Stroke Prevention Via Dental Radiographs
By Joseph Preziosi Jr., DMD
According to the American Heart Association stroke is the third leading cause of death in the United States behind heart disease and cancer. Nearly two thirds (66%) of theses strokes are caused by reduced blood flow, ischemia, by plaque formations in the internal carotid arteries. Pieces of the plaque, emboli, can dislodge and travel to and then block smaller arteries in the brain thus starving the region of the brain of oxygen that arteries supplies. Brain tissues starts to die in just four to five minutes once deprived of its oxygen supply.
Medical studies have shown that asymptomatic patients who have greater than 50% blockage, stenosis, of their internal carotid arteries from atherosclerotic plaque are at a much greater risk of developing a stroke. Because the timely treatment of the atherosclerotic plaque lesions can significantly reduce the risk of stroke it is imperative to diagnose any plaque formation as early as possible.
Until recently the screening, tests and diagnosis of these carotid artery calcified plaques was solely in the realm of physicians who would listen for irregular sounds in the blood flow of the patient’s neck. These are crude methods at best with low sensitivity, the ability to detect what you are testing for, and specificity, the confidence level of a test. However, today these carotid artery calcified plaques can be detected on dental panoramic radiographs (X-rays). This can be a very inexpensive and noninvasive screening test that many patients receive without any suspicion of carotid artery disease. Many dental offices will do these types of radiographs routinely every three years to evaluate patients for caries (dental decay), periodontal disease, jawbone abnormalities, tooth abscesses, tooth fractures and jawbone fractures. Panoramic radiographs are also essential in all implant cases, so dentists are in a position to serendipitously diagnose potential carotid artery disease.
When a dentist diagnoses suspicious carotid artery lesions through dental panoramic radiographs, conformation of the diagnoses can now be done by a noninvasive duplex ultrasonography. The ultrasonagraphy can confirm whether the radiographic opacities that show up on the panoramic radiographs are actually in the carotid arteries or not. These results can be further substantiated by Doppler ultrasonagraphy spectral analysis in which velocity and waveform demonstrate the change in velocity of blood flowing through the patient’s arteries. As the lumen, the inner diameter of a blood vessel, becomes more and more obstructed by calcified plaques the faster the velocity of the blood flow through these narrowed sections of the arteries. The faster the blood flow the more occluded the artery so the velocity of the blood flow can be correlated to the percentage that the artery’s lumen is obstructed. The amount of arterial lumen obstruction can the be related to the relative risk of the patient suffering a stroke so that the need for treatment and the type of treatments available can be assessed and presented to the patient.
As demonstrated in this article a dentist may be the first health care provider to diagnose asymptomatic patients who have calcified radio-opaque carotid artery plaques through routine dental panoramic radiographs. Since many of these plaques can lead to strokes their early diagnoses and treatment can reduce drastically reduce patient’s morbidity and mortality. Improving the quality of life and saving lives of patients while reducing the overall medical costs for the patient and reducing the societal costs associated with lost productivity from patients that develop stroke. Not to mention the heartache of the patient’s loved ones form the devastating effects of patients suffering from stroke or the loss of a loved one from stroke.
About the Author:
Joseph Preziosi Jr., DMD
New Jersey Cosmetic Dentist
phone. (908) 654-7100
fax 908-654-8764
email: Drpreziosi@aol.com
url: http://www.preziosidentistry.com/
