Prevalence of detectable carotid artery calcifications on panoramic radiographs of recent stroke victims

Cerebrovascular accidents are responsible for killing or disabling half a million Americans every year and are the third leading cause of death in this country. Finding cost-effective means of decreasing stroke mortality and morbidity is of great humanitarian and economic importance. Panoramic dental radiography was done on 19 white men who had a recent cerebrovascular accident and who were hospitalized at a Department of Veteran Affairs medical center. Inclusion criteria included clinical suspicion or imaging study evidence that the stroke arose from atheroembolic disease of the carotid artery bifurcation. Women were omitted from the study because of their paucity in the patient pool, and African-Americans and Asian-Americans were omitted because strokes in those groups usually develop as a result of disease of intracranial vessels. Carotid arterial calcifications appearing as a radiopaque nodular mass adjacent to the cervical vertebrae at or below intervertebral space C3-4 were noted in seven persons (37%). These patients had an average age of 65 years and demonstrated multiple risk factors (prior transient ischemic attacks, prior stroke, hypertension, obesity, tobacco and alcohol abuse, hyperlipidemia) associated with occurrence of a stroke. We concluded that some white men at risk for a cerebrovascular accident may be identified in the dentist's office by appropriate review of the panoramic dental radiograph and medical history. The presence of carotid artery calcifications demands an expeditious referral to an appropriate practitioner who can assist in the control of risk factors and arrange prophylactic surgical removal of the carotid arterial plaque, which are both safe and reliable methods of reducing the incidence of stroke.