Diagnosis of non-dental conditions. Carotid artery calcifications on panoramic radiographs identify patients at risk for stroke.
BACKGROUND
The oral and maxillofacial manifestations of some occult systemic disorders may be identified during the provision of dental care. Medical conditions so identified should be referred to a physician for confirmation by appropriate test and indicated therapy. Atherosclerosis at the bifurcation of the carotid artery is a common cause of stroke, and, when such lesions are calcified, they may easily be identified on a panoramic radiograph since the carotid bifurcation lies within the field of a properly performed X-ray.


METHODS
To examine the degree to which this finding is recognized by the dental community, the authors conducted a PubMed review to find publications that detailed the identification of carotid artery calcifications on panoramic radiographs.


RESULTS
Between 1981-2003, there were 39 peer-reviewed dental manuscripts and 29 pertinent abstracts reporting the observation of incidental carotid calcifications visible on routine panoramic radiographs. These studies documented a 3% to 5% prevalence of carotid artery calcifications in the general dental population, with higher percentages occurring in patients having medical illnesses associated with advanced atherosclerosis.


CONCLUSIONS
The widespread recognition that calcifications seen in the region of the carotid bifurcation can identify a population at increased risk of stroke supports the practice of routinely examining this area during review of panoramic radiographs. Since a panoramic radiograph is often obtained for dental reasons, in many instances, further examination of the area of the carotid bifurcation is essentially cost-free, and can serve to prolong lives and bring significant savings in overall health care costs by assisting in the prevention of critical events such as strokes.
Almog
Dov M
DM
University of Rochester, Eastman Dental Center, USA.
Illig
Karl A
KA
Carter
Laurie C
LC
Friedlander
Arthur H
AH
Brooks
Sharon L
SL
Grimes
Richard M
RM
D001161:Arteriosclerosis / Q000000981:diagnostic imaging; D002114:Calcinosis / Q000000981:diagnostic imaging*; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging*; D016893:Carotid Stenosis / Q000000981:diagnostic imaging; D006801:Humans; D011862:Radiography, Panoramic; D018570:Risk Assessment; D020521:Stroke / Q000517:prevention & control