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Cheng FC, Liu SY, Liu BL, Chiang CP. Carotid artery calcification detected on the panoramic radiographs. J Dent Sci 2024; 19:1906-1908. [PMID: 39035294 PMCID: PMC11259723 DOI: 10.1016/j.jds.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Indexed: 07/23/2024] Open
Affiliation(s)
- Feng-Chou Cheng
- Chia-Te Dental Clinic, New Taipei City, Taiwan
- School of Life Science, College of Science, National Taiwan Normal University, Taipei, Taiwan
- Science Education Center, National Taiwan Normal University, Taipei, Taiwan
| | - Shu-Yu Liu
- Department of Medical Imaging, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Bo-Lin Liu
- Department of Medical Imaging, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chun-Pin Chiang
- Department of Dentistry, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
- Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, Taipei, Taiwan
- Graduate Institute of Oral Biology, School of Dentistry, National Taiwan University, Taipei, Taiwan
- Department of Dentistry, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
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Kadyan V, Vaddi A, Nagpal A, Molina MR, Lurie AG, Tadinada A. Evaluation of Cone-Beam Computed Tomography Scans to Develop a Staging Method of External Carotid Artery Calcification. J Clin Med 2024; 13:3189. [PMID: 38892900 PMCID: PMC11173268 DOI: 10.3390/jcm13113189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 05/22/2024] [Accepted: 05/27/2024] [Indexed: 06/21/2024] Open
Abstract
Background: The objective of this study was to develop a practical staging method for reporting external carotid artery calcifications (ECACs) using cone-beam computed tomography (CBCT) imaging, specifically to standardize reporting for oral and maxillofacial radiologists. Methods: This retrospective study evaluated 489 CBCT scans for the presence of ECACs. Two calibrated evaluators assessed the scans in all three orthogonal planes, using the axial plane to develop the staging system. Calcifications were graded on a scale from 0 to 5. Results: ECACs were found in 170 out of 489 scans (34.7%). There was a statistically significant increase in ECAC distribution with age progression. The prevalence of ECACs was similar between genders. Grade 1 calcifications were most common in the 51-60 age group, Grade 2 in the 61-70 and 71-80 groups, and Grades 3 and 4 in the 81-90 group. No Grade 5 calcifications were observed in any age group. The inter-rater reliability showed an excellent correlation in the identification and grading of ECACs. Conclusions: The proposed grading system enables oral and maxillofacial radiologists to quantitatively report ECACs, facilitating timely referrals to physicians for further evaluation and early intervention, thereby potentially reducing the risk of cardiovascular events.
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Affiliation(s)
- Varsha Kadyan
- Division of Oral and Maxillofacial Radiology, University of Connecticut School of Dental Medicine, 263 Farmington Avenue, Farmington, CT 06030, USA; (V.K.); (A.N.); (A.G.L.); (A.T.)
| | - Anusha Vaddi
- Oral and Maxillofacial Radiology, Department of Oral Diagnostic Sciences, Virginia Commonwealth University School of Dentistry, Richmond, VA 23298, USA
| | - Archna Nagpal
- Division of Oral and Maxillofacial Radiology, University of Connecticut School of Dental Medicine, 263 Farmington Avenue, Farmington, CT 06030, USA; (V.K.); (A.N.); (A.G.L.); (A.T.)
| | - Marco R. Molina
- Department of Diagnostic Imaging, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT 06030, USA;
| | - Alan G. Lurie
- Division of Oral and Maxillofacial Radiology, University of Connecticut School of Dental Medicine, 263 Farmington Avenue, Farmington, CT 06030, USA; (V.K.); (A.N.); (A.G.L.); (A.T.)
| | - Aditya Tadinada
- Division of Oral and Maxillofacial Radiology, University of Connecticut School of Dental Medicine, 263 Farmington Avenue, Farmington, CT 06030, USA; (V.K.); (A.N.); (A.G.L.); (A.T.)
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Bladh M, Gustafsson N, Engström G, Kennbäck C, Klinge B, Nilsson PM, Jönsson D, Levring Jäghagen E. Defined shapes of carotid artery calcifications on panoramic radiographs correlate with specific signs of cardiovascular disease on ultrasound examination. Oral Surg Oral Med Oral Pathol Oral Radiol 2024; 137:408-420. [PMID: 38320892 DOI: 10.1016/j.oooo.2023.12.783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 11/28/2023] [Accepted: 12/09/2023] [Indexed: 02/08/2024]
Abstract
OBJECTIVE The aim was to optimize diagnostics for carotid artery calcifications (CACs) on panoramic radiographs (PRs) to identify cardiovascular disease (CVD) by investigating how 4 defined CAC shapes are associated with ultrasound (US) findings indicating CVD. STUDY DESIGN The study included 414 participants (802 neck sides) from the Malmö Offspring Dental Study, examined with PRs. The PRs were assessed for CAC shapes stratified into 4 categories: single, scattered, vessel-width defining, and vessel-outlining. The carotid arteries were examined with US for signs of CVD: the presence of plaques, largest individual area of a plaque, number of plaques, and percentage reduction of the lumen. Associations between the different CAC categories and US characteristics were analyzed. RESULTS All categories of CAC were significantly associated with a higher degree of US findings indicating CVD compared with no CAC (P < .001). The most significant differences were found for vessel-outlining CAC, with the mean of the largest individual plaque area of 17.9 vs 2.3 mm2, mean number of plaques 1.6 vs 0.2, and mean percentage reduction of the lumen 24.1% vs 3.5% (all P < .001). CONCLUSIONS Independent of shape, CACs detected on PRs were associated with a higher degree of US findings of CVD. This was most pronounced for vessel-outlining CAC. With refined differential diagnostics of CACs in PRs, dentists may contribute to improved identification of patients in need of cardiovascular prevention.
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Affiliation(s)
- Magnus Bladh
- Oral and Maxillofacial Radiology, Department of Odontology, Umeå University, Umeå, Sweden
| | - Nils Gustafsson
- Oral and Maxillofacial Radiology, Department of Odontology, Umeå University, Umeå, Sweden
| | - Gunnar Engström
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Cecilia Kennbäck
- Department of Clinical Sciences, Lund University, Malmö, Sweden; Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden
| | - Björn Klinge
- Department of Periodontology, Faculty of Odontology, Malmö University, Malmö, Sweden; Department of Dental Medicine, Karolinska Institutet, Solna, Sweden
| | - Peter M Nilsson
- Department of Clinical Sciences, Lund University, Malmö, Sweden; Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden
| | - Daniel Jönsson
- Department of Clinical Sciences, Lund University, Malmö, Sweden; Department of Periodontology, Faculty of Odontology, Malmö University, Malmö, Sweden; Public Dental Service of Skåne, Lund, Sweden
| | - Eva Levring Jäghagen
- Oral and Maxillofacial Radiology, Department of Odontology, Umeå University, Umeå, Sweden.
