Calcified carotid artery atheroma on standard dental radiographs: A public health opportunity for cardiovascular risk reduction

Abstract

Objective: Calcified carotid artery atheroma (CCAA) can be identified incidentally on standard dental panoramic radiographs (DPRs). We sought to (1) determine the prevalence of CCAA on DPRs in a general dental population and (2) establish the proportion of patients in whom this would represent a new statin-indicated condition.

Methods: We identified patients aged ≥30 with DPRs from 2019 to 2021 from the University of British Columbia Dental Clinic. Patient charts were reviewed for use of lipid-lowering therapies (LLT) and existing statin-indicated conditions. DPRs for each patient were evaluated for the presence and characteristics of CCAA.

Results: Of 921 patients with a DPR and documented medical history, 548 (59.5 %) were diagnostic for evaluation of CCAA. Although 116/548 (21.2 %) of these patients had evidence of CCAA, only 25.9 % (30/116) were already on LLT; another 20.7 % (24/116) of patients with CCAA had a pre-existing statin-indicated condition but were not on LLT. Therefore, in 53.4 % (62/116) of patients with CCAA-positive DPRs, this constituted a new diagnosis of atherosclerosis not yet treated with LLT, representing 6.7 % (62/921) of the clinic population and 11.3 % of individuals with DPRs of diagnostic quality (62/548). Dyslipidemia, hypertension, coronary artery disease, diabetes, atrial fibrillation, stroke/transient ischemic attack, older age, and male sex were all found to be significant predictors of CCAA.

Conclusion: CCAA is a common finding among patients with DPRs and in over half of cases, the presence of CCAA represents a new diagnosis of atherosclerosis. The high prevalence of new, untreated atherosclerosis in this population indicates an opportunity for risk factor modification and collaboration between dentists and physicians to optimize patient care.

Keywords: Atherosclerosis; Imaging.

Graphical abstract

Fig. 1

CCAA found on DPR. A) general opacities showing evidence of atherosclerosis; B) crescent-shaped opacity specific to CCAA.: A section of a DPR with evidence of CCAA superimposed upon the posterior pharynx. The presence of CCAA lateral to the vertebral column confirms the diagnosis of CCAA, as opposed to other areas of calcification, which can also appear due to calcified cervical lymph nodes and calcified tristichous thyroid cartilage.

Fig. 2

Prevalence of calcified carotid artery atheroma and associated use of lipid lowering therapy. Over half of patients with calcified carotid artery atheroma on dental panoramic radiographs represent a new diagnosis of atherosclerosis. CCAA-positive patients were stratified by those taking LLT and those with pre-existing indications for treatment with LLT. CCAA, calcified carotid artery atheroma; DPR, dental panoramic radiograph; LLT, lipid-lowering therapy.

Fig. 3

Distribution of calcified carotid artery atheroma by age (<50 y, 50–79 y, and >80). There was a significant difference in the prevalence of CCAA between age groups; p = 0.002. CCAA, calcified carotid artery atheroma; DPR, dental panoramic radiograph.

Fig. 4

Prevalence of lipid lowering therapy in patients with calcified carotid artery atheroma on dental panoramic radiograph by age group; age stratified <50 y, 50–79 y, and >80 y. CCAA, calcified carotid artery atheroma; DPR, dental panoramic radiograph; LLT, lipid-lowering therapy.

Fig. 5

Prevalence of calcified carotid artery atheroma on dental panoramic radiograph by sex. A greater proportion of male patients had CCAA on DPR compared to females; p = 0.004. CCAA, calcified carotid artery atheroma; DPR, dental panoramic radiograph; LLT, lipid-lowering therapy.

Fig. 6

Prevalence of lipid lowering therapy in patients with calcified carotid artery atheroma on dental panoramic radiograph by sex. CCAA calcified carotid artery atheroma; DPR dental panoramic radiograph.