The Prevalence of Carotid Artery Calcification on the Panoramic Radiographs in Cappadocia Region Population

ABSTRACT

Objectives: The aim of this study is to determine retrospectively the presence of carotid artery calcifications (CACs) detected on panoramic radiographs (PRs) in a group of Turkish population. Further, the relationships between CACs and gender, life style, and medical history were evaluated.

Methods:During the years 2004 to 2006, a random sample of 1282 PRs was collected from patients older than 40 years who were being treated by the School of Dentistry, Erciyes University. Of these 1282 PRs, 750 PRs were included in this study. Medical data was collected from the archival records of the dental school.

Results: About 38 (5.06%) CACs were found on the PRs of 12 (4.5%) males and 26 (5.4%) females. The CAC prevalence was not significantly different between the males and females (P=0.583). These calcifications were unilateral in 26 (68.4%) and bilateral in 12 (31.6%) subjects. Of those in the positive group, there were 12 subjects (31.58%) with hyperlipidemia, 12 subjects (31.58%) with hypertension, 7 subjects (18.4%) with diabetes mellitus, 6 subjects (15.8%) with cardiovascular disease, and 6 subjects (15.8%) with smoking history.

Conclusions: This study has the highest CACs prevalence in comparison to the other studies. Therefore, dentists caring for subjects with dental problems should carefully evaluate their PRs for the evidence of CACs, and refer them for medical evaluation as indicated. So, incidental findings could provide life-saving information. (Eur J Dent 2007;1:132-138)

Key words

Panoramic radiograph - Carotid artery calcification - Atherosclerosis - Risk factors

