Incidental Carotid Artery Calcification Detection on Routine Dental Radiographs: A Potential Cardiovascular Screening Tool for Resource-Limited Settings

Abstract Background and Research Question: Carotid artery calcification (CAC) is a key marker of atherosclerosis and a predictor of cardiovascular events. Although CT angiography is the gold standard for CAC detection, routine dental panoramic radiographs, which are low cost and widely accessible, may serve as an untapped screening tool, especially in resource-limited settings. This study investigated whether panoramic radiographs can identify incidental CACs and employed a visual grading system for CAC assessment. Study Design and Methods: A retrospective observational study was conducted using panoramic radiographs collected from six public and private dental facilities in Peshawar, Pakistan, between 2022 and 2024. Radiographs of patients aged 25 years and older, in which the carotid artery bifurcation (at or below the C3 vertebra) was clearly visualized, were independently reviewed by three blinded oral radiologists. In addition to determining the prevalence of CAC, a visual grading system was employed to classify calcifications as mild, moderate, or severe. Descriptive statistics were used to summarize demographic characteristics, and age-specific trends in CAC severity were analyzed. Results: Among the 332/1192 eligible radiographs, CAC was identified in 25 patients (7.5%), with prevalence rates of 7.8% in females and 7.1% in males. The mean age of the CAC-positive patients was 42.3 years (range 25–70 years). Among the CAC-positive patients, 60% had mild calcification, 28% had moderate calcification, and 12% had severe calcification. CAC incidence was significantly greater in the oldest patients (65–70 years, 15.8%) than in the youngest patients (25–34 years, 6.4%) (p < 0.05). Conclusion: Panoramic dental radiographs may represent a valuable, cost-effective, and low-radiation means for the incidental detection of CAC screening, especially in regions with limited access to advanced imaging modalities. Early detection could prompt timely further evaluation and interventions, potentially reducing morbidity and mortality from cardiovascular and neurovascular diseases. Implications: Integrating incidental CAC assessment into routine dental imaging could significantly increase preventive health efforts, particularly in underserved and resource-constrained populations. Further prospective research is needed to confirm these findings and develop standardized guidelines for identifying and providing recommendations regarding CAC on panoramic radiographs.