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Möst T, Winter L, Ballheimer YE, Kappler C, Schmid M, Adler W, Weber M, Kesting MR, Lutz R. Prevalence of carotid artery calcification detected by different dental imaging techniques and their relationship with cardiovascular risk factors, age and gender. BMC Oral Health 2023; 23:949. [PMID: 38037004 PMCID: PMC10691106 DOI: 10.1186/s12903-023-03564-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 10/22/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Atherosclerosis and its secondary diseases display a major threat to patient's health. Sequelae, like carotid artery calcification (CAC), usually develop over decades and remain asymptomatic for a long time, making preventive measures to reduce mortality and morbidity extremely important. Through panoramic radiography (PR) and cone beam computed tomography (CBCT), dentists may have helpful tools in aiding the holistic care of patients. In this context, the correlation of atherosclerotic risk factors and CAC development have not yet been sufficiently investigated. Thus, the aim of this observational radiological study was to evaluate the diagnostic value of PR compared with CBCT for the detection of CAC in patients older than 60 years. The radiological findings were correlated with gender, age, and cardiac risk factors. METHODS PRs and CBCTs of N = 607 patients were used for the qualitative analysis and compared. Basic patient information such as age, gender, body mass index (BMI), smoking history as well as patient's detailed medical history, including heart disease and cardiovascular risk factors such as hypercholesterolemia, arterial hypertension and diabetes mellitus type II were documented and their relation to CAC provided by radiological data was estimated in the form of odds ratios (OR), which were calculated using logistic regression models. Proportions of CAC in different risk groups were compared using Fisher's exact test, the significance level was set to α ≤ 0.05. The interrater reliability of two physicians was estimated using Cohen's kappa. RESULTS With an accuracy of 90.6%, a sensitivity of 67.5% and a specificity of 99.5% compared to CBCT, PR was a reliable method for the diagnosis of CAC. The overall detection rate for CAC was 27.8% across all age groups. Age (OR: 1.351; p = 0.021), the male sex (OR: 1.645; p = 0.006), arterial hypertension (OR: 2.217; p = < 0.001), heart disease (OR: 1.675; p = 0.006), hypercholesterolemia (OR: 1.904; p = 0.003) and chronic obstructive pulmonary disease (OR: 2.016; p = 0.036) were statistically significant risk factors. When correlated, neither history of stroke nor nicotine abuse showed any statistical significance. CONCLUSIONS Due to the capabilities of PR in the diagnosis of CAC, dentists can play a vital role in the early diagnosis of vascular disease. Awareness should therefore be raised among dentists regarding the detection of CAC in patients over 60 years of age, with a particular focus on those with arterial hypertension and hypercholesterolaemia.
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Affiliation(s)
- Tobias Möst
- Department of Oral and Maxillofacial Surgery, University Hospital Erlangen, Glückstraße 11, 91054, Erlangen, Germany.
| | - Linus Winter
- Department of Oral and Maxillofacial Surgery, University Hospital Erlangen, Glückstraße 11, 91054, Erlangen, Germany
| | - Yili Elisabeth Ballheimer
- Department of Oral and Maxillofacial Surgery, University Hospital Erlangen, Glückstraße 11, 91054, Erlangen, Germany
| | - Christian Kappler
- Department of Oral and Maxillofacial Surgery, University Hospital Erlangen, Glückstraße 11, 91054, Erlangen, Germany
| | - Magdalena Schmid
- Department of Oral and Maxillofacial Surgery, University Hospital Erlangen, Glückstraße 11, 91054, Erlangen, Germany
| | - Werner Adler
- Department of Medical Informatics, Biometry and Epidemiology (IMBE), University of Erlangen- Nuremberg, Erlangen, Germany
| | - Manuel Weber
- Department of Oral and Maxillofacial Surgery, University Hospital Erlangen, Glückstraße 11, 91054, Erlangen, Germany
| | - Marco Rainer Kesting
- Department of Oral and Maxillofacial Surgery, University Hospital Erlangen, Glückstraße 11, 91054, Erlangen, Germany
| | - Rainer Lutz
- Department of Oral and Maxillofacial Surgery, University Hospital Erlangen, Glückstraße 11, 91054, Erlangen, Germany
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Zaghden O, Jaziri R, Kammoun R, Chaabani I, Alaya TB. Benefit of Panoramic Radiography in the Detection of Carotid Calcifications: Clinical Case Reports and Review of the Literature. Case Rep Dent 2023; 2023:3989502. [PMID: 37305808 PMCID: PMC10257549 DOI: 10.1155/2023/3989502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/04/2023] [Accepted: 05/06/2023] [Indexed: 06/13/2023] Open
Abstract
Atherosclerotic lesions in the common carotid artery are one of the most frequent causes of ischemic stroke. They are usually diagnosed by cardiologists and are managed following complementary examinations. In dental practice, panoramic radiograph is a basic examination frequently performed in first line. On this radiography, possible unilateral or bilateral opacities projecting to the latero-cervical regions can be visualized, raising suspicion of carotid calcifications. The aim of this study was to present, through three cases and a review of the literature, the benefit of PR in the diagnosis of carotid calcifications and the approaches to be followed in case of such suspicious images. This would contribute, in some cases, to an early diagnosis and management, thus avoiding the evolution towards cerebral vascular accidents.
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Affiliation(s)
- Olfa Zaghden
- Department of Radiology, University Dental Clinic, University of Monastir, Monastir, Tunisia
| | - Rawia Jaziri
- Department of Radiology, University Dental Clinic, University of Monastir, Monastir, Tunisia
| | - Rym Kammoun
- Department of Radiology, University Dental Clinic, University of Monastir, Monastir, Tunisia
- Laboratory of Histology and Embryology, Faculty of Dental Medicine of Monastir, University of Monastir, Monastir, Tunisia
- ABCDF Laboratory for Biological Clinical and Dento-Facial Approach, University of Monastir, Monastir, Tunisia
| | - Imen Chaabani
- Department of Radiology, University Dental Clinic, University of Monastir, Monastir, Tunisia
- Unity of Bioactive Natural Substances and Biotechnology, Faculty of Dental Medicine, University of Monastir, Monastir, Tunisia
| | - Touhami Ben Alaya
- Department of Radiology, University Dental Clinic, University of Monastir, Monastir, Tunisia
- Unity of Bioactive Natural Substances and Biotechnology, Faculty of Dental Medicine, University of Monastir, Monastir, Tunisia
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Özkan G, Köse E, Yeşiltepe S. Ultrasonographic Evaluation of Soft Tissue Calcifications in the Head and Neck Region Detected on Panoramic Radiographs. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:1057-1064. [PMID: 36301624 DOI: 10.1002/jum.16117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 09/16/2022] [Accepted: 10/11/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE The aim of this study is to present a comparison between panoramic radiographs and USG imaging with a focus on revealing the advantages of USG over radiographs, and to show the distribution of calcifications detected in USG by considering the age and gender. METHODS A total of 148 patients with soft tissue calcifications as seen on panoramic radiographs were examined with USG imaging. Sialoliths, carotid artery calcifications, tonsilloliths, phleboliths and lymph node calcifications were examined in terms of anatomical localization, distribution and shape. RESULTS In the USG evaluation of these 148 patients, soft tissue calcifications were observed in 113 (76.4%) patients. The mean age of the patients with calcification was 55.6 ± 13.1 (min: 22-max: 77). Bilateral calcifications were detected in 25 (22.1%) patients, whereas unilateral calcifications were found in 88 (77.9%) patients. While the rates of tonsilloliths, sialoliths, phleboliths, and lymph node calcifications were statistically similar in male and female patients, the rate of carotid artery calcifications was found to be higher in men than in women (P = 0.017). No statistical significance was found between age groups in terms of the formation of soft tissue calcifications (P = 0.117). CONCLUSIONS Panoramic radiographs may mislead clinicians in the diagnosis and differential diagnosis of soft tissue calcifications in the head and neck region due to the presence of distortion, superpositions, metal artefacts, and ghost images. USG is an important diagnostic tool in determining the localization of soft tissue calcifications that can be confused on two-dimensional radiographs, their relationship with neighboring structures, and defining calcification. It can be used safely in the detection of soft tissue calcifications as it provides dynamic imaging without the use of radiation or contrast material compared to other advanced imaging methods.
