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

Calcified carotid artery atheroma (CCAA) can be identified incidentally on standard panoramic dental radiographs (DPRs). According to the 2021 Canadian Cardiovascular Society (CCS) Guidelines for the Management of Dyslipidemia, documented carotid artery disease is a statin-indicated condition as these individuals are at higher risk of future cardiovascular (CV) events. We sought to determine the prevalence of CCAA on DPRs and establish the proportion of patients in whom CCAA on DPR would represent a new statin-indicated condition. In this study, we identified patients aged ≥30 with DPRs from Jan 1, 2005 to April 23, 2021 from the patient database of the UBC dental clinic. Patient charts were reviewed for existing statin-indicated conditions as outlined by CCS 2021 Guidelines for the Management of Dyslipidemia and the use of lipid-lowering therapies. Additionally, DPRs for each patient were evaluated for the presence and characteristics of CCAA. We then examined the prevalence of patients with CCAAs which would constitute a new diagnosis of atherosclerosis. Out of 487 unique patients with a DPR, 15 were excluded for lack of documented medical history. Of the remaining 472, 215 were female (45.6%) and the mean age was 60.8±16.3 years. As DPRs were performed for dental indications, only 255/472 (54.0%) were diagnostic for the evaluation of CCAA. There were 52 (11.0%) of whom had evidence of CCAA on DPRs. Of those with CCAA, 10 (19.2%) were already on lipid-lowering therapy for a pre-existing condition, 11 (21.2%) were not on lipid-lowering therapy but had a pre-existing condition that would have warranted treatment, and 31 (59.6%) were not on lipid-lowering therapy and did not have a pre-existing condition, thus constituting a new DPR-mediated diagnosis of carotid atherosclerosis. Therefore, 6.6% of the overall dental population at this clinic were found to have newly identified atherosclerosis, as demonstrated by CCAA on DPR. Systematic reporting of CCAA on DPR will identify new atherosclerosis in a significant proportion of dental patients. Communication and collaboration between dental and medical professionals may allow for earlier diagnosis of atherosclerosis and an opportunity for lifestyle and medical treatment. The results of this project will lay the foundation for further studies which can examine the impact of interventions such as formalized shared care between dentists and physicians.