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Carotid artery calcifications visible on the right and left neck, adjacent to the upper intervertebral space between C3 and C4 (white arrows) as shown on a panoramic radiography.
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The aim of this study is to determine retrospectively the presence of carotid artery calcifications (CACs) detected on panoramic radiographs (PRs) in a group of Turkish population. Further, the relationships between CACs and gender, life style, and medical history were evaluated.
During the years 2004 to 2006, a random sample of 1282 PRs was collec...
Citations
... Bayer et al., Saati et al. and Garay et al. who reported a higher prevalence of calcifications of carotid artery in the middle-aged female population 3,17,21 .Women were more typically affected in the post-menopausal period (>50 years) owing to the diminished oestrogen levels. The role of oestrogen in the metabolism of lipoproteins is well established in the literature, and it is known to inhibit the formation of atheromatous plaques4,22 . The link between the risk of ischemic stroke and the occurrence of carotid artery calcifications has been a source of debate. ...
Aim: To evaluate the prevalence of soft tissue calcifications in orofacial region and their panoramic radiographic characteristics using digital panoramic radiographs among patients reporting to a tertiary dental hospital. Methods: 1,578 digital panoramic radiographs were retrieved from the archives and scrutinized for the presence of calcifications. Soft tissue calcifications were recorded according to age, gender, site (left or right). Data were analysed using Chi-square and Fisher’s exact test using SPSS software and a p < 0.05 was considered statistically significant. Results: Among the total number of radiographs, calcified carotid artery (34.3%), calcified stylohyoid ligament (21%), tonsillolith (10.3%), phlebolith (17.6%), antrolith (6.3%), sialolith (5.9%), rhinolith (2.5%) and calcified lymph nodes (1.9%) were identified. The most commonly observed calcifications were calcification of carotid artery and stylohyoid ligament and the least commonly observed calcifications were rhinolith and calcified lymph node. A statistically significant association of the presence of calcifications of carotid artery and stylohyoid ligament on the left and right side was observed in females and tonsillolith on the right side in males (p-value < 0.05). Considering the gender and age group, the occurrence of antrolith among males and rhinolith among females of young-adult population, tonsillolith among the males, calcified carotid artery and stylohyoid ligament among the females of middle-aged population was found to be significant. Conclusion: Soft tissue calcifications are often encountered in dental panoramic radiographs. Our study revealed that the soft tissue calcifications in orofacial region were more common in women and were found to be increased above 40 years of age.
... Assuming that a 1/3 of the CAC patients are MM and the other two thirds are CM [37], and that the ratio of CAC vs. clean is 1:5, the probabilities of predicting X or C on the three types of patients with the actual p 1 and p 2 from the performance on a single side is presented in Table 3. Assuming that the dataset consists of 144 patients: 8 MM, 16 CM and 120 CC we would get the confusion matrix presented in Table 3. ...
Ischemic stroke, a leading global cause of death and disability, is commonly caused by carotid arteries atherosclerosis. Carotid artery calcification (CAC) is a well-known marker of atherosclerosis. Such calcifications are classically detected by ultrasound screening. In recent years it was shown that these calcifications can also be inferred from routine panoramic dental radiographs. In this work, we focused on panoramic dental radiographs taken from 500 patients, manually labelling each of the patients' sides (each radiograph was treated as two sides), which were used to develop an artificial intelligence (AI)-based algorithm to automatically detect carotid calcifications. The algorithm uses deep learning convolutional neural networks (CNN), with transfer learning (TL) approach that achieved true labels for each corner, and reached a sensitivity (recall) of 0.82 and a specificity of 0.97 for individual arteries, and a recall of 0.87 and specificity of 0.97 for individual patients. Applying and integrating the algorithm in healthcare units and dental clinics has the potential of reducing stroke events and their mortality and morbidity consequences.
... It was expected that the present study would demonstrate a lower prevalence of CCAA compared to studies that assessed a population with a higher age range. These variations in prevalence may be due to sample size, patient selection, regional, dietary and lifestyle differences of the subjects (1,19 (20) observed that the incidence rate of CCAA in females was about three times higher than the rate in males. However, Bayram et al. (12) did not find significant difference between the genders, in line with Sisman et al. (19) that observed a higher occurrence in female than in male, but the difference was not significant. ...
