An inside look
When I say the word “dentist,” what do you think of? The whine of a dental drill? Your bi-annual check up that you put off until it turns into an annual check up?SteveMartinin “The Little Shop of Horrors”?
For the purposes of this e-Alert, let’s set aside all of those old ideas and re-imagine our dentists in this entirely new way: as one of the first lines of defense in preventing heart attacks and stroke.
The wide angle
Most dental x-rays are small – a couple of square inches that show only three or four teeth. A panoramic x-ray, as the name suggests, is much larger and gives your dentist a wide-angle view of the entire mouth, including the jaws and the sinuses.
This broader dental x-ray was the subject of a recent study by a team from the Stroke Program in the Division of Neurology at Cedars-Sinai Medical Center. At the outset they knew that carotid artery calcification (CAC) could be seen in panoramic dental x-rays and that patients with these calcifications typically have a high risk of subsequent heart attack and stroke. The two carotid arteries are located at the front of the neck and provide the primary blood supply to the head, neck and brain. The researchers wanted to determine if calcification visible on the dental x-rays was in fact a significant independent risk factor for later stroke and vascular events.
The researchers studied 46 males who showed CACs in routine panoramic dental x-rays. Each subject was then matched with a control subject of similar age who did not have CAC. Complete medical records were reviewed for history of stroke or heart attacks before the x-rays. Then the subjects’ cerebrovascular and cardiovascular health were tracked for 15 years after the date of the x-rays.
The research team concluded that x-rays showing CAC are a reliable indicator of increased risk for both serious cardiac events and strokes.
HSI Panelist view
Because the results of this study lead to a specific type of medical advice we usually don’t receive from dentists, I asked HSI panelist and dentist, Dr. Richard Cohan, D.D.S., M.B.A., to review this study and offer his insights.
In researching this matter Dr. Cohan learned that panoramic x-rays recently were examined at the dental school (University of the Pacific, where he is an associate professor and former Head of Diagnosis and Treatment Planning). The screening was conducted jointly by Dr. Thomas Schiff, Chairperson of Dental Radiology, and a pathologist.
Dr. Cohan reports: “The bottom line on the CAC is that while they do occur, they are quite infrequent (about six CAC’s were noted among approximately 1,000 films that were screened randomly). Nevertheless, given the demographical differences in given patient populations, in those areas where the 60+ crowd predominates it may make sense to use the panoramic x-ray as a screening device by dentists trained to look for the calcifications.”
Addressing a more practical matter, Dr. Cohan added, “The carotid arteries are seen along what usually constitutes nearly the edge of the film and many times to accommodate a pocket size in the chart that is smaller than the film, the film is cut, eliminating this data. So, as you can see that constitutes a logistical problem that will also have to be overcome if it is determined that screening for CAC is worthwhile.”
It would seem that CAC is not something that dentists are routinely checking on x-ray. So if your dentist takes a panoramic x-ray of your mouth, be sure to ask him to keep the entire x-ray intact so that he (or another qualified professional who has the training) can check your carotid arteries – especially if you’re over the age of higher risk that Dr. Cohan indicates. If your dentist doesn’t feel comfortable in attempting the diagnosis, make sure that you get your x-ray into the hands of someone who can read it accurately. You may find invaluable information about your health that goes far beyond the teeth and gums.
Off to the dentist now
To Your Good Health,
Jenny Thompson
Health Sciences Institute
Sources:
“Carotid Calcifications as a Risk Factor for Vascular Disease: A Case-Controlled Study”
Research presented at the 54th annual meeting of the American Academy of Neurology
“Dental X-Rays Can Spot Risk Of Heart Disease And Stroke” InteliHealth News Service
Copyright 1997-2002 by Institute of Health Sciences, L.L.C.