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Affiliation(s)
- Gökhan Özkan
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Aydın Adnan Menderes University, Aydın, Turkey
| | - Emre Köse
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Aydın Adnan Menderes University, Aydın, Turkey
| | - Selin Yeşiltepe
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Aydın Adnan Menderes University, Aydın, Turkey
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Comparison of detection performance of soft tissue calcifications using artificial intelligence in panoramic radiography. Sci Rep 2022; 12:19115. [PMID: 36352043 PMCID: PMC9646809 DOI: 10.1038/s41598-022-22595-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 10/17/2022] [Indexed: 11/11/2022] Open
Abstract
Artificial intelligence (AI) is limited to teeth and periodontal disease in the dental field, and is used for diagnosis assistance or data analysis, and there has been no research conducted in actual clinical situations. So, we created an environment similar to actual clinical practice and conducted research by selecting three of the soft tissue diseases (carotid artery calcification, lymph node calcification, and sialolith) that are difficult for general dentists to see. Therefore, in this study, the accuracy and reading time are evaluated using panoramic images and AI. A total of 20,000 panoramic images including three diseases were used to develop and train a fast R-CNN model. To compare the performance of the developed model, two oral and maxillofacial radiologists (OMRs) and two general dentists (GDs) read 352 images, excluding the panoramic images used in development for soft tissue calcification diagnosis. On the first visit, the observers read images without AI; on the second visit, the same observers used AI to read the same image. The diagnostic accuracy and specificity for soft tissue calcification of AI were high from 0.727 to 0.926 and from 0.171 to 1.000, whereas the sensitivity for lymph node calcification and sialolith were low at 0.250 and 0.188, respectively. The reading time of AI increased in the GD group (619 to 1049) and decreased in the OMR group (1347 to 1372). In addition, reading scores increased in both groups (GD from 11.4 to 39.8 and OMR from 3.4 to 10.8). Using AI, although the detection sensitivity of sialolith and lymph node calcification was lower than that of carotid artery calcification, the total reading time of the OMR specialists was reduced and the GDs reading accuracy was improved. The AI used in this study helped to improve the diagnostic accuracy of the GD group, who were not familiar with the soft tissue calcification diagnosis, but more data sets are needed to improve the detection performance of the two diseases with low sensitivity of AI.
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Janiszewska-Olszowska J, Jakubowska A, Gieruszczak E, Jakubowski K, Wawrzyniak P, Grocholewicz K. Carotid Artery Calcifications on Panoramic Radiographs. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14056. [PMID: 36360932 PMCID: PMC9654866 DOI: 10.3390/ijerph192114056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/23/2022] [Accepted: 10/26/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE The objective of this study was to evaluate the prevalence of carotid artery calcifications (CACs) on panoramic radiographs of Polish dental patients. METHODS Panoramic radiographs made between 2005 and 2012 in 4000 patients born between 1922 and 1958 were accessed from the server of the Department of Radiology and analyzed for the presence or absence of CACs by a group of trained dentists. RESULTS The anatomical area covered by the analysis was visible in 2189 images (54.73%). Calcifications in the carotid arteries were found in 468 (21.68%) patients, including 327 (14.94%) unilaterally and 141 (6.44%) bilaterally. CACs were found in 284 (60.68%) women and 184 (39.32%) men. CONCLUSIONS The prevalence rate of CACs detected on panoramic radiographs in patients aged 54 and older was 21.68%, which makes it an important clinical problem.
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Affiliation(s)
| | | | | | | | | | - Katarzyna Grocholewicz
- Department of Interdisciplinary Dentistry, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland
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Preethy M, Elangovan S, Lakshmi S, Kumar S. Incidental findings of soft tissue radiopacities on digital panoramic radiographs: A cross-sectional study. JOURNAL OF INDIAN ACADEMY OF ORAL MEDICINE AND RADIOLOGY 2022. [DOI: 10.4103/jiaomr.jiaomr_42_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Chang TI, Wu X, Boström KI, Tran HA, Couto-Souza PH, Friedlander AH. Panoramic imaged carotid atheromas are associated with increased neutrophil count: both validated, independent predictors of near-term myocardial infarction. Dentomaxillofac Radiol 2021; 50:20210045. [PMID: 34111366 DOI: 10.1259/dmfr.20210045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Panoramic images (PXs) demonstrating calcified carotid artery atheromas (CCAAs) are associated with heightened risk of near-term myocardial infarction (MI). Elevated neutrophil counts (NC) within normal range 2,500-6,000 per mm3 are likewise associated with future MI signaling the role neutrophils play in the chronic inflammation process underlying coronary artery atherogenesis. We determined if CCAAs on PXs are associated with increased NC. METHODS Investigators implemented a retrospective study of PXs and accompanying medical records of white males ≥ 65 years treated by a VA dental service. Two groups (N = 60 each) were constituted, one with atheromas (CCAA+) and one without (CCAA-). Predictor variable was CCAA + and outcome variable was NC. Bootstrapping analysis determined the difference in mean NCs between two groups, significance set at ≤0.05. RESULTS The study group of (CCAA+) (mean age 75.9; range 69-91 years) demonstrated a mean NC of 4,843 per mm3 and control group (CCAA-) (mean age 75.3; range; 66-94) a mean NC of 4,108 per mm3. The difference between the groups was significant (p = 0.0008) (95% CI of difference of mean: -432, 431; observed effect size 736). CONCLUSIONS CCAAs on PXs of elderly white males are associated with elevated NC; amplifying need for medical consultation prior to invasive dental procedures.
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Affiliation(s)
- Tina I Chang
- Inpatient Oral and Maxillofacial Surgery, Veterans Affairs Great Los Angeles Healthcare System, Los Angeles, CA, USA.,Oral and Maxillofacial Surgery, School of Dentistry, University of California, Los Angeles, CA, USA
| | - Xiuju Wu
- Division of Cardiology, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA
| | - Kristina I Boström
- Cardiology, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.,Medicine/Cardiology, David Geffen School of Medicine at UCLA and at the Molecular Biology Institute, University of California, Los Angeles, CA, USA
| | - Hoang-Anh Tran
- Periodontology, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Paulo Henrique Couto-Souza
- Maxillofacial Radiology, Dentistry/School of Life Sciences, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - Arthur H Friedlander
- Maxillofacial Surgery & Medicine, Dental Service, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA.,Quality Assurance Hospital Dental Service, Ronald Reagan UCLA Medical Center and Professor-in-Residence of Oral and Maxillofacial Surgery, School of Dentistry, University of California, Los Angeles, CA, USA
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SÖNMEZ KAPLAN S, KAPLAN T, SEZGİN G. Assessment of the frequency and correlation of carotid artery calcifications and pulp stones with idiopathic osteosclerosis using digital panoramic radiographs. CLINICAL AND EXPERIMENTAL HEALTH SCIENCES 2021. [DOI: 10.33808/clinexphealthsci.841006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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12
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Çetin MB, Sezgin Y, Yilmaz MNN, Seçgin CK. Assessment of carotid artery calcifications on digital panoramic radiographs and their relationship with periodontal condition and cardiovascular risk factors. Int Dent J 2020; 71:160-166. [PMID: 32996164 PMCID: PMC9275109 DOI: 10.1111/idj.12618] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The main purpose of this study is to determine the presence of carotid artery calcification (CAC) detected on digital panoramic radiographs (DPRs) retrospectively and correlate the findings with cardiovascular risk factors including gender, age, smoking status, hypertension, diabetes, and hyperlipidemia, along with atherosclerotic cardiovascular disease and periodontal status. METHODS This clinical study is registered at ClinicalTrials.gov as NCT04017078. DPRs, periodontal status and cardiovascular risk factors of 1,101 patients (576 males, 525 females) were evaluated. The patients were grouped based on whether CAC was detected in dental DPRs [CAC (+)] or not [CAC (-)]. Periodontal status was categorised as gingivitis, periodontitis, and gingivitis with reduced periodontium (periodontally stable patient). RESULTS Out of 1,101 patients, whose mean age was 42.1 ± 15.5 years and 525 (47.7%) were female, 34 (3.1%) were diagnosed with CAC on DPRs. No significant difference was observed between groups considering gender, hypertension, diabetes, hyperlipidemia, smoking, and periodontal status. Patients aged 40-55 years (n = 398, 36.15%) and patients older than 55 years (n = 222, 20.16%) were associated with CAC (odds ratio = 4.49, 95% confidence interval = 1.65-12.17, P = 0.003; odds ratio = 4.41, 95% confidence interval = 1.33-14.61, P = 0.015, respectively). CONCLUSION Among all parameters, only age exhibited significant correlation with an increased risk of carotid calcification. Further studies with prospective designs and larger study populations are needed.
