Can carotid artery calcifications on dental radiographs predict adverse vascular events? A systematic review

Lim, Li Zhen; Koh, Pamela Shu Fen; Cao, Shuo; Wong, Raymond Chung Wen

doi:10.1007/s00784-020-03696-5

Cited by 4 publications

(3 citation statements)

References 46 publications

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“…The study concluded that CAC detection on PRs could serve as a risk marker for future MIs [42]. However, a systematic review evaluating the role of PRs in the detection of CAC as a predictor for CAD or CVA concluded that it was unclear but may aid the identification of at-risk patients who need further medical assessment [43]. In the review, most patients with CAC detected on PRs were overall more likely to develop a future CAD or CVA event compared to a control group; nonetheless, the majority of the studies did not show a statistical significance [43].…”

Section: Discussionmentioning

confidence: 99%

Carotid Artery Calcification Detected on Panoramic Radiography Is Significantly Related to Cerebrovascular Accident, Coronary Artery Disease, and Poor Oral Health: A Retrospective Cross-Sectional Study

Brar,

DeColibus,

Rasner

et al. 2024

Dentistry Journal

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Panoramic radiography imaging modality is widely used by dentists for diagnosing dental and jaw conditions. It can also detect carotid artery calcification (CAC), indicative of calcified atherosclerotic plaques in the carotid arteries. This cross-sectional retrospective study at the University of Tennessee Health Science Center investigated the link between CAC identified on panoramic radiograph (PR) and cerebrovascular accident (CVA), coronary artery disease (CAD), and poor oral health. Data from 314 CAC patients collected from 2014 to 2023 included age at diagnosis, gender, and clinical histories of hypertension, hyperlipidemia, diabetes mellitus, CVA, CAD, and the decay, missing, and filled permanent teeth (DMFT) index. These patients were age- and gender-matched with non-CAC patients for analysis. The findings revealed high prevalences of hypertension (86.2%), hyperlipidemia (57.6%), diabetes mellitus (30.7%), CVA (15.5%), and CAD (28.7%) amongst CAC patients and the average DMFT index was 26.6. A comparative analysis of 276 matched controls demonstrated significant differences in hypertension (85.9% vs. 57.6%), hyperlipidemia (58.3% vs. 33.7%), diabetes (32.6% vs. 22.1%), CVA history (14.9% vs. 5.1%), CAD (26.1% vs. 9.8%), and DMFT scores (26.3 vs. 23.7), all indicating strong associations between CAC and these health conditions. The adjusted analysis showed that hypertension (aOR: 3.20 [95% CI: 2.06–5.07]), hyperlipidemia (aOR: 1.70 [95% CI: 1.14–2.50]), CVA (aOR: 2.20 [95% CI: 1.13–4.30]), and CAD (aOR: 2.10 [95% CI: 1.28–3.60]) were significantly associated with CAC. Notably, only 41.7% of the patients received a medical consultation after CAC detection on PR. It is crucial for dentists to refer patients for further evaluation.

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Section: Discussionmentioning

confidence: 99%

Carotid Artery Calcification Detected on Panoramic Radiography Is Significantly Related to Cerebrovascular Accident, Coronary Artery Disease, and Poor Oral Health: A Retrospective Cross-Sectional Study

Brar,

DeColibus,

Rasner

et al. 2024

Dentistry Journal

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“…In a systematic review, Lim et al (30) states that it is difficult to separate the effects of CCAAs and atherosclerosis from other risk factors due to their pathophysiological interrelationship. Still, there is heterogeneity between the studies, as there are important risk factors that were not explicitly addressed, for example, if the patients were well medicated and if they had active lifestyles.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of suggestive images of atheroma in panoramic radiographs: clinical profile and risk factors for cardiovascular disease / Prevalência de imagens sugestivas de ateroma em radiografias panorâmicas: perfil clínico e fatores de risco para a doença cardiovascular

Moro¹,

Melo²,

Maior³

et al. 2021

BJDV

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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.

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“…Several studies showed that patients aged 60–96 with carotid artery calcification (CAC) found in panoramic radiograph are 2.4 fold more likely to suffer from vascular events, including stroke and/or ischemic heart diseases [ 4 , 5 ]. Although evidence for the predictive value of CAC is still variable, as reviewed by Lim et al , it is established as useful for identifying at risk patients and referral for further evaluation [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Deep convolution neural network for screening carotid calcification in dental panoramic radiographs

et al. 2023

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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.

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Can carotid artery calcifications on dental radiographs predict adverse vascular events? A systematic review

Cited by 4 publications

References 46 publications

Carotid Artery Calcification Detected on Panoramic Radiography Is Significantly Related to Cerebrovascular Accident, Coronary Artery Disease, and Poor Oral Health: A Retrospective Cross-Sectional Study

Carotid Artery Calcification Detected on Panoramic Radiography Is Significantly Related to Cerebrovascular Accident, Coronary Artery Disease, and Poor Oral Health: A Retrospective Cross-Sectional Study

Prevalence of suggestive images of atheroma in panoramic radiographs: clinical profile and risk factors for cardiovascular disease / Prevalência de imagens sugestivas de ateroma em radiografias panorâmicas: perfil clínico e fatores de risco para a doença cardiovascular

Deep convolution neural network for screening carotid calcification in dental panoramic radiographs

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