Evaluation of the relationship between periodontal risk and carotid artery calcifications on panoramic radiographs

ABSTRACT

Objective: To evaluate if there is a relationship between findings of carotid artery calcification (CAC) and periodontal risk in nonsmoker subjects by using panoramic radiographs (DPR). Materials and Methods: A total of 1146 DPRs were investigated. Gender, age, severity of bone loss, tooth loss, periodontal risk, and findings of carotid calcification were recorded. The periodontal risk was evaluated and classified according to the degree of alveolar bone loss. Results: CAC was diagnosed in %13.6 (n: 156) of DPRs. Of 1146 patients, 338 (29.5%) had low, 668 (60%) had moderate, and 120 (10.5%) had high periodontal risk. A statistically significant relation was observed between carotid calcification and periodontal risk. Conclusion: Positive findings of carotid calcification may be related with periodontal problems. Clinicians must be careful about diagnosing CACs on DPRs during routine examinations. In the case of positive findings of CAC and periodontitis together, the patient may be consulted to a specialist for further investigation.

Key words:

Calcified carotid artery - nonsmokers - panoramic radiograph - periodontitis

• REFERENCES

• 1 Pornprasertsuk-Damrongsri S, Thanakun S. Carotid artery calcification detected on panoramic radiographs in a group of Thai population. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006; 101: 110-5
• 2 Suyambukesan S, Perumal GL. Correlation between the detection of carotid artery calcifications on panaromic radiographs and the presence of the potential risk factors. J Dent Clin 2012; 4: 10-3
• 3 Mannami T, Konishi M, Baba S, Nishi N, Terao A. Prevalence of asymptomatic carotid atherosclerotic lesions detected by high-resolution ultrasonography and its relation to cardiovascular risk factors in the general population of a Japanese city: The Suita study. Stroke 1997; 28: 518-25
• 4 Christou P, Leemann B, Schimmel M, Kiliaridis S, Müller F. Carotid artery calcification in ischemic stroke patients detected in standard dental panoramic radiographs – A preliminary study. Adv Med Sci 2010; 55: 26-31
• 5 Wyman RA, Fraizer MC, Keevil JG, Busse KL, Aeschlimann SE, Korcarz CE. et al. Ultrasound-detected carotid plaque as a screening tool for advanced subclinical atherosclerosis. Am Heart J 2005; 150: 1081-5
• 6 Handa N, Matsumoto M, Maeda H, Hougaku H, Kamada T. Ischemic stroke events and carotid atherosclerosis. Results of the Osaka Follow-up Study for Ultrasonographic Assessment of Carotid Atherosclerosis (the OSACA Study). Stroke 1995; 26: 1781-6
• 7 Friedlander AH, Gratt BM. Panoramic dental radiography as an aid in detecting patients at risk for stroke. J Oral Maxillofac Surg 1994; 52: 1257-62
• 8 Friedlander AH, Maeder LA. The prevalence of calcified carotid artery atheromas on the panoramic radiographs of patients with type 2 diabetes mellitus. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000; 89: 420-4
• 9 Haraszthy VI, Zambon JJ, Trevisan M, Zeid M, Genco RJ. Identification of periodontal pathogens in atheromatous plaques. J Periodontol 2000; 71: 1554-60
• 10 Ravon NA, Hollender LG, McDonald V, Persson GR. Signs of carotid calcification from dental panoramic radiographs are in agreement with Doppler sonography results. J Clin Periodontol 2003; 30: 1084-90
• 11 Beck JD, Elter JR, Heiss G, Couper D, Mauriello SM, Offenbacher S. Relationship of periodontal disease to carotid artery intima-media wall thickness: The atherosclerosis risk in communities (ARIC) study. Arterioscler Thromb Vasc Biol 2001; 21: 1816-22