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Affiliation(s)
- Mehtap Bilgin Çetin
- Department of Periodontology, Faculty of Dentistry, Baskent University, Ankara, Turkey
| | - Yasemin Sezgin
- Department of Periodontology, Faculty of Dentistry, Baskent University, Ankara, Turkey
| | | | - Cansu Köseoğlu Seçgin
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Baskent University, Ankara, Turkey
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13
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The Prevalence and Correlation of Carotid Artery Calcifications and Dental Pulp Stones in a Saudi Arabian Population. Diseases 2019; 7:diseases7030050. [PMID: 31311129 PMCID: PMC6787572 DOI: 10.3390/diseases7030050] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Accepted: 07/09/2019] [Indexed: 11/22/2022] Open
Abstract
Background: This study sought to determine the prevalence of carotid artery calcifications (CACs) and pulp stones detected on panoramic radiographs (PRs) and ascertain their correlation. Methods: A total of 2013 digital PRs were retrospectively retrieved and thoroughly examined to determine the prevalence of CACs and pulp stones, their correlation with patient age and gender, and the relationship between the presence of pulps stones and radiographically detectable CACs. Results: The prevalence of CACs on PRs was 2.0%; the prevalence of pulp stones was 4.6%. There was no statistical relationship between pulp stones and CACs (p = 0.714). Older patients exhibited a significantly higher prevalence of CACs than younger patients (p < 0.001); pulp stones were statistically more prevalent in younger patients than older patients (p = 0.001). There were no significant differences between male and females in terms of the prevalence of either CACs or pulp stones (p = 0.087 and p = 0.278, respectively). Conclusions: Dentists should be trained to detect CACs on PRs belonging to patients older than 40 to exclude the presence of CACs. Moreover, pulp stones do not function as a diagnostic marker for CACs.
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Schroder AGD, de Araujo CM, Guariza-Filho O, Flores-Mir C, de Luca Canto G, Porporatti AL. Diagnostic accuracy of panoramic radiography in the detection of calcified carotid artery atheroma: a meta-analysis. Clin Oral Investig 2019; 23:2021-2040. [PMID: 30923911 DOI: 10.1007/s00784-019-02880-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 02/07/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To determine the diagnostic accuracy of panoramic radiography (PR) in detecting calcified carotid artery atheroma (CCAA) compared with Doppler ultrasonography or angiography (the reference standard). SOURCES Cochrane, LILACS, PubMed, Scopus, Web of Science, Google Scholar, Open Grey, and ProQuest were searched. The reference lists of the included studies were also screened. DATA Observational studies. METHODS Only studies comparing the diagnostic accuracy of PR in detecting CCAA to Doppler ultrasonography or angiography (the reference standard) were included. The primary outcome measures were sensitivity and specificity. The secondary outcomes were negative predictive values, positive predictive values, diagnostic odds ratios, likelihood ratios (positive and negative), receiver operating characteristic curves, accuracy, and Youden's index. Two reviewers independently participated in the study selection, data extraction, and risk of bias assessment without language restriction. Risk of bias was assessed thought QUADAS-2, and the level of evidence was assessed through GRADE. RESULTS A total of 773 citations were identified after duplicates were removed, and 12 studies including 1002 patients were included in the final study. The sensitivity and specificity of the different selected studies varied substantially, with sensitivity ranging from 0.31 to 0.95 and specificity from 0.19 to 0.99. CONCLUSIONS Most studies reported excellent sensitivity and good specificity. The diagnostic accuracy of PR was good or excellent in 50% of the studies. CLINICAL SIGNIFICANCE The identification of CCAA by PR can be a risk predictor for stroke when used as a secondary screening tool.
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Affiliation(s)
| | | | - Odilon Guariza-Filho
- Department of Orthodontics, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil. .,School of Health and Bioscience, Department of orthodontics, Pontifícia Universidade Católica do Paraná, Street Imaculada Conceição, 1155, Prado Velho, Curitiba, PR, 80215-901, Brazil.
| | | | - Graziela de Luca Canto
- Brazilian Centre for Evidence-based Research, Department of Dentistry, Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | - André Luís Porporatti
- Brazilian Centre for Evidence-based Research, Department of Dentistry, Federal University of Santa Catarina, Florianópolis, SC, Brazil
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Constantine S, Roach D, Liberali S, Kiermeier A, Sarkar P, Jannes J, Sambrook P, Anderson P, Beltrame J. Carotid Artery Calcification on Orthopantomograms (CACO Study) - is it indicative of carotid stenosis? Aust Dent J 2018; 64:4-10. [DOI: 10.1111/adj.12651] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2018] [Indexed: 12/14/2022]
Affiliation(s)
- S Constantine
- South Australian Dental Service; The Queen Elizabeth Hospital; Women's and Children's Hospital; Adelaide South Australia Australia
- The University of Adelaide; Adelaide South Australia Australia
| | - D Roach
- The University of Adelaide; Adelaide South Australia Australia
- The Queen Elizabeth Hospital; Adelaide South Australia Australia
| | - S Liberali
- Special Needs Unit; Adelaide Dental Hospital; SA Dental Service; Adelaide South Australia Australia
| | - A Kiermeier
- Statistical Process Improvement Consulting and Training Pty Ltd; Gumeracha South Australia Australia
| | - P Sarkar
- The Queen Elizabeth Hospital; Adelaide South Australia Australia
| | - J Jannes
- Central Adelaide Local Health Network; Adelaide South Australia Australia
- University of Adelaide; Adelaide South Australia Australia
| | - P Sambrook
- SA Dental Service; Head of Unit OMS; Royal Adelaide Hospital; Adelaide South Australia Australia
| | - P Anderson
- Australian Craniofacial Unit; Women's and Children's Hospital; Adelaide South Australia Australia
| | - J Beltrame
- Michell Professor of Medicine; The Queen Elizabeth Hospital; University of Adelaide; Cardiology Academic Lead; Central Adelaide Local Health Network; Adelaide South Australia Australia
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Ribeiro A, Keat R, Khalid S, Ariyaratnam S, Makwana M, do Pranto M, Albuquerque R, Monteiro L. Prevalence of calcifications in soft tissues visible on a dental pantomogram: A retrospective analysis. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2018; 119:369-374. [PMID: 29730464 DOI: 10.1016/j.jormas.2018.04.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 04/04/2018] [Accepted: 04/23/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVES To determine the frequency and spectrum of soft tissues calcifications identified on Dental Pantomograms (DPT) at a University Dental Clinic in the northern region of Portugal and to compare the data obtained with those published in the literature. METHODS We conducted a 3-year descriptive analysis (2012-2014) of DPT calcifications within soft tissues at the University Clinic (CESPU), in Oporto, Portugal. Information on gender, age, location of the lesions and the radiographic diagnosis were analysed. DPTs were interpreted by two examiners (Kappa test 0.8). Data were entered into a database and analysed with Chi-square and Fisher exact tests. Statistical analysis was performed using the Kolmogorov-Smirnov and Shapiro-Wilk test. RESULTS 2375 DPTs were analysed, with 468 calcifications observed in the radiographs of 420 individuals. Calcifications of the stylohyoid and stylomandibular ligament were most common, with atheroma, sialoliths, tonsilloliths rhinoliths and antroliths also identified. A statistically significant relationship was observed between the presence of calcifications of the stylohyoid and stylomandibular ligaments, atheromatous calcifications in the carotid artery and tonsilloliths in individuals older than 40. CONCLUSIONS This is the largest sample analysis ever done in Portugal, providing useful information about the incidence and distribution of soft tissue calcifications identifiable on DPTs, allowing valuable comparison with other countries. ADVANCES IN KNOWLEDGE Despite mostly being incidental findings, panoramic radiography can be the first relevant test that aids dental practitioners in the process of requesting other imaging techniques or forwarding to the correct specialty.
