# Carotid artery calcifications on panoramic radiographs are associated with vascular disease severity on carotid ultrasound

## TL;DR

This study shows that signs of artery calcification seen in dental X-rays are linked to more severe heart and blood vessel disease, suggesting dentists can help spot early signs of cardiovascular issues.

## Contribution

The study demonstrates that vessel-outlining calcification on panoramic radiographs is a novel indicator of severe cardiovascular disease.

## Key findings

- All CAC types on panoramic radiographs were associated with increased carotid plaque and thicker cIMT on ultrasound.
- Vessel-outlining CAC showed the strongest association with severe CVD indicators like plaque and cIMT.
- Dentists can use CAC detection on X-rays to identify patients at higher risk of cardiovascular events.

## Abstract

The aim of this study was to investigate whether any feature of carotid artery calcification (CAC) detected on panoramic radiographs (PRs) is associated with more severe signs of cardiovascular disease (CVD), as assessed by carotid ultrasound (CUS) including multi-view assessment of carotid intima media thickness (cIMT).

The present investigation was a retrospective sub-study of the randomized controlled trial visualization of asymptomatic atherosclerotic disease for optimum cardiovascular prevention (VIPVIZA), which included 60-, 50-, and 40-year-old inhabitants of Västerbotten County, each of whom underwent CUS. The present sub-study included 135 participants who had undergone PR for odontological indications within 18 months before or after CUS examination. Findings of CAC on PR were compared with CUS findings of cIMT and carotid plaque. CAC features were categorized into 4 types: single, scattered, vessel width-defining, or vessel-outlining.

Compared to participants without CAC on PR, those with any CAC type on PR exhibited significantly more carotid plaque (80.9% vs 43.2%, P < .001) and a higher average cIMT score (0.83 vs 0.77 mm, P = .013) on CUS. The vessel-outlining CAC group exhibited the most pronounced cIMT and carotid plaque occurrence (P = .011).

All CAC types detected on PR were associated with CVD on CUS, and vessel-outlining CAC indicated more severe CVD. By detecting CAC on PR, especially vessel-outlining CACs, dentists could contribute to the early identification of patients with asymptomatic CVD, and recommend that these patients seek medical attention for preventive treatment.

All types of CAC detected on PR—particularly the vessel-outlining type—are associated with carotid ultrasound findings, including carotid intima media thickness, indicating CVD and increased risk of stroke and myocardial infarction. Thus, dentists can identify patients at increased risk of cardiovascular events by detecting CAC  on PR, with higher diagnostic reliability in cases with vessel-outlining calcification.