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Prevalence of findings compatible with carotid artery calcifications on dental panoramic radiographs

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Abstract

Cerebrovascular accidents are responsible for killing or disabling more than half a million Americans every year. They are the third leading cause of death in this country. In Germany, the annual stroke incidence reaches 182 cases per 100,000 inhabitants. Stroke there is the fourth leading cause of death. There is a need of finding cost-effective means of decreasing stroke mortality and morbidity. Instruments for early diagnosis are of great humanitarian and economic importance. All possible clinical findings should be taken into account. It is not the demand of this study to present the panoramic radiograph as a screening test method for early diagnosis of atherosclerosis. The aim is to show the potential of this radiograph used in everyday clinical dental practice by the prevalence of radiopaque findings in the carotid region. This study included panoramic dental radiographs of 2,557 patients older than 30 years of age. Fifty-nine percent of the patients were women and 41% were men. The radiographs were adjudged for signs compatible with carotid arterial calcifications appearing as a radiopaque nodular mass adjacent to the cervical vertebrae at or below the intervertebral space C3–4. Of all these radiographs, 4.8% showed radiopaque findings compatible with atherosclerotic lesions. The proportion of women reached 64.8% and that of men reached 35.2%. In accordance to recent literature, the results of this study show that about 5% of the patients show radiological findings compatible with carotid arterial calcifications. Some of these patients at risk for a cerebrovascular accident may be identified in the dentist's office by appropriate review of the panoramic dental radiograph. The suspicion of carotid artery calcifications demands an impetuous referral to an appropriate practitioner who can assist in the control of risk factors and if necessary arrange surgical removal of the carotid arterial plaque. So, the dentist should be aware of this problem and able to make a contribution to stroke prevention.

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References

  1. Robert-Koch-Institut (2007) Health in Germany. Health Report of the Federal Department

  2. American Heart Association (2002) Heart and stroke statistical update. American Heart Association, Dallas

  3. Böcker W, Denk H, Heitz PU (1996) Pathologie. Urban & Schwarzenberg, München, pp 227–235

    Google Scholar 

  4. Ogata J, Masuda J, Yutani C, Yamaguchi T (1990) Rupture of atheromatous plaque as a cause of thrombotic occlusion of stenotic internal carotid artery. Stroke 21:1740–1745

    Article  PubMed  Google Scholar 

  5. Muller M, Ciccotti P, Reiche W, Hagen T (2001) Comparison of color-flow Doppler scanning, power Doppler scanning, and frequency shift for assessment of carotid artery stenosis. J Vasc Surg 34:1090–1095

    Article  PubMed  Google Scholar 

  6. Jaff MR, Goldmakher GV, Lev MH, Romero JM (2008) Imaging of the carotid arteries: the role of duplex ultrasonography, magnetic resonance arteriography, and computerized tomographic arteriography. Vasc Med 13:281–292

    Article  PubMed  Google Scholar 

  7. Latchaw RE, Alberts MJ, Lev MH, Connors JJ, Harbaugh RE, Higashida RT, Hobson R, Kidwell CS, Koroshetz WJ, Mathews V, Villablanca P, Warach S, Walters B (2009) Recommendations for imaging of acute ischemic stroke: a scientific statement from the American Heart Association. Stroke 40:3646–3678, A journal of cerebral circulation

    Article  PubMed  Google Scholar 

  8. Kauffmann GW, Moser E, Sauer R (2001) Radiologie. Urban & Fischer, München, pp 91–96

    Google Scholar 

  9. White SC, Heslop EW, Hollender LG, Mosier KM, Ruprecht A, Shrout MK (2001) Parameters of radiologic care: an official report of the American Academy of Oral and Maxillofacial Radiology. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 91:498–511

    Article  PubMed  Google Scholar 

  10. Jahromi AS, Cina CS, Liu Y, Clase CM (2005) Sensitivity and specificity of color duplex ultrasound measurement in the estimation of internal carotid artery stenosis: a systematic review and meta-analysis. J Vasc Surg 41:962–972