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Affiliation(s)
- A Ribeiro
- Medicine and Oral Surgery Department and Institute of Research and Advanced Training in Health Sciences and Technologies (IINFACTS), University Institute of Health Sciences (IUCS-N), CESPU, 4585-116 Paredes, Portugal
| | - R Keat
- Oral medicine department, Birmingham Dental Hospital & School of Dentistry, University of Birmingham, Mill Pool Way B5 7EG, United Kingdom.
| | - S Khalid
- Oral medicine department, Birmingham Dental Hospital & School of Dentistry, University of Birmingham, Mill Pool Way B5 7EG, United Kingdom
| | - S Ariyaratnam
- Unit of Oral Medicine, University Dental Hospital of Manchester, Manchester M15 6FH, United Kingdom
| | - M Makwana
- Oral medicine department, Birmingham Dental Hospital & School of Dentistry, University of Birmingham, Mill Pool Way B5 7EG, United Kingdom
| | - M do Pranto
- Medicine and Oral Surgery Department and Institute of Research and Advanced Training in Health Sciences and Technologies (IINFACTS), University Institute of Health Sciences (IUCS-N), CESPU, 4585-116 Paredes, Portugal
| | - R Albuquerque
- Oral medicine department, Birmingham Dental Hospital & School of Dentistry, University of Birmingham, Mill Pool Way B5 7EG, United Kingdom
| | - L Monteiro
- Medicine and Oral Surgery Department and Institute of Research and Advanced Training in Health Sciences and Technologies (IINFACTS), University Institute of Health Sciences (IUCS-N), CESPU, 4585-116 Paredes, Portugal
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Abstract
General dental practitioners are less confident at diagnosing radiopaque lesions of the jaws than radiolucent ones, possibly because the incidence of jaw radiopacities is comparatively low. The current review covers the majority of radiopaque lesions that are referred for a specialist opinion, and focuses on those lesions that occur commonly or those that mimic other diagnoses. The majority of radiopaque jaw lesions represent normal anatomy/normal variants or superimposed soft tissue calcifications that are typically of no clinical significance. Common pathological radiopacities of the jaws include sclerosing (condensing) osteitis, a response to low-grade chronic apical infection, and odontomes, a form of odontogenic hamartoma. The typical imaging appearances of these and other jaw radiopacities are discussed.
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Assessment of carotid calcifications on digital panoramic radiographs: Retrospective analysis and review of the literature. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2017; 119:102-106. [PMID: 29158070 DOI: 10.1016/j.jormas.2017.11.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 11/03/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To assess the validity of digital panoramic radiographs as an effective means of diagnosis for atherosclerosis and as a potential aid in the early detection of the disease. STUDY DESIGN We reviewed 2014 digital panoramic radiographs taken throughout 2012 and 2013 to identify the presence of calcified atherosclerotic plaques of both female and male patients all aged over 18 years. In addition the medical records of these patients were reviewed in order to establish if there were any predisposing risk factors for atherosclerosis. Statistical analysis was performed to identify any possible link between radiographic atherosclerotic plaques and predisposing risk factors for atherosclerosis using univariate and multivariate models. Statistical significance criteria was defined as P<0.05. RESULTS Out of 2014 patients (1149 female and 865 male), 191 (9.5%) were determined to have calcified atherosclerotic plaques on panoramic radiography. There was a statistically significant relationship between the presence of calcified atherosclerotic plaques and the established risk factors of atherosclerosis such as gender (OR=2.39, P<0.001), age (OR=1.5, P<0.001), stroke (OR=5.38, P<0.001) and hypertension (OR=2.11, P<0.001). CONCLUSION To our knowledge this is the largest study investigating atherosclerotic plaques on digital panoramic radiographs ever carried out in Portugal. Dental practitioners need to be aware of these incidental findings and to consider referring these patients for further investigations to confirm diagnosis.
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Calcified carotid artery atheromas in panoramic radiographs are associated with a first myocardial infarction: a case-control study. Oral Surg Oral Med Oral Pathol Oral Radiol 2017; 125:199-204.e1. [PMID: 29242130 DOI: 10.1016/j.oooo.2017.10.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 10/10/2017] [Accepted: 10/23/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The aim of this case-control study was to investigate whether patients with a first myocardial infarction (MI) had a higher prevalence of calcified carotid artery atheromas (CCAAs) on panoramic radiographs (PRs) than age-, gender-, and residential area-matched controls without MI. STUDY DESIGN Six hundred ninety-six cases with a first MI and 696 controls were included in this substudy of the Swedish multicentre PAROKRANK study. All participants underwent panoramic radiography, and the PRs were evaluated for CCAAs. RESULTS The prevalence of CCAAs detected by PR was 33.8% (235 of 696) in cases and 27.6% (192 of 696) in controls (odds ratio [OR] 1.24; 95% confidence interval [CI] 1.04-1.44; P = .012). Among males, 32.7% of cases (184 of 562) and 26.5% of controls (149 of 562) displayed CCAAs on PRs (OR 1.24; 95% CI 1.03-1.48; P = .022). Among both genders, bilateral CCAAs were significantly more common among cases than among controls (P = .002). CONCLUSIONS Cases with recent MIs had a significantly higher prevalence of CCAAs on PRs compared with controls without MIs. This difference between groups was more pronounced for bilateral CCAAs. These findings supported the hypothesis that CCAA detection could serve as a risk indicator for future MIs.
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20
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Prevalence of calcified carotid artery atheromas on digital panoramic images among perimenopausal and postmenopausal African American women. Oral Surg Oral Med Oral Pathol Oral Radiol 2017; 123:621-625. [PMID: 28407989 DOI: 10.1016/j.oooo.2017.01.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 11/21/2016] [Accepted: 01/17/2017] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Health care disparities, often of an obscure nature, result in African American women (AAw) having enhanced risk of adverse cardiovascular events. Therefore, we sought to determine the prevalence of calcified carotid artery atheromas (CCAA), a validated risk indicator of these events, on their digital panoramic images. STUDY DESIGN Comprehensive electronic medical records and digital panoramic images of self-identified AAw aged ≥45 years treated between 2007 and 2014 were retrieved from a Veterans Affairs Dental Service. Images were reviewed for CCAA in the cervical bifurcation region, and medical records were reviewed for atherogenic risk factors: hypertension, diabetes, and dyslipidemia. RESULTS The study sample of 171 AAw (mean age 58.2 ± 8.0 years) evidenced a 24% CCAA positive prevalence rate. In comparison with the CCAA negative group, those with atheromas were significantly older (61.4 ± 10.1 vs. 57.2 ± 7.0), diabetic, and dyslipidemic. Also observed among the full study sample was significant concordant increase of CCAA prevalence with age. Among those who were CCAA positive, there was a significant increased prevalence of dyslipidemia with age. CONCLUSIONS Panoramic images of older AAw frequently revealed carotid atheromas, a risk indicator of generalized atherosclerosis and future adverse cardiovascular events.