... These variations in prevalence may be due to sample size, patient selection, regional, dietary and lifestyle differences of the subjects (1,19 (20) observed that the incidence rate of CCAA in females was about three times higher than the rate in males. However, Bayram et al. (12) did not find significant difference between the genders, in line with Sisman et al. (19) that observed a higher occurrence in female than in male, but the difference was not significant. The result of women having a significantly higher incidence of CCAAs suggests a relationship between CCAAs and the decline of estrogen levels in the blood that affects postmenopausal women (20). ...
... ). Sisman et al.(19) found that all patients who had a higher prevalence of CCAA compared to the normal population, were due to underlying disorders causing atherosclerosis.The present study identified a significant difference (p = 0.013) between genders,25 (35.2%) male and 46 female (64.8%), with the majority of female patients presenting images suggestive of CCAA, in agreement with previous studies; Santos et al. (21) (70,8% female and 29,2% male), Agacayak et al. (18) (66.7% female and 33.3% male), Ohba et al. (16) (25 female and 8 male) and Ravon et al. (22) also detected a higher prevalence in female. Tamura et al. ...
Background: In recent years, the use of panoramic radiography (PR) has been proposed as a reliable method for early diagnosis of calcified carotid artery atheroma (CCAA). The aim of this study was to determine the prevalence of images suggestive of CCAA, observed in digital PRs from users of a Brazilian military organization, and investigate the presence of cardiovascular risk factors. Material and methods: The study analyzed a total of 2.015 digital PRs, taken for dental diagnostic purposes between January and September 2019 from patients of both genders and older than 18 years. Data were analyzed regarding prevalence of CCAA and cardiovascular risk factors using the Chi-square test at the significance level of 5%. Patients with a suggestive diagnosis of CCAA were contacted by telephone and invited to further evaluation. Results: Of 2.015 patients, 105 (6.06%; 46 women, 25 men) had CCAA detected on digital images. Of the 71 patients who agreed to further evaluation, 64.8% were women, 54.9% were 60 years or older, 38% military service, 45.1% overweight, 64.3% blood pressure alterations, 23.9% diabetics, 11.3% cardiovascular and respiratory disorders, 5.6% history of COVID-19, 12% cholesterol ≥ 240mg/dL, 26.5 % triglycerides ≥ 200mg/dL and 51% glycaemia ≥ 100mg/dL. For all variables analyzed there was statistically significant differences (p0.05), except for glycaemia (p=889). Conclusion: The presence of risk factors for stroke was meaningful in the population with CCAA, indicating the relevant role of the dentist in the early diagnosis.
... While most of the practitioners focus on teeth and jaws, it is advocated that the surrounding anatomical landmarks like cervical vertebrae, carotid bulb, thyroid cartilage, hyoid bone, portion of larynx and other ligaments should also be equally taken care of. The identification of calcified atherosclerotic plaque in the extra cranial carotid vasculature on panoramic radiographs has drawn a considerable attention among the oral and maxillofacial radiologists and by general dentists [21]. Stroke is considered as one of the leading cause of death in India [1]. ...
... Friedlander et al. [29], Mansur Ahmad et al. [30], Laurie. C carter et al. [31] determined the importance of identifying structures resembling carotid calcifications on panoramic radiographs have been reported in several different studies [20][21][22][23][24][25][26][27][28][29][30][31]. Most of the dental practitioners were unaware of pathologic radiopacities (calcified lymphnodes, phleboliths, tonsilloliths, and sialoliths) and anatomic radiopacities (hyoid bone, triticeous cartilage, stylomandibular ligament) on panoramic radiographs. ...
