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.

Literature Reviewed: 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.

Practice Implications: 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.