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Iwamoto Y, Uchida K, Sugino N, Kuroiwa H, Kitamura Y, Udagawa N, Shinohara A, Higashi Y, Taguchi A. Osteoporosis, osteoporotic fractures, and carotid artery calcification detected on panoramic radiographs in Japanese men and women. Oral Surg Oral Med Oral Pathol Oral Radiol 2016; 121:673-80. [PMID: 27055732 DOI: 10.1016/j.oooo.2016.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 02/01/2016] [Accepted: 02/10/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVES We investigated the association among diagnosed osteoporosis, osteoporotic fractures, and carotid artery calcification (CAC) detected on panoramic radiographs. Additionally, we assessed whether osteoporosis or fractures could be predicted by an incidental finding of CAC. STUDY DESIGN One thousand twenty-one patients participated in this study. Patients completed a structured questionnaire. Logistic regression analysis adjusted for covariates was used to calculate the odds ratio (95% confidence interval) for diagnosed osteoporosis or fractures according to the presence of CAC. Extended receiver operating characteristic (ROC) curve analysis was used to clarify whether osteoporosis or fractures were predicted by the detection of CAC. RESULTS The odds ratios for diagnosed osteoporosis or fracture associated with CAC were 1.82 (1.02-3.24) and 0.77 (0.33-1.77), respectively. The areas under the ROC curves for identifying patients with osteoporosis or fractures according to the detection of CAC were 0.54 and 0.50, respectively. CONCLUSIONS CAC may not be useful for identifying Japanese individuals with osteoporosis or those at risk of fracture, although the presence of CAC was significantly associated with a history of diagnosed osteoporosis without osteoporotic fractures.
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Affiliation(s)
- Yae Iwamoto
- Doctoral Student, Department of Hard Tissue Research, Graduate School of Oral Medicine, Matsumoto Dental University, Nagano, Japan
| | - Keiichi Uchida
- Associate Professor, Department of Oral and Maxillofacial Radiology, School of Dentistry, Matsumoto Dental University, Nagano, Japan
| | - Noriyuki Sugino
- Assistant Professor, Department of Oral and Maxillofacial Radiology, School of Dentistry, Matsumoto Dental University, Nagano, Japan
| | - Hiroko Kuroiwa
- Assistant Professor, Department of Oral and Maxillofacial Radiology, School of Dentistry, Matsumoto Dental University, Nagano, Japan
| | - Yutaka Kitamura
- Director, Center of Oral and Maxillofacial Surgery and Dental Implant, Nagano, Japan
| | - Nobuyuki Udagawa
- Professor and Chair, Department of Biochemistry, School of Dentistry, Matsumoto Dental University, Nagano, Japan
| | - Atsushi Shinohara
- Professor, Department of Oral and Maxillofacial Surgery, School of Dentistry, Matsumoto Dental University, Nagano, Japan
| | - Yukihito Higashi
- Professor, Department of Regeneration and Medicine, Research Center for Radiation Genome Medicine, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Akira Taguchi
- Professor and Chair, Department of Oral and Maxillofacial Radiology, School of Dentistry, Matsumoto Dental University, Nagano, Japan.
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Friedlander AH, Giaconi JA, Tsui I, Aghazadehsanai N, Chang TI, Garrett NR. Meaningful correlation between asymptomatic retinal arteriole emboli and calcified carotid plaque found on panoramic dental imaging of males with diabetes. Oral Surg Oral Med Oral Pathol Oral Radiol 2016; 121:434-40. [PMID: 26972542 DOI: 10.1016/j.oooo.2015.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 12/01/2015] [Accepted: 12/14/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE There is ongoing controversy with regard to the stability of calcified carotid artery plaques (CCAPs) seen in the bifurcation area on panoramic images (PIs). Therefore, we sought to evaluate the possibility of these plaques shedding emboli by observing their relationship with ipsilateral retinal emboli. STUDY DESIGN The study group included 50 neurologically and visually asymptomatic males with diabetes, with PIs that incidentally demonstrated CCAPs (CCAP+) and contemporaneous digital retinal images that had been obtained for evaluation of diabetic retinopathy. The control group consisted of 50 males with diabetes who were matched for age and body mass index and had undergone both imaging studies and whose PIs were devoid of carotid plaques (CCAP-). The presence of retinal emboli was determined by two ophthalmologists blinded to the patients' medical histories, and the prevalence rates for the two groups were calculated. RESULTS The presence of asymptomatic retinal arteriolar emboli was found in the eye ipsilateral to the radiographically observed carotid atheroma in 10 of 50 (20%) of the patients in the CCAP+ group, compared with 2 of 50 (4%) in the CCAP- group, and this difference was statistically significant (Fisher's exact P < .03). CONCLUSIONS Some male patients with diabetes mellitus type II having calcified carotid artery atheromas in the bifurcation area, as visualized on PIs, may have significant sequelae as evidenced by retinal artery emboli.
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Affiliation(s)
- Arthur H Friedlander
- Associate Chief of Staff and Director of Graduate Medical Education, Veterans Affairs Greater Los Angeles Healthcare System; Director of Quality Assurance, Hospital Dental Service, Ronald Reagan UCLA Medical Center; Professor-in-Residence of Oral and Maxillofacial Surgery, School of Dentistry, University of California, Los Angeles, CA, USA.
| | - JoAnn A Giaconi
- Chief of Ophthalmology, Veterans Affairs Greater Los Angeles Healthcare System; Associate Clinical Professor at the UCLA Jules Stein Eye Institute, Los Angeles, CA, USA
| | - Irena Tsui
- Staff Ophthalmologist, Veterans Affairs Greater Los Angeles Healthcare System and Assistant Professor at the UCLA Jules Stein Eye Institute, Los Angeles, CA, USA
| | - Nona Aghazadehsanai
- Oral and Maxillofacial Surgery Research Fellow, Veterans Affairs, Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Tina I Chang
- Director of the Research Fellowship and Inpatient Oral and Maxillofacial Surgery, Veterans Affairs Greater Los Angeles Healthcare System; Instructor of Oral and Maxillofacial Surgery, School of Dentistry, University of California, Los Angeles, CA, USA
| | - Neal R Garrett
- Professor Emeritus, School of Dentistry, University of California, Los Angeles, CA, USA
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Kamak G, Yildirim E, Rencber E. Evaluation of the relationship between periodontal risk and carotid artery calcifications on panoramic radiographs. Eur J Dent 2016; 9:483-489. [PMID: 26929685 PMCID: PMC4745228 DOI: 10.4103/1305-7456.172614] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Objective: To evaluate if there is a relationship between findings of carotid artery calcification (CAC) and periodontal risk in nonsmoker subjects by using panoramic radiographs (DPR). Materials and Methods: A total of 1146 DPRs were investigated. Gender, age, severity of bone loss, tooth loss, periodontal risk, and findings of carotid calcification were recorded. The periodontal risk was evaluated and classified according to the degree of alveolar bone loss. Results: CAC was diagnosed in %13.6 (n: 156) of DPRs. Of 1146 patients, 338 (29.5%) had low, 668 (60%) had moderate, and 120 (10.5%) had high periodontal risk. A statistically significant relation was observed between carotid calcification and periodontal risk. Conclusion: Positive findings of carotid calcification may be related with periodontal problems. Clinicians must be careful about diagnosing CACs on DPRs during routine examinations. In the case of positive findings of CAC and periodontitis together, the patient may be consulted to a specialist for further investigation.
