Jornal Vascular Brasileiro
Jornal Vascular Brasileiro

Early diagnosis of atherosclerosis with panoramic radiographs: a review

O diagnóstico precoce de aterosclerose através de radiografias panorâmicas: uma revisão

Daiane Landim Borba, Ulisses Vilela Hipólito, Yamba Carla Lara Pereira

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Carotid artery disease has been linked with cerebral vascular accident, also known as stroke, cerebral hemorrhage, or cerebral ischemia. It is caused by narrowing or obstruction of arteries in the neck (the carotid arteries) that are responsible for transporting blood from the aorta to the brain. Panoramic radiographs are used in dentistry to show both dental arches as a supplement to the clinical dental examination. The objective of this study is to highlight the importance of panoramic radiographs for diagnosis of arterial disease, by means of a bibliographic review. The PubMed database was searched using the keywords “atherosclerosis” and “panoramic”, with the filters “last 5 years” and “humans”. Twenty articles were identified, six of which were chosen for this study because they were open access. The review concluded that panoramic radiographs enable early diagnosis of carotid artery calcification, resulting in earlier interventions, and offer an accessible cost.


panoramic radiographs; atherosclerosis; early diagnosis


Doenças das artérias carótidas estão associadas a casos de acidente vascular cerebral, também chamados de derrame ou isquemia cerebral. Ocorrem devido ao estreitamento ou obstrução das artérias do pescoço, ou artérias carótidas, responsáveis por levar o sangue da aorta para o cérebro. A radiografia panorâmica é um exame de ambos os arcos dentários que ajuda no exame clínico odontológico. Destacar a importância da radiografia panorâmica no diagnóstico de doença arterial é o objetivo deste trabalho, que foi realizado através de pesquisa bibliográfica na PubMed, com as palavras-chave “atherosclerosis” e “panoramic”, e os filtros: últimos 5 anos e humanos. Vinte artigos foram elencados, dos quais seis formaram a base para este estudo, graças ao acesso livre ao seu conteúdo. Conclui-se que a radiografia panorâmica permite o d


radiografia panorâmica; aterosclerose; diagnóstico precoce.


1. Friedlander AH, El Saden SM, Hazboun RC, Chang TI, Wong WK, Garrett NR. Detection of carotid artery calcification on the panoramic images of post-menopausal females is significantly associated with severe abdominal aortic calcification: a risk indicator of future adverse vascular events. Dentomaxillofac Radiol. 2015;44(7):20150094. PMid:25945511.

2. Ramesh A, Pabla T. Panoramic radiographs: a screening tool for calcified carotid atheromatous plaque. J Mass Dent Soc. 2007;56(2):20-1. PMid:17691505.

3. Zétola A, Ferreira FM, Larson R, Shibli JA. Recombinant human bone morphogenetic protein-2 (rhBMP-2) in the treatment of mandibular sequelae after tumor resection. Oral Maxillofac Surg. 2011;15(3):169-74. PMid:20571845.

4. Manzi FR, Bóscolo FN, Almeida SM, Haiter F No. Panoramic radiography as an auxiliary in detecting patients at risk for cerebrovascular accident (CVA): a case report. J Oral Sci. 2003;45(3):177-80. PMid:14650584.

5. Abreu TQ, Ferreira EB, Brito SB Fo, Sales KP, Lopes FF, Oliveira AE. Prevalence of carotid artery calcifications detected on panoramic radiographs and confirmed by Doppler ultrasonography: Their relationship with systemic conditions. Indian J Dent Res. 2015;26(4):345-50. PMid:26481878.

6. Romano-Sousa CM, Krejci L, Medeiros FM, et al. Diagnostic agreement between panoramic radiographs and color Doppler images of carotid atheroma. J Appl Oral Sci. 2009;17(1):45-8. PMid:19148405.

7. 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(1):36-40. PMid:24748296.

8. Friedman MH, Weisberg J. The craniocervical connection: a retrospective analysis of 300 whiplash patients with cervical and temporomandibular disorders. Cranio. 2000;18(3):163-7. PMid:11202833.

9. Ramesh A, Soroushian S, Ganguly R. Coincidence of calcified carotid atheromatous plaque, osteoporosis, and periodontal bone loss in dental panoramic radiographs. Imaging Sci Dent. 2013;43(4):235-43. PMid:24380062.

10. Martinez-Cruz S, Manson-Hing LR. Comparison of focal trough dimensions and form by resolution measurements in panoramic radiography. J Am Dent Assoc. 1987;114(5):639-42. PMid:3474266.

11. Hoke M, Schmidt B, Schillinger T, et al. Evidence of carotid atherosclerosis in orthopantomograms and the risk for future cardiovascular events. Vasa. 2010;39(4):298-304. PMid:21104618.

12. Friedlander AH, Golub MS. The significance of carotid artery atheromas on panoramic radiographs in the diagnosis of occult metabolic syndrome. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;101(1):95-101. PMid:16360613.

13. Sobotta, J. Sobotta atlas de anatomia humana. 23 ed. Rio de Janeiro: Guanabara Koogan; 2012. 3 v.

14. Khalil H. A basic review on the inferior alveolar nerve block techniques. Anesth Essays Res. 2014;8(1):3-8. PMid:25886095.

15. Mathew S, Lund RJ, Strebeck F, Tustison KS, Geurs T, Hruska KA. Reversal of the adynamic bone disorder and decreased vascular calcification in chronic kidney disease by sevelamer carbonate therapy. J Am Soc Nephrol. 2007;18(1):122-30. PMid:17182886.