• References

• 1 Lusis AJ. Atherosclerosis. Nature 2000; 407: 233-241
• 2 Ross R. Atherosclerosis: an inflammatory disease. N Engl J Med 1999; 340: 115-126
• 3 Hertzer NR, O’Hara PJ, Mascha EJ, Krajewski LP, Sullivan TM, Beven EG. Early outcome assessment for 2228 consecutive carotid endarterectomy procedures: the Cleveland clinic experience from 1989 to 1992. J Vasc Surg 1997; 26: 001-010
• 4 Friedlander AH. Identification of stroke-prone patients by panoramic and cervical spine radiography. Dentomaxillofac Radiol 1995; 24: 160-164
• 5 Hoyert DL, Arias E, Smith BL, Murphy SL, Kochhanek KD. Deaths: final data for 1999.. Natl Vital Stat Rep 2001; 49: 001-113
• 6 Williams GR, Jiang JG, Matchar DB, Samsa GP. Incidence and occurrence of total (first-ever and recurrent) stroke. Stroke 1999; 30: 2523-2528
• 7 Matchar DB, Duncan PW. Cost of Stroke. Stroke Clin Updates 1994; 05: 009-012
• 8 Olalla MT, Medrano MJ, Sierra MJ, Almazan J. Mortalidad por enfermeddad cerebrovascular en España. Rev Neurol 1999; 29: 872-878
• 9 Prime Ministry Republic of Turkey: Turkish Statistical Institute (Turkstat) Report, 2005 http://www.turkstat.gov.tr (Statistics/social security & health/health statistics/reason of disease) 0
• 10 Almog DM, Tsimidis K, Moss ME, Gottlieb RH, Carter LC. Evaluation of a training program for detection of carotid artery calcifications on panoramic radiographs. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000; 90: 111-117
• 11 Anderson CS, Jamrozik KD, Burvill PW, Chakera TM, Johnson GA, Stewart-Wynne EG. Determining the incidence of different subtypes of stroke: results from the Perth Community Stroke Study, 1989-1990. Med J Aust 1993; 158: 085-089
• 12 Hubar JS. Carotid artery calcification in the black population: a retrospective study on panoramic radiographs. Dentomaxillofac Radiol 1999; 28: 348-350
• 13 Friedlander AH, Lande A. Panoramic radiographic identification of carotid arterial plaques. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1981; 52: 102-104
• 14 Cohen SN, Friedlander AH, Jolly DA, Date L. Carotid calcification on panoramic radiographs: An important marker for vascular risk. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002; 94: 510-514
• 15 Tamura T, Inui M, Nakase M, Nakamura S, Okumura K, Tagawa T. Clinicostatistical study of carotid calcification on panoramic radiographs. Oral Diseases 2005; 11: 314-317
• 16 Pornprasertsuk-Damrongsri s, Thanakun s. Carotid artery calcification detected on panoramic radiographs in a group of Thai population. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006; 101: 110-115
• 17 Lewis DA, Brooks SL. Cartoid artery calcification in a general dental population: a retrospective study of panoramic radiographs. Gen Dent 1999; 47: 098-103
• 18 Kumagai M, Yamagishi T, Fukui N, Chiba M. Long-term cigarette smoking increases the prevalence of carotid artery calcification seen on panoramic dental radiographs in male patients. Tohoku J Exp Med 2007; 212: 021-025
• 19 Kumagai M, Yamagishi T, Fukui N, Chiba M. Carotid artery calcification seen on panoramic dental radiographs in the Asian population in Japan. Dentomaxillofac Radiol 2007; 36: 092-096
• 20 Beckstrom BW, Horsley SH, Scheetz JP. et al Correlation between carotid area calcifications and periodontitis: a retrospective study of digital panoramic radiographic findings in pretreatment cancer patients. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007; 103: 359-366
• 21 Tanaka T, Morimoto Y, Ansai T. et al Can the presence of carotid artery calcification on panoramic radiographs predict the risk of vascular diseases among 80-yearolds. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006; 101: 777-783
• 22 Friedlander AH, Altman L. Carotid artery atheromas in postmenopausal women: their prevalence on panoramic radiographs and their relationship to atherogenic risk factors. J Am Dent Assoc 2001; 132: 1130-1136
• 23 Ohba T, Takata Y, Ansai T. et al Evaluation of calcified carotid artery atheromas detected by panoramic radiograph among 80-year-olds. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2003; 96: 647-650
• 24 Bayram B, Uckan S, Acikgoz A, Muderrisoglu H, Aydinalp A. Digital panoramic radiography: a reliable method to diagnose carotid artery atheromas. Dentomaxillofac Radiol 2006; 35: 266-270
• 25 Carter LC. Discrimination between calcified triticeous cartilage and calcified carotid atheroma on panoramic radiography. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000; 90: 108-110
• 26 Tegos TJ, Kalodiki E, Nicolaides AN. Stroke: management and rehabilitation. Part III of III. Angiology 2000; 51: 977-984
• 27 Friedlander AH, Friedlander IK. Identification of stroke prone patients by panoramic radiography. Aust Dent J 1998; 43: 051-054
• 28 Friedlander RH. Panoramic radiography: the differential diagnosis of carotid artery atheromas. J Spec Care Dent 1995; 15: 223-227
• 29 Friedlander AH, Friedlander I. Panoramic dental radiography: an aid in detecting individuals prone to stroke. Br Dent J 1996; 181: 23-26
• 30 Madden RP, Hodges JS, Salmen CW. et al Utility of panoramic radiographs in detecting cervical calcified carotid atheroma. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007; 103: 543-548
• 31 Kansu Ö, Özbek M, Avcu N, Gençtoy G, Kansu H, Turgan C. The prevalence of carotid artery calcification on the panoramic radiographs of patients with renal disease. Dentomaxillofac Radiol 2005; 34: 016-019
• 32 Carter LC, Haller AD, Nadarajah V, Calamel AD, Aguirre A. Use of panoramic radiography among an ambulatory dental population to detect patients at risk of stroke. J Am Dent Assoc 1997; 128: 977-984
• 33 Friedlander AH, Golub MS. The significance of carotid artery atheromas on panoramic radiographs in the diagnosis of occult metabolic syndrome. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006; 101: 095-101
• 34 Friedlander AH, August M. The role of panoramic radiography in determining an increased risk of cervical atheromas in patients treated with therapeutic irradiation. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998; 85: 339-344
• 35 Sung EC, Friedlander AH, Kobashigawa JA. The prevalence of calcified carotid atheromas on the panoramic radiographs of patients with dilated cardiomyopathy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004; 97: 404-407
• 36 Friedlander AH, Maeder LA. 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 2000; 89: 420-424
• 37 Friedlander AH, Yueh R, Littner MR. The prevalence of calcified carotid artery atheromas in patients with obstructive sleep apnea syndrome. J Oral Maxillofac Surg 1998; 56: 950-954