The role of the dentist in detection of carotid atherosclerosis

Abstract

Cerebrovascular accidents (CVA), or stroke, afflict 731,000 Americans each year, with 165,000 of these individuals dying. Stroke is a major cause of death and disability throughout the world, including southern Africa. Atherosclerosis-related formation of thrombi and emboli at the bifurcation of the common carotid artery and proximal internal carotid artery represents a common cause of stroke. The detection of carotid atherosclerosis by dentists using panoramic radiographs recently has been presented to the public through television news stories and the press, but many dentists still do not know how to interpret panoramic radiographs for detection of this condition. This communication illustrates examples in which carotid atherosclerosis was detected using panoramic radiography. Differential diagnoses are presented. Since not every carotid plaque calcifies, panoramic radiography should never be used alone to exclude the possibility of carotid atherosclerosis. It should also be remembered that the mere presence of calcified carotid plaque is not necessarily a reflection on the degree of carotid stenosis. Definitive diagnosis and treatment requires referral of patients deemed to be at risk to an appropriate physician. A variety of advanced diagnostic methods, including gadolinium-enhanced MRI, Duplex Doppler sonography and angiography are used to confirm carotid stenosis.