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Affiliation(s)
- Gulen Kamak
- Department of Periodontology, Faculty of Dentistry, Kirikkale University, Kirikkale, Turkiye
| | - Eren Yildirim
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Kirikkale University, Kirikkale, Turkiye
| | - Emin Rencber
- Department of Public Health, School of Medicine, Ondokuz Mayıs University, Samsun, Turkiye
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Barona-Dorado C, Gutierrez-Bonet C, Leco-Berrocal I, Fernández-Cáliz F, Martínez-González JM. Relation between diagnosis of atheromatous plaque from orthopantomographs and cardiovascular risk factors. A study of cases and control subjects. Med Oral Patol Oral Cir Bucal 2016; 21:e66-71. [PMID: 26595828 PMCID: PMC4765754 DOI: 10.4317/medoral.20183] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 09/20/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND In recent years the use of orthopantomography has been proposed as a low-cost, reliable and non-invasive diagnostic medium for detecting atheromatous plaque. The purpose of this study was to correlate the presence of carotid calcifications (atheroma) in orthopantomographs with specific risk factors for cerebrovascular accidents (previous cerebrovascular accidents, arterial hypertension, and diabetes). PATIENT AND METHODS The methods used in this observational study of cases and control subjects followed STROBE (Strengthening the Reporting of Observational studies in Epidemiology) recommendations. The study analyzed a total of 1,602 panoramic radiographs taken for dental diagnostic purposes between January 2010 and February 2014. The main variables analyzed were the incidence of atheromatous plaque and other cardiovascular risk factors. Epidat 3.1 statistical software was used to determine minimum sample sizes and the results were analyzed using PASW (Predictive Analytics Software) Statistics 10.0.0. RESULTS For all the variables analyzed, the correlation between radiographic detection of atheromatous plaque and the presence of cardiovascular disease risk factors was found to be statistically significant (RR>1.5). CONCLUSIONS The presence of cardiovascular risk factors is related to the incidence of radiopaque lesions at the carotid artery bifurcation, indicating the presence of atheromatous plaque.
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Atalay Y, Asutay F, Agacayak KS, Koparal M, Adali F, Gulsun B. Evaluation of calcified carotid atheroma on panoramic radiographs and Doppler ultrasonography in an older population. Clin Interv Aging 2015; 10:1121-9. [PMID: 26185431 PMCID: PMC4501685 DOI: 10.2147/cia.s84683] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim The aim of this study is to determine the reliability of panoramic radiograph (PR) as a screening tool for the detection of calcified carotid atheroma (CCA) by comparing it with Doppler ultrasonography (DU) examination. A second aim was to evaluate the relationship among CCA, systemic diseases, smoking, and body mass index in an older population. Materials and methods A total of 1,650 PRs of patients aged over 45 years (736 males and 914 females) were randomly selected. All the patients had been referred to the Faculty of Dentistry, Afyon Kocatepe University, Afyonkarahisar, Turkey, during 2013–2014 for routine PR screening. Medical data were collected from the archival records of the dental school. The patients were divided into two groups: Group A (study group), CCA findings were confirmed by DU (n=59); and Group B (control group), CCA findings were not confirmed by DU (n=34). Results Of the 1,650 individuals, 93 (5.63%) were detected to have CCA on PR. The population consisted of 43 males and 50 females with mean age of 59.84±10.92 years. No difference was determined in respect of CCA between the sexes (P=0.745). There was a significant difference between Group A and Group B in respect of hypertension (P=0.004). But there was no difference between Group A and Group B in respect of age (P=0.495), BMI (P=0.756), diabetes (P=0.168), and smoking (P=0.482) distribution. Conclusion Although PR cannot be used as an initial diagnostic method when searching for CCA, dentists should be aware of CCA on a routine PR, particularly in older patients who may also have the risk factors of obesity, diabetes mellitus, hypertension, and smoking. Recognizing of CCA especially in hypertensive patients could potentially increase the length and quality of life for individuals.
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Affiliation(s)
- Yusuf Atalay
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Afyon Kocatepe University, Afyonkarahisar, Turkey
| | - Fatih Asutay
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Afyon Kocatepe University, Afyonkarahisar, Turkey
| | - Kamil Serkan Agacayak
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Dicle University, Diyarbakır, Turkey
| | - Mahmut Koparal
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Adıyaman University, Adıyaman, Turkey
| | - Fahri Adali
- Department of Cardiovascular Surgery, Faculty of Medicine, Afyon Kocatepe University, Afyonkarahisar, Turkey
| | - Belgin Gulsun
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Dicle University, Diyarbakır, Turkey
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26
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Friedlander AH, El Saden SM, Hazboun RC, Chang TI, Wong WK, Garrett NR. Detection of carotid artery calcification on the panoramic images of post-menopausal females is significantly associated with severe abdominal aortic calcification: a risk indicator of future adverse vascular events. Dentomaxillofac Radiol 2015; 44:20150094. [PMID: 25945511 DOI: 10.1259/dmfr.20150094] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Outcome studies among post-menopausal females with calcified carotid artery plaque (CCAP) on their panoramic images have not been previously undertaken. We sought to compare the extent of abdominal aortic calcification (AAC) on lateral lumbar spine radiographs (LLSRs), among groups of females with (CCAP+) and without (CCAP-) carotid lesions on their panoramic images. "Severe" levels of AAC have previously been validated as a risk indicator of future adverse cardiovascular events. METHODS This cross-sectional case-control study included a "CCAP+ group" consisting of females more than 50 years of age having the carotid lesion diagnosed by their dentists and an atherogenic risk factor (age, body mass index, hypertension, diabetes and dyslipidaemia)-matched "CCAP- group". A physician radiologist, using the Framingham index, evaluated the LLSRs for the magnitude of AAC. Summary statistics for key variables were computed and conditional logistic regression techniques were considered. RESULTS Members of the CCAP+ group were significantly (p=0.038) more likely to demonstrate "severe" levels of AAC on their LLSRs than members of the CCAP group. CONCLUSIONS This is the first published study demonstrating that CCAP on panoramic images of post-menopausal females is significantly associated with "severe" levels of AACs on LLSRs independent of traditional risk factors. Given that these levels of AAC are a validated risk indicator of future myocardial infarction and stroke, dentists must evaluate the panoramic images of post-menopausal females for the presence of CCAP. Patients with carotid atheromas should be referred to their physicians for further evaluation given the systemic implications.
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Affiliation(s)
- A H Friedlander
- 1 Department of Graduate Medical Education, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA.,2 Department of Oral and Maxillofacial Surgery, School of Dentistry, University of California Los Angeles, Los Angeles, CA, USA
| | - S M El Saden
- 3 Imaging Service, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA.,4 Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - R C Hazboun
- 5 Dental Service, Oral and Maxillofacial Surgery Division, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - T I Chang
- 2 Department of Oral and Maxillofacial Surgery, School of Dentistry, University of California Los Angeles, Los Angeles, CA, USA.,5 Dental Service, Oral and Maxillofacial Surgery Division, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - W K Wong
- 6 Department of Biostatistics, School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
| | - N R Garrett
- 7 Dean's Office, School of Dentistry, University of California Los Angeles, CA, USA
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Lee JS, Kim OS, Chung HJ, Kim YJ, Kweon SS, Lee YH, Shin MH, Yoon SJ. The correlation of carotid artery calcification on panoramic radiographs and determination of carotid artery atherosclerosis with ultrasonography. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 118:739-45. [DOI: 10.1016/j.oooo.2014.09.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 08/26/2014] [Accepted: 09/11/2014] [Indexed: 10/24/2022]
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Bengtsson VW, Persson GR, Renvert S. Assessment of carotid calcifications on panoramic radiographs in relation to other used methods and relationship to periodontitis and stroke: a literature review. Acta Odontol Scand 2014; 72:401-12. [PMID: 24432815 DOI: 10.3109/00016357.2013.847489] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To assess the literature on carotid calcifications defined from panoramic radiographs (PMX) and concurrent diagnosis of stroke and periodontitis. MATERIALS AND METHODS A literature search screening for publications using search terms such as PMX and carotid calcification, stroke and periodontitis was performed in November 2012. RESULTS A total of 189 articles were retrieved, among which 30 were included in the review. The sensitivity for PMX findings of carotid calcifications (CC) compared to a diagnosis by Doppler sonography varied between 31.1-100%. The specificity for PMX findings of carotid calcifications compared to a diagnosis by Doppler sonography varied between 21.4-87.5%. Individuals with CC findings from PMX have more periodontitis and risk for stroke. CONCLUSIONS There is a shortage of well-designed studies in older dentate individuals assessing the associations between periodontitis and radiographic evidence of CC and in relation to stroke or other cardiovascular diseases. STATEMENT OF CLINICAL RELEVANCE: Carotid calcifications are prevalent in patients with periodontitis and such individuals may have an increased risk for stroke. The absence of signs of carotid calcification on panoramic radiographs is indicative of no calcification of carotid arteries.
