The Prevalence and Correlation of Carotid Artery Calcifications and Dental Pulp Stones in a Saudi Arabian Population

Radiographic evaluation of teeth with pulp stones and pulp canal obliteration: characteristics, and associations with dental parameters

The study aimed to radiographically assess the characteristics of pulp stones (PS) and pulp canal obliteration (PCO) in teeth and examined their associations with various dental parameters such as caries, restorations, periodontal status, and age. This cross-sectional observational study was conducted at the Faculty of Dentistry, King Abdulaziz University between September 2022, and May 2023, involved 101 patients exhibiting 402 teeth with PS or PCO. Data were collected from periapical and bitewing radiographs, and analyzed by two calibrated dentists. Multiple dental parameters were assessed, including caries level, presence and level of restorations, periodontal condition, and age of the patient. The study population consisted of 62 females and 39 males, with an age range of 18-65 years. Inter- and intra-examiner reliability were high (Kappa = 0.88 and 0.98 respectively). PS were more commonly found in molars (81.2%), while PCO were presented in only 115 teeth (23%). Age significantly affected the type of calcification (p < 0.001), with PS more common in the 20-30 age group and PCO more common in individuals over 40. Presence of caries was significantly associated with the type of calcification (p = 0.013), but restoration was not. The majority of teeth with PS (76%) or PCO (93%) had healthy periodontium. Around 40% of teeth with PCO showed signs of periapical changes, a finding significantly different from those with PS (p < 0.001). Pulp calcifications were significantly associated with various dental parameters, including caries presence, age, and periodontal status. The findings provide crucial insights into the epidemiology and aetiology of pulp calcifications.

Cone-Beam Computed Tomography-Based Investigation of the Prevalence and Distribution of Pulp Stones and Their Relation to Local and Systemic Factors in the Makkah Population: A Cross-Sectional Study

Objectives This study aimed to assess the prevalence and distribution of dental pulp stones and evaluated their possible associations with local and systemic factors in the Makkah population in Saudi Arabia. Materials and methods Archived cone-beam computed tomography (CBCT) images for 390 patients, from the electronic health records (EHR) in the Dental Teaching Hospital, Umm Al-Qura University, were used. Images were examined in all planes (coronal, sagittal, and axial) for a discrete radiopaque mass in the pulp of all teeth, in both arches. The teeth conditions (the presence of caries, restoration, the periodontal condition, and the presence of pulp stones) were recorded. Additional patient information, including age, gender, and medical condition, was obtained from the patients' archived files. The collected data were statistically analyzed using the Statistical Package for Social Sciences (SPSS) (IBM SPSS Statistics, Armonk, NY) software; a p-value of ≤ 0.05 is considered statistically significant. Results Pulp stone prevalence was 78.97% of the subjects (308 out of 390) and 15.92% of the examined teeth (1644 out of 10326). There were statistically significant differences regarding nationality (p=0.043) and age (p=0.023) but no significant difference between males and females (p=0.876), maxillary and mandibular teeth (p=0.392), and right and left sides (p=0.222) in pulp stone prevalence. Significant differences were found between pulp stone prevalence of sound versus and carious and restored teeth and between periodontally affected teeth and periodontally healthy teeth (p=0.031). Conclusion The prevalence of pulp stones in the Makkah population is high. A positive association was found between nationality, age, tooth restorations, caries, periodontal diseases, and pulp stone prevalence, but no correlation was found with patients' health or gender. The molars were the most affected teeth, while the incisors were the least.

A systematic review assessing the dental pulp stone prevalence in the Saudi Arabian population

This Systematic Review (SR) was to report on the prevalence of pulp stones in the Saudi Arabian (KSA) population. The electronic databases were searched for scientific research articles during May 2021. The data search was performed in electronic search engines like PubMed, Scopus, Web of science, and Saudi Digital Library, and 6 original research articles which fulfilled the eligibility criteria were assessed for qualitative data. The prevalence of pulp stones among the KSA population ranged from 4.6% to 50.93% among the study participants and it ranged between 10.2%-13.34% in the teeth assessed. The pulp stones were more frequently reported in decayed teeth, periodontal diseases, attrition, teeth with dental restorations, and higher in the molar teeth in comparison with the premolar teeth. The data on the prevalence of pulp stones among the Saudi population will be helpful for clinicians in planning endodontic procedures.