Background: Stroke had been the leading cause of death in industrialized countries, following cardiovascular disease and cancer. Aim and Objective: The present study aims to evaluate the fact that dental practitioners as health care providers ought to play their part in the early detection of patients at risk of having a cerebrovascular stroke. Materials and Methods: Initial study design consisted of 1000 panoramic radiographs (PRs), which were taken for patients visiting the department of Oral Medicine and Radiology. Two examiners reviewed all the radiographs. Sixty-one patients were found to have suspected carotid artery calcifications. Out of them, only 43 patients were subjected to Doppler ultrasound for confirmation of the carotid artery calcifications (CAC's). Results: Out of the 61 patients suspected of having carotid calcifications, 30 were male (49.2%) and 31 were female (50.8%) P value=0.844.Patients with age group between 51-61 had higher incidence of calcifications on orthopanograph (OPG). Mean age of the patients with calcifications on OPG was 56.67 ± SD of 10.15 (p=0.004). Of the final 43 subjects, only 11 patients were confirmed to have positive carotid calcifications in Doppler ultrasonography study. Out of 11 patients, only 9 patients had atherosclerotic plaques that were not hemodynamically important and 2 patients had less than 50% carotid artery stenosis. Based on the Kappa value of 0.397, the level of agreement would be moderate with p value <0.001. Conclusion: Our study suggests that panoramic radiography can be a significant measure for detecting stroke prone patient. The role of Dental practitioners can be extended further, and overcome certain obstacles before panoramic radiography can be implemented as a new screening method for patients at risk of having a stroke.
... PRs may help in the early diagnosis and evaluation of CACs in patients with or without associated risk factors, thus contributing to reducing the morbidity and mortality rates due to diseases caused by atherosclerosis. 8 Dentists play an important role in their early diagnosis by identifying calcified carotid artery atheroma in PRs. CACs are usually located posterosuperiorly to the angle of the mandible, approximately at the inferior margin of the third cervical vertebra (between C3 and C4) near the hyoid bone; however, their location is not limited to the hyoid bone or the thyroid cartilage. ...
... Sisman et al reported hyperlipidemia in 31.58% of their patient population with CAC. 8 In this study, although more atheroma plaques were found in patients with hypertension than in those with other systemic diseases, this did not reach the level of statistical significance. Nevertheless, hypertension was significantly higher than the other systemic diseases among patients with atheroma plaques. ...
... Regarding diseases and lifestyle factors associated with CAC, hyperlipidemia, hypertension, cardiovascular diseases, smoking, obesity, renal disease, diabetes mellitus, obstructive sleep apnea syndrome, and periodontitis have been reported. 8 30 In our study, the rate was 8.8%. The reason for the high prevalence of CAC compared to our study may be due to the differences in nutritional habits socially. ...
Background:
The aim of this study is to investigate the relationship of carotid artery calcifications detected in panoramic radiographs of patients aged 60 or older with isolated systemic diseases.
Patients and methods:
From October 2018 to December 2019, 867 panoramic radiographs of patients, who applied to Dicle University Faculty of Dentistry for various dental reasons, were collected for examination. Of these 867 panoramic radiographs, 444 panoramic radiographs were included in this study. Medical data were collected from the archival records of the dental school.
Results:
The study population consisted of 240 female (54.1%) and 204 male (45.9%) patients. Their mean age was 66 ± 7.3 (range: 60-92) years. Only 39 (8.8%) of the 444 patients had atherosclerotic plaques. Of the 39 patients with carotid artery calcification, 13 (33.3%) were male and 26 (66.7%) were female. As a result of statistical analysis, carotid artery calcification compared to other systemic diseases was found to be significantly more common in patients with hypertension (p = 0.009).
Conclusion:
Carotid artery calcifications detected coincidentally in standard panoramic radiographs of dental patients may be important markers for preventing serious risks such as coronary artery disease, stroke, and death. The relationship between carotid artery calcifications found on dental panoramic radiographs and hypertension was significant. Therefore, it seems that detection of carotid artery calcifications on panoramic images of hypertension patients must be considered by dentists.
... [5] The prevalence in the general population is reportedly 3-5%. [6] Tonsilloliths occur following chronic inflammation of tonsils. They are formed by dystrophic calcification. ...
