ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Carotid Artery Calcifications Can Be Identified on Panoramic Radiographs and May Assist in Early Detection of Cardiovascular Disease
Clinical Question Can the risk of cardiovascular disease be predicted by the identification of cervical calcifications on dental panoramic radiographs?
Clinical Bottom Line Cervical atheromatous plaques can be identified on panoramic radiographs as carotid artery calcifications and may be the first clinical sign that a patient has cardiovascular disease.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 25232373Alves, N et. al/2014Prevalence: 31 studies with 35,110 subjects. Reliability: 7 articles with 430 subjects.Review of Literature
Key resultsPrevalence of 0.43% to 9.4% was reported in the general population, and was much higher at 38.8% for subjects with systemic disease. Of the 7 studies accounting for reliability of panoramic radiographs to detect common carotid artery calcification, a wide variation of sensitivity (22.2%-79.8%) and specificity (36.8%-90%) were reported, and the authors concluded that “calcified atheroma in the common carotid artery can be demonstrated in panoramic radiograph, and this is an important tool for early detection…” of the calcifications.
Evidence Search (calcified carotid arteries AND panoramic radiography AND Review[ptyp]) MeSH Terms: radiography, panoramic; carotid arteries Publication Type: review
Comments on
The Evidence
Validity: The prevalence range is acceptable due to the large subject pool studied from a broad 33-year range. The reliability statistics varied widely, which may be due to differences in sample sizes and the application of different gold standard measurements (Doppler, color ultrasound, magnetic resonance angiography, subtraction angiography and computed tomography.” Perspective: Due to the variations in populations studied and their confounding variables, no clear prevalence rate was established, but rather a range. The varied reliability data led the authors to their conclusion, but no suggestion was made to replace the gold standard diagnostic assessment of carotid artery stenosis with panoramic radiography. However, there was enough evidence to suggest that the appearance of carotid artery calcifications on panoramic radiographs warrants referral for positive diagnosis by a cardiologist. The only exclusion criteria used was if an article did not have an abstract or if it was a case report. More specific inclusion and exclusion criteria could have narrowed the scope of this review and provided for more definitive prevalence and reliability.
Applicability The presence of atheromatous plaque in the common carotid arteries is “associated with greater severity of coronary artery disease and also stroke”. Possession of a high index of suspicion due to the prevalence rates reported will guide dentists to evaluate panoramic radiographs, a frequently utilized diagnostic aid in dentistry, for cervical calcifications, identify the incidental findings as potentially pathologic (common carotid artery calcification) or a normal variation of anatomy (calcified triticeous or thyroid cartilage, ligament or lymph node) and confidently refer their patient to cardiology for evaluation and definitive therapy.
Specialty/Discipline (Public Health) (Oral Medicine/Pathology/Radiology) (Endodontics) (General Dentistry) (Oral Surgery) (Periodontics) (Prosthodontics) (Restorative Dentistry)
Keywords Carotid Artery; Common Carotid Artery; Calcification; Panoramic Radiograph; Cervical Calcification
ID# 3281
Date of submission: 10/27/2017spacer
E-mail hershbergers@livemail.uthscsa.edu
Author Sean Hershberger DDS
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Basic Science Rationale
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Comments on the CAT
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