Early diagnosis of aortic calcification through dental X-ray examination for dental pulp stones

Vascular calcification, an ectopic calcification exacerbated by aging and renal dysfunction, is closely associated with cardiovascular disease. However, early detection indicators are limited. This study focused on dental pulp stones, ectopic calcifications found in oral tissues that are easily identifiable on dental radiographs. Our investigation explored the frequency and timing of these calcifications in different locations and their relationship to aortic calcification. In cadavers, we examined the association between the frequency of dental pulp stones and aortic calcification, revealing a significant association. Notably, dental pulp stones appeared prior to aortic calcification. Using a rat model of hyperphosphatemia, we confirmed that dental pulp stones formed earlier than calcification in the aortic arch. Interestingly, there were very few instances of aortic calcification without dental pulp stones. Additionally, we conducted cell culture experiments with vascular smooth muscle cells (SMCs) and dental pulp cells (DPCs) to explore the regulatory mechanism underlying high phosphate-mediated calcification. We found that DPCs produced calcification deposits more rapidly and exhibited a stronger augmentation of osteoblast differentiation markers compared with SMCs. In conclusion, the observation of dental pulp stones through X-ray examination during dental checkups could be a valuable method for early diagnosis of aortic calcification risk.

Antunes L, Gabbardo MCL, Silva Barroso de Oliveira D, Sousa-Neto MD, Baratto-Filho F, Küchler EC. The investigation of WNT6 and WNT10A single nucleotide polymorphisms as potential biomarkers for dental pulp calcification in orthodontic patients

The aim of this study is to evaluate if single nucleotide polymorphisms (SNPs) in WNT6 and WNT10A are associated with the risk of dental pulp calcification in orthodontic patients. This cross-sectional study followed the "Strengthening the Reporting of Genetic Association Studies" (STREGA) guidelines. Panoramic radiographs (pre- and post-orthodontic treatment) and genomic DNA from 132 orthodontic patients were studied. Dental pulp calcification (pulp stones and/or pulp space narrowing) was recorded in upper and lower first molars. The SNPs in WNT6 and WNT10A (rs7349332, rs3806557, rs10177996, and rs6754599) were assessed through genotyping analysis using DNA extracted from buccal epithelial cells. The association between pulp calcification and SNPs were analyzed using allelic and genotypic distributions and haplotype frequencies (p<0.05). Prevalence of dental pulp calcification was 42.4% in the 490 studied molars. In the genotypic analysis, the SNPs in WNT10A showed a statistically significant value for molar calcification (p = 0.027 for rs1017799), upper molar calcification (p = 0.040 for rs1017799) (recessive model), and molar calcification (p = 0.046 for rs3806557) (recessive model). In the allelic distribution, the allele C of the SNP rs10177996 in WNT10A was associated with molar calcifications (p = 0.042) and with upper first molar calcification (p = 0.035). Nine combinations of haplotypes showed statistically significant value (p<0.05). The findings of this study indicates that SNPs in WNT10A and WNT6 are associated with dental pulp calcification in molars after orthodontic treatment and may be considered as biomarkers for dental pulp calcification.

Association between the prevalence of pulp stones and calcified atherosclerotic plaques: a systematic review and meta-analysis

OBJECTIVE

To evaluate the association between the prevalence of pulp stones (PS) in permanent teeth and calcified atherosclerotic plaques (CAP).

METHODS

An electronic search was performed in 10 databases to locate observational studies that investigated the association between PS in permanent teeth and CAP, published until March 2022. Two reviewers performed the search, selection and extraction of data from eligible studies. The individual risk of bias of eligible studies was assessed using the JBI Critical Appraisal Tools. The meta-analysis was conducted using fixed and random effects and odds ratio (OR) as an effect measure with a 95% confidence interval (CI). The heterogeneity between the studies was quantified using the I² test. The certainty of evidence was evaluated using the GRADE approach.

