Association between internal carotid artery calcifications detected as incidental findings and clinical characteristics associated with atherosclerosis: A dental volumetric tomography study

Onofre, Niége Michelle Lazzari de; Vizzotto, Mariana Boessio; Wanzeler, Ana Márcia Viana; Silveira, Priscila Fernanda da; Arús, Nádia Assein; Arriola-Guillén, Luis Ernesto; Silveira, Heraldo Luís Dias da

doi:10.1016/j.ejrad.2021.110045

Cited by 5 publications

(3 citation statements)

References 36 publications

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“…Currently, CBCT images are increasingly being used in various clinical applications, such as identification and location of pathological lesions, implant planning, temporomandibular joint imaging, orthodontic assessment, and endodontic diagnosis (Park et al, 2017). Notwithstanding, even though CBCT images are acquired for a specific clinical purpose, abnormalities outside the predetermined area of interest and unrelated to the initial purpose of the examination can often be found, being called incidental findings (de Onofre et al, 2021;Zinman et al, 2010), such as soft tissue calcifications.…”

Section: Discussionmentioning

confidence: 99%

“…Even though these soft tissue calcifications observed on dental CBCT images can be considered incidental findings that per se do not require specific treatment, their presence might signal existing vascular diseases, being commonly associated with patients that are at risk of cardiovascular and cerebral complications. Therefore, their recognition on CBCT images is of paramount importance, being the dental practitioner's responsibility to ensure a timely referral to the patient's medical physician for further assessment (Damaskos et al, 2016;de Onofre et al, 2021).…”

Section: Discussionmentioning

confidence: 99%

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Atherosclerosis and arteriosclerosis: two case reports of CBCT incidental findings

Carneiro

Salgado

Costa

et al. 2023

RSD

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Different types of vascular calcifications can be observed as incidental findings on Cone Beam Computed Tomography (CBCT) images. Atherosclerosis consists of atherosclerotic plaque accumulation, an inflammatory condition that can result in the narrowing of the blood vessel lumen. On the other hand, arteriosclerosis is the hardening of the artery wall, and Mönckeberg’s arteriosclerosis, a non-obstructive calcification of medium and small-sized muscular arteries, is the most common type of arteriosclerosis. The aim of this paper is to report two cases of soft tissue calcifications observed on CBCT images. Case report 1: a 75-year-old female patient was scanned on CBCT unit KaVo OP 3D Pro for implant planning, and a unilateral radiopacity presenting high density and irregular shape was observed on soft tissues, located inferiorly and internally to the right gonial angle of the mandible, suggesting a calcified carotid atheroma. Case report 2: a 60-year-old female patient was scanned on CBCT unit KaVo OP 3D Pro for implant planning, and bilateral radiopacities presenting circular and elongated shapes with radiolucent interior and tortuous course were observed on soft tissues of the buccal aspect of the mandible, suggesting Mönckeberg’s arteriosclerosis of the facial vasculature. Even though these soft tissue calcifications do not require specific treatment, their presence is commonly associated with patients at risk of cardiovascular and cerebral complications. Therefore, their recognition on CBCT images is of great importance, being the dental practitioner’s responsibility to ensure a timely referral to the patient’s medical physician for further assessment.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Atherosclerosis and arteriosclerosis: two case reports of CBCT incidental findings

Carneiro

Salgado

Costa

et al. 2023

RSD

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“…The inclusion of young patients [11,12] or the study of a small number of patients with significant risk factors [13] result in a prevalence that is not free from bias. Compared to the PR findings, the prevalence of CAC diagnosed by using dental cone beam computed tomography (CBCT) appears to be similar with a rate of 5.7-11.6% and up to 30% or 63% in older populations [14,15].…”

Section: Introductionmentioning

confidence: 92%

Prevalence of carotid artery calcification detected by different dental imaging techniques and their relationship with cardiovascular risk factors, age and gender

Möst,

Winter,

Ballheimer

et al. 2023

BMC Oral Health

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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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Soft Tissue Calcifications in the Head and Neck Region

Vardhan

Gopal

Ganesh³

et al. 2022

Journal of Indian Academy of Oral Medicine and Radiology

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Background: Soft tissue calcifications are most commonly seen in two-dimensional radiographs. Some may be physiological, and some may be pathological and need treatment. CBCT images provide valuable information about anatomic structures and pathologies. These soft tissue calcifications can be seen clearly in CBCT without superimposition and can be diagnosed appropriately. Aim and Objectives: This study aimed to assess the type and prevalence of calcifications found in CBCT volumes obtained for various diagnostic purposes. The objective of the present study was to determine the prevalence of soft tissue and to find their anatomic location, size, and type as well as their relation to age and gender. Materials and Method: Three hundred full-skull CBCT volumes were retrieved retrospectively from the age-group of 9–75 yrs and were evaluated for calcifications. The study sample included CBCT volumes taken for all diagnostic purposes, and those which contained artifacts were excluded. Results: Of 300 CBCT volumes, 133 were females, and 167 were males. Among them, 446 calcifications were encountered in 177 individuals. Their distribution was pineal gland calcification (24.8%), tonsillolith (18%), choroid plexus calcification (24%), pulp stone (12.4%), calcified stylohyoid chain (8%), sialolith (4%), triticeous cartilage calcification (2%), phlebolith (3%), and extracranial carotid artery calcification (1%). Conclusion: Although most of the calcifications are asymptomatic and require no treatment, correct identification of these findings will reduce further diagnostic assessment and provide more appropriate treatment plans. It will also provide the ability to evaluate underlying diseases comprehensively, and practitioners will have life-saving information by early diagnosis.

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Association between internal carotid artery calcifications detected as incidental findings and clinical characteristics associated with atherosclerosis: A dental volumetric tomography study

Cited by 5 publications

References 36 publications

Atherosclerosis and arteriosclerosis: two case reports of CBCT incidental findings

Atherosclerosis and arteriosclerosis: two case reports of CBCT incidental findings

Prevalence of carotid artery calcification detected by different dental imaging techniques and their relationship with cardiovascular risk factors, age and gender

Soft Tissue Calcifications in the Head and Neck Region

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