16. Friedlander AH, López-López J, Velasco-Ortega E. Diagonal ear lobe crease and atherosclerosis: a review of the medical literature and dental implications. Med Oral Patol Oral Cir Bucal. 2012;17(1):e153-9. PMid:21743392.

17. Friedlander AH, Aghazadehsanai N, Chang TI, Harada N, Garrett NR. Prevalence of calcified carotid artery atheromas on panoramic images of individuals with primary hyperparathyroidism. Dentomaxillofac Radiol. 2013;42(8):20130118. PMid:23775925.

18. Baumann-Bhalla S, Meier RM, Burow A, et al. Recognizing calcifications of the carotid artery on panoramic radiographs to prevent strokes. Schweiz Monatsschr Zahnmed. 2012;122(11):1016-29. PMid:23184365.

19. Virtue A, Mai J, Yin Y, et al. Structural evidence of anti-atherogenic microRNAs. Front Biosci. 2011;16(1):3133-45. PMid:21622224.

20. Lee JS, Kim OS, Chung HJ, et al. The prevalence and correlation of carotid artery calcification on panoramic radiographs and peripheral arterial disease in a population from the Republic of Korea: the Dong-gu study. Dentomaxillofac Radiol. 2013;42(3):29725099. PMid:22752323.

21. Alman AC, Johnson LR, Calverley DC, Grunwald GK, Lezotte DC, Hokanson JE. Validation of a method for quantifying carotid artery calcification from panoramic radiographs. Oral Surg Oral Med Oral Pathol Oral Radiol. 2013;116(4):518-24. PMid:24035118.

22. Rabelo LM, Viana RM, Schimith MA, et al. Risk factors for atherosclerosis in students of a private university in São PauloBrazil. Arq Bras Cardiol. 1999;72(5):569-80. PMid:10668227. http://

23. Ashley KE, Geraci SA. Ischemic heart disease in women. South Med J. 2013;106(7):427-33. PMid:23820324.

24. Buttar HS, Li T, Ravi N. Prevention of cardiovascular diseases: Role of exercise, dietary interventions, obesity and smoking cessation. Exp Clin Cardiol. 2005;10(4):229-49. PMid:19641674.

25. Singh RB, Mengi SA, Xu YJ, Arneja AS, Dhalla NS. Pathogenesis of atherosclerosis: A multifactorial process. Exp Clin Cardiol. 2002;7(1):40-53. PMid:19644578.

26. van Hinsbergh VW. Endothelium--role in regulation of coagulation and inflammation. Semin Immunopathol. 2012;34(1):93-106. PMid:21845431.

27. Singh N, Dhalla AK, Seneviratne C, Singal PK. Oxidative stress and heart failure. Mol Cell Biochem. 1995;147(1-2):77-81. PMid:7494558.

28. Galkina E, Ley K. Immune and inflammatory mechanisms of atherosclerosis. Annu Rev Immunol. 2009;27(1):165-97. PMid:19302038.

29. Herrmann N, Mamdani M, Lanctôt KL. Atypical antipsychotics and risk of cerebrovascular accidents. Am J Psychiatry. 2004;161(6):1113-5. PMid:15169702.

30. Percudani M, Barbui C, Fortino I, Tansella M, Petrovich L. Secondgeneration antipsychotics and risk of cerebrovascular accidents in the elderly. J Clin Psychopharmacol. 2005;25(5):468-70. PMid:16160623.

31. Chodobski A, Zink BJ, Szmydynger-Chodobska J. Blood-brain barrier pathophysiology in traumatic brain injury. Transl Stroke Res. 2011;2(4):492-516. PMid:22299022.

32. Lee JM, Grabb MC, Zipfel GJ, Choi DW. Brain tissue responses to ischemia. J Clin Invest. 2000;106(6):723-31. PMid:10995780.

33. Tillema JM, Pirko I. Neuroradiological evaluation of demyelinating disease. Ther Adv Neurol Disorder. 2013;6(4):249-68. PMid:23858328.

34. Kundel HL, Nodine CF. A visual concept shapes image perception. Radiology. 1983;146(2):363-8. PMid:6849084.

35. Gross H, Nilsson M, Hellén-Halme K. Detectability of normal anatomy in digital panoramic radiographs. Swed Dent J. 2014;38(4):179-85. PMid:25771652.

36. Jones KB, Jordan R. White lesions in the oral cavity: clinical presentation, diagnosis, and treatment. Semin Cutan Med Surg. 2015;34(4):161-70. PMid:26650693.

37. Barron RP, Kainulainen VT, Gusenbauer AW, Hollenberg R, Sàndor GK. Management of traumatic dislocation of the mandibular condyle into the middle cranial fossa. J Can Dent Assoc. 2002;68(11):676-80. PMid:12513935.

38. Shah N, Bansal N, Logani A. Recent advances in imaging technologies in dentistry. World J Radiol. 2014;6(10):794-807. PMid:25349663.

39. Kiefer H, Lambrecht JT, Roth J. Dose exposure from analog and digital full mouth radiography and panoramic radiography. Schweiz Monatsschr Zahnmed. 2004;114(7):687-93. PMid:15360104.

40. Patil SR. Prevalence of carotid artery calcification in postmenopausal women and its correlation with atherogenic risk factors. J Nat Sci Biol Med. 2015;6(Suppl 1):S1-6. PMid:26604593.

41. Friedlander AH. Panoramic radiography: the differential diagnosis of carotid artery atheromas. Spec Care Dentist. 1995;15(6):223-7. PMid:9002923. tb00522.x.

42. Friedlander AH, Friedlander IK. Identification of stroke prone patients by panoramic radiography. Aust Dent J. 1998;43(1):51-4. PMid:9583227. tb00153.x.

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