• 12 Almog DM, Horev T, Illig KA, Green RM, Carter LC. Correlating carotid artery stenosis detected by panoramic radiography with clinically relevant carotid artery stenosis determined by duplex ultrasound. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002; 94: 768-73
• 13 Madden RP, Hodges JS, Salmen CW, Rindal DB, Tunio J, Michalowicz BS. et al. Utility of panoramic radiographs in detecting cervical calcified carotid atheroma. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007; 103: 543-8
• 14 Bassiouny MA, Grant AA. The accuracy of the Schei ruler: A laboratory investigation. J Periodontol 1975; 46: 748-52
• 15 Schei O. Alveolar bone loss as related to oral hygiene and age. J Periodontol 1959; 30: 7-16
• 16 Björn H, Holmberg K. Radiographic determination of periodontal bone destruction in epidemiological research. Odontol Revy 1966; 17: 232-50
• 17 Papapanou PN. Epidemiology of periodontal diseases: An update. J Int Acad Periodontol 1999; 1: 110-6
• 18 Renvert S, Ohlsson O, Persson S, Lang NP, Persson GR. Analysis of periodontal risk profiles in adults with or without a history of myocardial infarction. J Clin Periodontol 2004; 31: 19-24
• 19 Dietrich T, Sharma P, Walter C, Weston P, Beck J. The epidemiological evidence behind the association between periodontitis and incident atherosclerotic cardiovascular disease. J Clin Periodontol 2013; 40 (Suppl. 14) S70-84
• 20 Cohen SN, Friedlander AH, Jolly DA, Date L. Carotid calcification on panoramic radiographs: An important marker for vascular risk. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002; 94: 510-4
• 21 Towne JB, Hobson 2^nd RW. 4 Current status of operative treatment for asymptomatic carotid stenosis. Can J Surg 1994; 37: 128-34
• 22 Khambete N, Kumar R, Risbud M, Joshi A. Reliability of digital panoramic radiographs in detecting calcified carotid artery atheromatous plaques: A clinical study. Indian J Dent Res 2014; 25: 36-40
• 23 Ezoddini-Ardakani F, Mirzaei M, Nayer S, Besharati S, Moeini M. Evaluation of positive predictive value for digital panoramic radiography in comparison to ultrasound in the diagnosis of calcified carotid atheroma. Health 2014; 6: 1933-40
• 24 Bayram B, Uckan S, Acikgoz A, Müderrisoglu H, Aydinalp A. Digital panoramic radiography: A reliable method to diagnose carotid artery atheromas?. Dentomaxillofac Radiol 2006; 35: 266-70
• 25 Yoon SJ, Yoon W, Kim OS, Lee JS, Kang BC. Diagnostic accuracy of panoramic radiography in the detection of calcified carotid artery. Dentomaxillofac Radiol 2008; 37: 104-8
• 26 Tamura T, Inui M, Nakase M, Nakamura S, Okumura K, Tagawa T. Clinicostatistical study of carotid calcification on panoramic radiographs. Oral Dis 2005; 11: 314-7
• 27 Sung EC, Friedlander AH, Kobashigawa JA. The prevalence of calcified carotid atheromas on the panoramic radiographs of patients with dilated cardiomyopathy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004; 97: 404-7
• 28 Ohba T, Takata Y, Ansai T, Morimoto Y, Tanaka T, Kito S. et al. Evaluation of calcified carotid artery atheromas detected by panoramic radiograph among 80-year-olds. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2003; 96: 647-50
• 29 Tiller R, Bengel W, Rinke S, Ziebolz D. Association between carotid area calcifications and periodontal risk: A cross sectional study of panoramic radiographic findings. BMC Cardiovasc Disord 2011; 11: 67
• 30 Ertas ET, Sisman Y. Detection of incidental carotid artery calcifications during dental examinations: Panoramic radiography as an important aid in dentistry. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011; 112: e11-7
• 31 Cullinan MP, Westerman B, Hamlet SM, Palmer JE, Faddy MJ, Lang NP. et al. A longitudinal study of interleukin-1 gene polymorphisms and periodontal disease in a general adult population. J Clin Periodontol 2001; 28: 1137-44