RESULTS

The electronic search resulted in 2968 records, of which only 7 studies were considered eligible. The total sample consisted of 3770 participants from 5 countries. All studies showed biases of confounding factors and exposure assessment. Based on six studies and with very low certainty of evidence, the meta-analysis showed that patients with PS were more likely to also have CAP in carotid or coronary arteries (OR: 1.70; 95% CI: 1.21; 2.38, I² = 0%).

CONCLUSIONS

Limited evidence suggests that there is a positive association between the prevalence of PS in permanent teeth detected using panoramic radiography and CAP in the coronary or carotid arteries.

The association of dental pulp stones to cardiovascular and renal diseases: A systematic review and meta-analysis

BACKGROUND

Pulp stone (PS) is a dystrophic calcification in the tooth's pulp chamber and was suggested in the literature to be associated with other calcifications in the body. This study aimed to investigate the association of PS to cardiovascular diseases (CVD) and renal stones (RS).

METHODS

Three databases were searched until June 2021 in addition to manual searching of Google Scholar and grey literature. Original studies were only included and critically appraised using an adapted version of the Newcastle-Ottawa scale. The odds ratio (OR) effect measure was calculated using the Mantel-Haenszel statistical test (95% confidence interval [CI]) to investigate the association of PS with CVD and or RS (p-value ˂ 0.05).

RESULTS

The database search identified 4933 studies, and 19 studies were finally included. The risk of bias was low in thirteen studies, moderate in four studies, and high in two studies. The meta-analysis of the moderate-and-low risk of bias studies revealed a significant association between PS and CVD (OR 3.35, 95% CI 1.91-5.89, P < 0.001, I² = 65%), but no association was found between PS and RS. The results also revealed an association between PS and CVD in patients older than 40 (OR 8.78, 95% CI 3.64-21.17, P < 0.001, I² = 0%).

CONCLUSIONS

The current study results showed an association between PS and CVD, but no association was found between PS and RS. PS in patients younger than 40 years, compared to older patients (> 40 years), was associated with CVD.

Dental pulp calcifications in prehistoric and historical skeletal remains

BACKGROUND

The prevalence of hard tissue formations in the dental pulp varies considerably. Beside ageing processes and irritations of the dental pulp, etiological associations with cardiovascular disease and dietary habits have been discussed, which are of particular research interest. The aim of this pilot study is to provide new insights on structural and etiological factors involved in the development of pulp calcifications by investigating skeletal remains from different (pre)historic periods.

METHODS

The jaws of 46 skeletons excavated in central Germany, were examined for the presence of pulp stones using digital volume tomography (DVT). A total of 1122 teeth were examined with all tooth types considered. To obtain information about the three-dimensional structure of pulp calcifications, micro-CT images were taken. Thin sections of three molars were histologically analysed. Potential dietary effects were studied by analysing stable isotope ratios of nitrogen (δ¹⁵N) in bone samples collected from each individual.

RESULTS

The analysis indicates that pulp stones affect molars in particular and increase slightly with age and dental wear. The micro-CT scans and the histological analysis show that the structures are much more complex than presumed on the basis of DVT imaging. Individuals with lower δ¹⁵N-isotope values and thus with a potentially lower proportion of animal protein in their diet appear to be less affected by pulp stones.

CONCLUSION

When comparing between archaeological and recent data, DVT analysis provides qualitatively comparable results. Micro-CT and histological images illustrate the excellent preservation of pulp calcifications and their complex structure. Differences in prevalence rates and δ¹⁵N-isotope values of Neolithic and historical individuals support the assumption that dietary habits and living conditions could have an influence on the development of pulp calcifications. Due to the small sample size these results require further validation.

Incidence and distribution of pulp stones among Southern Saudi Arabian sub-population

Purpose:

To assess the incidence of pulp stones in molar and premolar teeth of Southern Saudi Arabian adult sub-population.

Materials and Methods:

Six hundred patient files were randomly selected from the database (records) of the College of Dentistry outpatient department screened by Oral Medicine and Radiology division. Orthopantomogram and bitewing radiographs using radiovisiographs of first and second maxillary and mandibular molars and premolars were interpreted by three examiners. Pulp stones were identified as definite radiopaque masses and scored as present or absent. Data were subjected to statistical analysis using SPSS version 19.

