.

Dosimetry of Three Cone Beam Computerized Tomography Scanners at Different Fields of View in Terms of Various Head and Neck Organs

Background

Marketing new radiography devices necessitates documenting their absorbed X-ray doses. Since the current literature lacks studies on new devices, we assessed the doses of two new devices that had not previously been assessed.

Objectives

The new devices were compared to the Promax three dimensional (3D) scanner at two fields of view (FOV) in nine critical head and neck tissues and organs.

Materials and Methods

Seventeen thermoluminescence dosimeters positioned in an average-sized male RANDO phantom were used to determine the dosimetry of the three cone beam computerized tomography devices (NewTom VGi, NewTom 5G, and Promax 3D) at two field of views (FOVs), one small and one large. The exposure by each device per FOV was performed five times (30 exposures). The absorbed and effective doses were calculated for the thyroid, parotid, submandibular gland, sublingual gland, calvarium, cervical vertebra, trunk of the mandible, and mandibular ramus. The doses pertaining to the different devices, the FOVs, and the tissues were compared using the Kruskal-Wallis, Mann-Whitney U, and Wilcoxon tests.

Results

The average absorbed doses, respectively, for the large and small FOVs were 17.19 and 28.89 mGy in the Promax 3D, 19.25 and 35.46 mGy in the NewTom VGi, and 18.85 and 30.63 mGy in the NewTom 5G. The absorbed doses related to the FOVs were not significantly different (P value = 0.1930). However, the effective doses were significantly greater at the smaller FOVs / higher resolutions (P = 0.0039). The doses of the three devices were not significantly different (P = 0.8944). The difference among the nine organs/tissues was significant (Kruskal-Wallis P=0.0000).

Conclusion

The absorbed doses pertaining to the devices and the FOVs were not significantly different, although the organs/tissues absorbed considerably different doses.