• 32 Bergström J. Tobacco smoking and chronic destructive periodontal disease. Odontology 2004; 92: 1-8
• 33 Wood D. Joint European Societies Task Force. Established and emerging cardiovascular risk factors. Am Heart J 2001; 141 (02) Suppl S49-57
• 34 Persson RE, Hollender LG, Powell VL, MacEntee M, Wyatt CC, Kiyak HA. et al. Assessment of periodontal conditions and systemic disease in older subjects. II. Focus on cardiovascular diseases. J Clin Periodontol 2002; 29: 803-10
• 35 Vedin O, Hagstrom E, Gallup A, Neely ML, Stewart R, Koeing W. et al. Periodontal disease in patients with chronic coronary heart disease: Prevalence and association with cardiovascular risk factors. Eur J Prev Cardiol 2014; 10: 51-9
• 36 Albandar JM, Rise J, Gjermo P, Johansen JR. Radiographic quantification of alveolar bone level changes. A 2-year longitudinal study in man. J Clin Periodontol 1986; 13: 195-200
• 37 Joshipura KJ, Hung HC, Rimm EB, Willett WC, Ascherio A. Periodontal disease, tooth loss, and incidence of ischemic stroke. Stroke 2003; 34: 47-52
• 38 Loesche WJ, Schork A, Terpenning MS, Chen YM, Kerr C, Dominguez BL. The relationship between dental disease and cerebral vascular accident in elderly United States veterans. Ann Periodontol 1998; 3: 161-74
• 39 DeStefano F, Anda RF, Kahn HS, Williamson DF, Russell CM. Dental disease and risk of coronary heart disease and mortality. BMJ 1993; 306: 688-91
• 40 Wiener RC, Sambamoorthi U. Cross-sectional association between the number of missing teeth and cardiovascular disease among adults aged 50 or older: BRFSS 2010. Int J Vasc Med 2014; 2014: 421567
• 41 Rosado A, Marcos H, Gómez P. Scientific evidence for the relationship between periodontitis and cardiovascular disease. World J Cardiovasc Dis 2013; 3: 62-8
• 42 Craven TE, Ryu JE, Espeland MA, Kahl FR, McKinney WM, Toole JF. et al. Evaluation of the associations between carotid artery atherosclerosis and coronary artery stenosis. A case-control study. Circulation 1990; 82: 1230-42
• 43 Beckstrom BW, Horsley SH, Scheetz JP, Khan Z, Silveira AM, Clark SJ. et al. Correlation between carotid area calcifications and periodontitis: A retrospective study of digital panoramic radiographic findings in pretreatment cancer patients. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007; 103: 359-66
• 44 Engebretson SP, Lamster IB, Elkind MS, Rundek T, Serman NJ, Demmer RT. et al. Radiographic measures of chronic periodontitis and carotid artery plaque. Stroke 2005; 36: 561-6
• 45 Dietrich T, Jimenez M, Krall KayeEA, Vokonas PS, Garcia RI. Age-dependent associations between chronic periodontitis/edentulism and risk of coronary heart disease. Circulation 2008; 117: 1668-74
• 46 Katz J, Chaushu G, Sharabi Y. On the association between hypercholesterolemia, cardiovascular disease and severe periodontal disease. J Clin Periodontol 2001; 28: 865-8
• 47 Ramírez JH, Parra B, Gutierrez S, Arce RM, Jaramillo A, Ariza Y. et al. Biomarkers of cardiovascular disease are increased in untreated chronic periodontitis: A case control study. Aust Dent J 2014; 59: 29-36
• 48 Kodovazenitis G, Pitsavos C, Papadimitriou L, Vrotsos IA, Stefanadis C, Madianos PN. Association between periodontitis and acute myocardial infarction: A case-control study of a nondiabetic population. J Periodontal Res 2014; 49: 246-52
• 49 Madianos PN, Bobetsis GA, Kinane DF. Is periodontitis associated with an increased risk of coronary heart disease and preterm and/or low birth weight births?. J Clin Periodontol 2002; 29 (Suppl. 03) 22-36
• 50 Desvarieux M. Periodontal disease, race, and vascular disease. Compend Contin Educ Dent 2001; 22: 34-41
• 51 Papapanou PN. Periodontal diseases: Epidemiology. Ann Periodontol 1996; 1: 1-36