Results:

Out of total 600 patients, pulp stones were found in 88 (14.7%) patients. Females showed statistically significant higher presence of pulp stones in mandibular molars than males. The patients belonging to middle age group (31–40 years) showed statistically significant higher presence of pulp stones than the other two groups in all first and second molar teeth in both arches. The presence of pulp stones was observed to be higher in maxillary arch than mandibular arch with left side having more frequency than the right side of the arch.

Conclusion:

The prevalence of pulp stones in the study population was found to be 14.7%, and it was higher in molars than premolars. It is quite significant to know the frequency distribution of pulp stones especially for an endodontist or a dentist to plan the root canal treatment of such teeth accordingly.

Assessing the Prevalence and Association of Pulp Stones with Cardiovascular Diseases and Diabetes Mellitus in the Saudi Arabian Population-A CBCT Based Study

The detection of pulp stone in a patient suffering from undiagnosed systemic diseases can be an early diagnostic indicator. Thus, the aim of the study was to assess the prevalence of pulp stones in the Saudi Arabian population with cardiovascular diseases and diabetes mellitus. In a retrospective study, we included cone-beam computed tomography (CBCT) scans of 73 patients with cardiovascular disease and 76 patients with diabetes mellitus as group I and II, respectively. Group III comprised of CBCT scan of 80 healthy controls. From a total of 229 scans, 4807 teeth were screened for pulp stones throughout the arches. A chi-square test was used for comparing the prevalence of pulp stones among the groups. Univariable and multivariable analysis was done to evaluate the independent risk indicators for pulp stones. The tooth-wise prevalence of pulp stones in group I, II, and III was found to be 16.65%, 9.01%, and 3.86%, respectively. Patient-wise (p < 0.01) and tooth-wise (p < 0.01) prevalence was recorded significantly highest in the cardiovascular group followed by the diabetic group. The control group had the least prevalence. Significantly (p < 0.01) higher number of pulp stones were found in cardiovascular patients with age > 50 years compared to other groups. Similarly, a significantly increased number of pulp stones were seen in the 1st molar (p < 0.05) and the maxillary jaw (p < 0.05) of patients with cardiovascular diseases. Subjects with cardiovascular disease and diabetes were found to have 2.94 times (p < 0.001; CI 1.54-3.10) and 1.81 times (p < 0.01; CI 0.48-2.06) higher risk of having pulp stones in comparison to healthy subjects. The first molar has 2.20 times (p < 0.001; CI 0.84-2.45) increased the risk of having pulp stones compared to other tooth types. Systemic disease such as cardiovascular disease and diabetes mellitus poses a higher risk for the development of pulp stones. Among the systemic disease group, patients in the cardiovascular group showed a higher risk for pulp stones and also reported the maximum number of pulp stones compared to the diabetic and healthy subjects.

Sialometric and Sialochemical Analysis in Individuals With Pulp Stones

The aim of this study was to analyze the saliva of patients with pulp stones, with sialometric and sialochemical tests. Eighty individuals, aged between18 and 65 years, of both sexes, were investigated. Patients were included in the pulp stone group when radiographic examination was suggestive of pulp stones in at least one permanent tooth, whereas those without this alteration were considered controls. Saliva was collected by stimulation, followed by salivary flowrate (SFR) and pH analysis tests. The organic components, such as urea (URE), glucose (GLU), total proteins (TPTs), alkaline phosphatase, creatinine (CRE), salivary amylase (SAM), and uric acid (URA), and the inorganic components, such as calcium, iron, and phosphorus, were evaluated by colorimetric techniques in an ultraviolet–visible (UV–vis) spectrophotometer. Differences among pulp stones and control groups were compared using Student’s t-test, with a significance level of p < 0.05. In both groups prevailed the female. Statistically significant differences between groups were observed for pH (p = 0.027), SFR (p = 0.002), alkaline phosphatase (p = 0.008), and URA (p = 0.005). None of the inorganic components showed significant difference (p > 0.05). In the analyses stratified by sex, difference between groups was observed for pH (p = 0.007) and URA (p = 0.003) in women. In conclusion, sialometric and sialochemical alterations occurred in patients with pulp stones, with significantly higher levels of pH, SFR, alkaline phosphatase, and URA.