Dear Colleagues,

I thought it would be helpful to elaborate on the diagnosis and management of patients who have chance findings on panoramic and CBCT radiographs which are suggestive of calcification of the Carotid arteries. In adult patients who do not have chronic renal disease the chance of seeing an irregular shaped and variable density opacity at the level of C3- C4 in the parapharyngeal regions is about 4-5% of radiographs. If the patient is a smoker with a known history of cardiovascular disease then chances increase of finding a calcification.

Patients with Chronic Renal disease have a 50% prevalence of carotid artery calcification on radiographs. In the average general practice of about 1,500 people with 50% being adults then about 30 people are likely to have carotid artery calcifications  so you should definitely see this condition in your office population.

71 M R CACA

In this CBCT image of a 71 year old male with known problems of cardiovascular disease and hypertension,  a 4 mm opacity appeared with 2 distinct white lines which are compatible with calcification of the walls of the carotid artery. The carotid artery bifurcation is about 6 mm in diameter.

A letter was sent to the patient’s MD regarding the need for further evaluation and the possible complications for the planned tooth extractions. A Doppler ultrasound examination was performed and calcification of the Internal Carotid artery was found bilaterally. The Internal carotid artery is smaller than the Common Carotid which explains why the calcification measured 4 mm.

The ultrasound reported a narrowing of the artery lumen of between 1-49% and as such is not producing a significant reduction of blood flow. The MD recommended that provided a general anesthetic (GA) was not planned for the extractions then no special precautions were necessary. However, an EKG should be performed prior to any GA.
In this particular case the patient was already under medical care for cardiovascular disease and associated hypertension  reducing the likelihood of stroke or heart attack. However, in patients with no history of cardiovascular or renal disease, the finding of a carotid artery calcification can be an alarm signal indicating that it is important to inform the patient and their MD as there is likely to be occult cardiovascular disease with the possibility of sudden death from a heart attack or a stroke.

– Dr. Douglas K Benn

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