... This type of calcification has been the subject of many studies in recent years, due to the fact this calcification is implicated with an increase in morbidity and mortality, particularly cerebrovascular disease (e.g ischaemic stroke). A number of studies point to a prevalence ranging from 3% to 5%, showing our data to be consistent [3,6,20,21]. "Bayer et al. [20] reported in their study that the presence of calcified carotid atheromas were more common in females than males. There were similar findings in our data, however the results were not statistically significant (p=0.093) ...
... Carotid artery atheromas are often misdiagnosed as calcification of the triticeous cartilage, thyroid cartilage, salivary stones, hyoid bone, lymph nodes and stylomandibularand stylohyoid ligaments [3,[20][21][22][23][24][25][26][27]. Kamikawa et al. [14] undertook a study on cadavers, which determined a great variability between the observers in the distinction between these anatomical structures. ...
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.
... awareness of calcification of surrounding soft tissues may mask the true presentation. Incidental calcification of carotid arteries have been previously reported as high as 5.06% in patients undergoing routine dental x-rays [3], therefore, appropriate translation is required on interpretation of lateral soft tissue neck x-rays. ...
Authors present an 80-year-old male attending with obstructive food bolus. Lateral soft tissue neck x-ray demonstrated a suspected calcified foreign body at the level of the larynx. Subsequent senior radiological input reported the findings as incidental calcification of carotid arteries. ENT surgeons should demonstrate increased awareness for potentially calcified soft tissues on interpreting such x-rays.
... The incidence of CAC detected on panoramic radiographs was investigated by many authors in different populations [15][16][17][18][19][20][21][22]. ...
Objective:
The aim of this study was to estimate the incidence of carotid artery calcification (CAC) in a sample of Lebanese population using digital panoramic radiographs.
Materials and methods:
Panoramic radiographs of 500 patients (281 females and 219 males), aged between 18 and 88 years (mean: 47.9 years), were assessed for CAC. Data collected were analyzed statistically using IBM® SPSS® for Windows version 20.0 (SPSS, Chicago, IL, USA).
Results:
CAC were found in 34 cases (6.8%), among them, 23 females (8.18%) and 11 males (5.02%). Six of all the calcifications were on the right side, against six on the left side, and 22 on both sides. The mean age of patients affected with CAC was 60.9 years (ranging from 18 to 88 years). Chi-square test showed no statistical significance between gender and CAC, while Spearman correlation analysis showed positive low correlation with age (r = 0.179).
Conclusion:
CAC can be found on routine panoramic radiographs taken in dental clinics; dentists should automatically refer the patients in question for specialized medical evaluation.
... The presence of carotid artery calcifi cations (CACs) on standard panoramic radiographs was first showed by Friedlander and Lande in 198112). CAC are seen adjacent to the cervical vertebrae at the level of the C3-C4 intervertebral junction as a radiopaque vertical line or nodular radiopaque mass inferior to the angle of mandible 13) . Even though most of the studies agree with the high diagnostic and preventive value of panoramic radiography in detecting atheromas the fi nal confi rmation of CAC should be confi rmed by angiography or Doppler ultrasound. ...
... Women have been found to show greater percentage of carotid artery calcifi cations especially after menopause as the protective eff ect of female hormones is then absent 14) . Apart from female gender the other causes of atherosclerosis are hypertension, diabetes mellitus, smoking, obesity, advanced age, improper diet, high stress, inadequate blood supply, and lack of physical exercise 1, 13) . ...
This study estimates and quantifies the prevalence of soft tissue calcifications using CBCT scans of patients. CBCT scans of 624 patients were viewed for evidence of visible soft tissue calcifications of orofacial region. Axial, coronal and sagittal orthogonal CBCT views were analyzed. Data regarding age of the patient, gender, presence or absence of calcification and type of calcification were recorded. The data was analyzed by using unpaired t test and chi-square test. The number of CBCT scans with the evidence of calcification was 159 (25.48%). Most common calcifications were arteriosclerosis (45.91%) and calcified atherosclerotic plaques (31.45%). Females had more percentage of calcifications which was statistically significant. CBCT may prove to be a helpful and early diagnostic tool in detecting soft tissue calcifications.
