Strokes: Dental x-rays reveal more than cavities

Dental visits usually result in patient recommendations to floss or reschedule more appointments to treat a cavity, however, some patients are learning they may be at risk for a stroke too, according to a case report in the November/December issue of General Dentistry, the Academy of General Dentistry’s (AGD) clinical, peer-reviewed journal.

According to the American Stroke Association (ASA), every 45 seconds, someone in America has a stroke. Stroke is the third leading cause of death in the United States today and the leading cause of serious disability. But a trip to the dentist may help determine risk for a stroke.

Radiographs (x-rays) help a dentist observe the condition of a patient’s teeth, roots, jaw placement and overall placement of facial bones. X-rays can pinpoint the location of cavities and other signs of disease impossible to detect through a visual examination. A panoramic x-ray allows a dentist to see the entire structure of the mouth in a single image. Because of their proximity to the mouth, carotid arteries (located on each side of the neck) often appear in these x-rays. Communicating any stroke risk factors patients have can help a dentist determine if their patient is at risk.

In his case report, Dov M. Almog, DMD, incidentally detected in his patient’s panoramic x-ray calcifications in one of the carotid arteries. He referred the patient to his primary care physician for further testing and observation, revealing 80 percent stenosis (blockage).

“Panoramic x-rays are extremely useful for observing a patient’s oral health,” says Dr. Almog. “But they are also a beneficial adjunct screening tool for identifying patients at risk for stroke.”

Patients already at risk should share their medical history with their dentist and ask the dentist to be aware of any signs of calcifications that may show up during their regular dental check-ups.

“Dentists are concerned not only with a patient’s oral health, but also their overall well-being,” says Eric Curtis, DDS, and AGD spokesperson. “If a dentist is aware of the medical history of the patient, he/she can pay close attention to the radiographs and refer patients for follow-up medical care when appropriate.”

If blockage were detected on the radiograph, a patient would likely be referred for a Carotid Duplex Ultrasound. This test uses high-frequency sound waves to view the blood vessels in the neck. The blockage could be treated in a variety of ways including: lifestyle modification, medications such as blood thinners, surgery or other interventional procedures such as a catheter.

Treatable risk factors for stroke

• High blood pressure
• Tobacco use
• Diabetes mellitus
• Carotid or other artery disease
• Heart disease or disorders
• Transient ischemic attacks (warning strokes)
• Blood disorders
• High blood cholesterol
• Obesity
• Excessive alcohol use
• Illegal drug use