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Takahashi R, Muramatsu C, Hara T, Hayashi T, Katsumata A, Zhou X, Fujita H. [Improvements to an automated method for detecting carotid artery calcifications by adopting a positional feature and feature selection]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2014; 70:526-33. [PMID: 24953317 DOI: 10.6009/jjrt.2014_jsrt_70.6.526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The purpose of this study was to improve an automated scheme for detecting carotid artery calcification (CAC) in dental panoramic radiographs (DPRs). Using 100 DPRs, the sensitivity of CAC detection employing our previous method was 90.0% with 5.0 false positives (FPs) per image. This study describes two enhancements. One is the adoption of a new feature for the position of CACs in addition to previous features. The other is feature selection employing the support vector machine using all combinations. Five of 12 features were selected. Using our proposed method, the average sensitivity for the same database proved to be 90.0%, with only 2.5 FPs per image. These results indicate the potential effectiveness of the new positional feature and feature selection.
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Affiliation(s)
- Ryo Takahashi
- Department of Intelligent Image Information, Division of Regeneration and Advanced Medical Sciences, Graduate School of Medicine
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30
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Association of calcified carotid atheromas visualized on panoramic images and aortic arch calcifications seen on chest radiographs of postmenopausal women. J Am Dent Assoc 2014; 145:345-51. [DOI: 10.14219/jada.2013.46] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Brasileiro Junior VL, Luna AHB, Sales MAOD, Rodrigues TLC, Sarmento PLDFA, Mello Junior CFD. Reliability of digital panoramic radiography in the diagnosis of carotid artery calcifications. Radiol Bras 2014. [DOI: 10.1590/s0100-39842014000100011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objective The present study evaluated the reliability of digital panoramic radiography in the diagnosis of carotid artery calcifications. Materials and Methods Thirty-five patients under high-risk for development of carotid artery calcifications who had digital panoramic radiography were referred to undergo ultrasonography. Thus, 70 arteries were assessed by both methods. The main parameters utilized to evaluate the panoramic radiography reliability in the diagnosis of carotid artery calcifications were accuracy, sensitivity, specificity and positive predictive value of this method as compared with ultrasonography. Additionally, the McNemar's test was utilized to verify whether there was a statistically significant difference between digital panoramic radiography and ultrasonography. Results Ultrasonography demonstrated carotid artery calcifications in 17 (48.57%) patients. Such individuals presented with a total of 29 (41.43%) carotid arteries affected by calcification. Radiography was accurate in 71.43% (n = 50) of cases evaluated. The degree of sensitivity of this method was 37.93%, specificity of 95.12% and positive predictive value of 84.61%. A statistically significant difference (p < 0.001) was observed between the methods evaluated in their capacity to diagnose carotid artery calcifications. Conclusion Digital panoramic radiography should not be indicated as a method of choice in the investigation of carotid artery calcifications.
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Prevalence of calcified carotid artery atheromas in panoramic radiographs of HIV-positive patients undergoing antiretroviral treatment: a retrospective study. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 117:67-74. [DOI: 10.1016/j.oooo.2013.08.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2013] [Revised: 08/23/2013] [Accepted: 08/28/2013] [Indexed: 12/11/2022]
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Friedlander AH, Chang TI, Aghazadehsanai N, Berenji GR, Harada ND, Garrett NR. Panoramic images of white and black post-menopausal females evidencing carotid calcifications are at high risk of comorbid osteopenia of the femoral neck. Dentomaxillofac Radiol 2013; 42:20120195. [PMID: 23571481 DOI: 10.1259/dmfr.20120195] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES Femoral neck fractures in older females resulting from decreased bone mineral density (BMD; osteopenia) are associated with increased morbidity and mortality. Bone mineralization inhibition is probably controlled by proteins which also foster vascular calcification. Therefore, we evaluated the relationship between calcified carotid artery plaque (CCAP) on panoramic images and BMD on dual energy X-ray absorptiometry (DXA) bone scans. METHODS Images and hospital records identified by dentists defined two study groups (20 white females and 24 black females) having CCAP and an incidentally obtained bone scan. Ethnically matched (age±7 years, body mass index ±3 units) control groups with panoramic images devoid of CCAP and accompanying DXA scan were likewise constituted. A physician determined the BMD on the DXA. RESULTS Females with CCAP had significantly (p = 0.03) poorer BMD at the femoral neck than those without CCAP. Although mean femoral neck BMD was significantly lower (p = 0.009) for white than for black females, there was no significant interaction between race and CCAP (p = 0.80). CONCLUSION We observed a significant inverse association between the CCAP on panoramic images and femoral neck BMD in post-menopausal white females.
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Affiliation(s)
- A H Friedlander
- VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA.
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MacDonald D, Chan A, Harris A, Vertinsky T, Farman AG, Scarfe WC. Diagnosis and management of calcified carotid artery atheroma: dental perspectives. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 114:533-47. [PMID: 22986250 DOI: 10.1016/j.oooo.2012.06.020] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2012] [Revised: 06/26/2012] [Accepted: 07/09/2012] [Indexed: 10/27/2022]
Abstract
The calcification of cervical carotid artery atheroma (CCAA) represents maturation of a lumenal atherosclerotic plaque that has been associated with a high risk of cerebral stroke. The demonstration of CCAA on rotational panoramic images has received increasing attention in dentistry since it was first described in 1981. The purposes of this article are to provide a background to the mechanism of arterial calcification, to review the clinical diagnostic and management algorithms for dental practitioners when CCAA are identified radiologically, and to describe and illustrate current appropriate radiographic modalities and medical management strategies used to confirm and assess stenosis associated with CCAA.
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Affiliation(s)
- David MacDonald
- Division of Oral and Maxillofacial Radiology, Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada.
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Friedlander AH. Carotid Artery Calcifications are a Risk Indicator for Both Stroke and Myocardial Infarction. J Evid Based Dent Pract 2013; 13:37. [DOI: 10.1016/j.jebdp.2012.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 12/13/2012] [Indexed: 10/27/2022]
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Friedlander AH, Chang TI, Chantra PK, Aghazadehsanai N, Harada ND, Garrett NR. Do carotid atheromas on panoramic images prognosticate arterial calcifications on mammograms: acknowledged markers of future adverse cardiovascular events? Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 114:526-32. [PMID: 22986249 DOI: 10.1016/j.oooo.2012.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Revised: 04/26/2012] [Accepted: 05/14/2012] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the relationship between calcified carotid artery plaque (CCAP) on panoramic images and breast arterial calcifications (BAC) on mammograms, a validated independent risk indicator of fatal myocardial infarctions and strokes. MATERIALS AND METHODS Women ≥55 years old having CCAP diagnosed by their dentists had their mammograms evaluated for BAC by a physician. Other study variables were age, ethnicity, body mass index, and medications for hypertension, diabetes, and dyslipidemia. Descriptive and bivariate statistics and logistic regression were computed. RESULTS Researchers identified 40 women (mean age 62.2 ± 6.2 years old) with CCAP, of whom 9 (prevalence rate 22.5%) also had BAC. The women with BAC tended to be older (65.1 vs 61.3 years old), more frequently hypertensive (100% vs 80.6%), and more frequently black than those without BAC, although these differences were not statistically significant (P > 0.10). CONCLUSIONS CCAP on panoramic images of women is unrelated to the presence of BAC on mammograms.
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Affiliation(s)
- Arthur H Friedlander
- Veterans Affairs Greater Los Angeles Healthcare System, Oral and Maxillofacial Surgery, School of Dentistry, University of California, Los Angeles, California, USA.
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