    Article  PubMed  Google Scholar 

  11. Goren AD, Lundeen RC, Deahl ST 2nd, Hashimoto K, Kapa SF, Katz JO, Ludlow JB, Platin E, Van Der Stelt PF, Wolfgang L (2000) Updated quality assurance self-assessment exercise in intraoral and panoramic radiography. American Academy of Oral and Maxillofacial Radiology, Radiology Practice Committee. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 89:369–374

    Article  PubMed  Google Scholar 

  12. American Dental Association Council on Scientific Affairs (2006) The use of dental radiographs: update and recommendations. J Am Dent Assoc 137:1304–1312

    Google Scholar 

  13. American Dental Association (2004) The selection of patients for dental radiographic examinations. American Dental Association, Chicago

    Google Scholar 

  14. Ngan DC, Kharbanda OP, Geenty JP, Darendeliler MA (2003) Comparison of radiation levels from computed tomography and conventional dental radiographs. Aust Orthod J 19:67–75

    PubMed  Google Scholar 

  15. Rother U (2001) Modern imaging diagnostics in dentistry (Moderne bildgebende Diagnostik in der Zahn-, Mund- und Kieferheilkunde). Urban & Fischer, München, pp 52–65

    Google Scholar 

  16. Bor D, Toklu T, Olgar T et al (2006) Variations of patient doses in interventional examinations at different angiographic units. Cardiovasc Intervent Radiol 29:797–806

    Article  PubMed  Google Scholar 

  17. Friedlander AH, Lande A (1981) Panoramic radiographic identification of carotid arterial plaques. Oral Surg Oral Med Oral Pathol 52:102–104

    Article  PubMed  Google Scholar 

  18. Friedlander AH, Manesh F, Wasterlain CG (1994) Prevalence of detectable carotid artery calcifications on panoramic radiographs of recent stroke victims. Oral Surg Oral Med Oral Pathol 77:669–673

    Article  PubMed  Google Scholar 

  19. Carter LC, Haller AD, Nadarajah V, Calamel AD, Aguirre A (1997) Use of panoramic radiography among an ambulatory dental population to detect patients at risk of stroke. J Am Dent Assoc 128:977–984

    PubMed  Google Scholar 

  20. Friedlander AH, Maeder LA (2000) The prevalence of calcified carotid artery atheromas on the panoramic radiographs of patients with type 2 diabetes mellitus. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 89:420–424

    Article  PubMed  Google Scholar 

  21. Cohen SN, Friedlander AH, Jolly DA, Date L (2002) Carotid calcification on panoramic radiographs: an important marker for vascular risk. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 94:510–514

    Article  PubMed  Google Scholar 

  22. Craven TE, Ryu JE, Espeland MA et al (1990) Evaluation of the associations between carotid artery atherosclerosis and coronary artery stenosis. A case–control study. Circulation 82:1230–1242

    Article  PubMed  Google Scholar 

  23. Carter LC (2000) Discrimination between calcified triticeous cartilage and calcified carotid atheroma on panoramic radiography. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 90:108–110

    Article  PubMed  Google Scholar 

  24. Friedlander AH (1995) Panoramic radiography: the differential diagnosis of carotid artery atheromas. Spec Care Dent 15:223–227

    Article  Google Scholar 

  25. Almog DM, Illig KA, Carter LC et al (2004) Diagnosis of non-dental conditions. Carotid artery calcifications on panoramic radiographs identify patients at risk for stroke. N Y State Dent J 70:20–25

    PubMed  Google Scholar 

  26. Friedlander AH, Altman L (2001) Carotid artery atheromas in postmenopausal women. Their prevalence on panoramic radiographs and their relationship to atherogenic risk factors. J Am Dent Assoc 132:1130–1136

    PubMed  Google Scholar 

  27. Friedlander AH, Friedlander IK, Yueh R, Littner MR (1999) The prevalence of carotid atheromas seen on panoramic radiographs of patients with obstructive sleep apnea and their relation to risk factors for atherosclerosis. J Oral Maxillofac Surg 57:516–521

    Article  PubMed  Google Scholar 

  28. Sung EC, Friedlander AH, Kobashigawa JA (2004) The prevalence of calcified carotid atheromas on the panoramic radiographs of patients with dilated cardiomyopathy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 97:404–407

    Article  PubMed  Google Scholar 

  29. Madden RP, Hodges JS, Salmen CW et al (2007) Utility of panoramic radiographs in detecting cervical calcified carotid atheroma. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 103:543–548

    Article  PubMed  Google Scholar 

  30. Tohno S, Tohno Y (1998) Age-related differences in calcium accumulation in human arteries. Cell Mol Biol 44:1253–1263

    PubMed  Google Scholar 

  31. Elliott RJ, McGrath LT (1994) Calcification of the human thoracic aorta during aging. Calcif Tissue Int 54:268–273

    Article  PubMed  Google Scholar 

  32. Dunmore-Buyze PJ, Moreau M, Fenster A, Holdsworth DW (2002) In vitro investigation of calcium distribution and tissue thickness in the human thoracic aorta. Physiol Meas 23:555–566

    Article  PubMed  Google Scholar 

  33. Yu SY, Blumenthal HT (1963) The calcification of elastic fibers. I. Biochemical studies. J Gerontol 18:119–126

    PubMed  Google Scholar 

  34. Sadoshima S, Kurozumi T, Tanaka K et al (1980) Cerebral and aortic atherosclerosis in Hisayama, Japan. Atherosclerosis 36:117–126

    Article  PubMed  Google Scholar 

  35. Aronow WS, Ahn C, Kronzon I, Gutstein H, Schoenfeld MR (1997) Association of extracranial carotid arterial disease, prior atherothrombotic brain infarction, systemic hypertension, and left ventricular hypertrophy with the incidence of new atherothrombotic brain infarction at 45-month follow-up in 1,482 older patients. Am J Cardiol 79:991–993

    Article  PubMed  Google Scholar 

  36. Monsour PA, Romaniuk K, Hutchings RD (1991) Soft tissue calcifications in the differential diagnosis of opacities superimposed over the mandible by dental panoramic radiography. Aust Den J 36:94–101

    Article  Google Scholar 

  37. Sitzmann F (1993) When are radiographs needed in diagnostics and therapy? Dtsch Zahnarztl Z 48

  38. Kopp H, Ludwig M (2007) Doppler- und Duplexsonographie. Thieme, Stuttgart, pp 1–20

    Google Scholar 

  39. Almog DM (2007) Utility of panoramic radiographs in detecting cervical calcified carotid atheroma. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 104:451

    Article  PubMed  Google Scholar 

  40. Friedlander AH, Friedlander IK (1998) Identification of stroke prone patients by panoramic radiography. Aust Dent J 43:51–54

    Article  PubMed  Google Scholar 

  41. Farman AG, Farman TT, Khan Z et al (2001) The role of the dentist in detection of carotid atherosclerosis. SADJ 56:549–553

    PubMed  Google Scholar 

  42. Friedlander AH, Freymiller EG (2003) Detection of radiation-accelerated atherosclerosis of the carotid artery by panoramic radiography. A new opportunity for dentists. J Am Dent Assoc 134:1361–1365

    PubMed  Google Scholar 

  43. Friedlander AH, Friedlander IK (1996) Panoramic dental radiography: an aid in detecting individuals prone to stroke. Br Dent J 181:23–26

    Article  PubMed  Google Scholar 

  44. Friedlander AH, Friedlander IK (1996) Identification of stroke prone patients by panoramic dental radiography. Oral Health 86(7):9–10

    Google Scholar 

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The authors declare that they have no conflict of interest.

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Correspondence to Stefan Bayer.

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Bayer, S., Helfgen, EH., Bös, C. et al. Prevalence of findings compatible with carotid artery calcifications on dental panoramic radiographs. Clin Oral Invest 15, 563–569 (2011). https://doi.org/10.1007/s00784-010-0418-6

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  • DOI: https://doi.org/10.1007/s00784-010-0418-6

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