As a hygienist, the beginning of my patient’s visit is a perfect opportunity for me to help to identify any key medical issues with my patients.
I believe that education is the key to all purposes in life. We must educate our patients on the potential for health concerns. I first watch my patient as they walk into the room and get seated in the dental chair. This gives me at a first glance, any signs that I should be concerned of such as difficulty breathing, skin color or any swaying when they walk.
I will then review with the patient medical history. I make notes in the chart of the patient’s comments about each item marked on the history form. If the patient is being treated for any type of cardiovascular disorder such as High Blood Pressure, Heart Attack, etc. or even diabetes or thyroid disease; I will use these topics to discuss the new findings that link periodontal disease to many other systemic diseases. I make a point to especially stress the issues that they have marked on the medical history form. I will then take the patients Blood Pressure. Again, this is a good indication of the patient’s health and gives the patient the feeling that we as dental professionals are genuinely concerned about the patient’s health.
After taking the Blood Pressure, we will begin the radiographs. It is important to let patient know what type of radiographs are being taken and why. I say to my patients: “I will begin the exam by taking some radiographs to help with diagnosing any signs of decay or disease. The first films will be cavity detecting films. I place them in your mouth and have you bite down. The next film is a panorex. This film will help us to see the roots of all your teeth, your sinus cavity, and the bone of the jaw and TMJ. This radiograph also helps to diagnose any signs of cancer, bone deformities or even plaque calcifications on the carotid artery.”If the patient is a patient of record in the dental practice, I will review the previous x-rays, explaining that I am looking for any signs of changes in any of the films, including the panorex and the carotid artery.I will stress to the patient that the carotid artery is not visible on many films, but we always want to look for it, to help prevent any serious medical conditions.
Since learning about the carotid artery on panorex films a little over 3 years ago, I have had only two patients that I could see the carotid artery on the film. (One is my Father in Law and the other an active patient in the practice).
In this patient’s case, the patient is a woman in her early 70’s. I learned after reviewing her medical history that she had surgery to clean the plaque from her arteries. I then mentioned to the patient that it has recently been discovered that we can sometimes see thickening of the plaque in the carotid artery on a panorex x-ray and asked for the patient’s permission to take the radiograph. We saw the plaque on the film. I explained to the patient what the doctor and I were seeing and recommended that she have her physician check it out as she had not had a complete physical since her surgery over 5 years ago..
It has been proven that many people in the United States see their dentists for a complete exam once or twice a year, while seeing their physician for a physical examination only once in a 5 – 10-year period. To best serve the needs of our patients, we must be able to identify key signs and symptoms of serious illness and health conditions.
In most dental practices, a complete exam consists of dental x-rays, carries detection, periodontal and oral cancer screenings. Each of these procedures where developed to identify potential problems in the oral cavity. We as dental professionals can take this one significant step forward, by using the information we must help our patients become more aware of their risk for Heart Attacks, Strokes and other systemic diseases.
In study after study, a connection has been found between periodontal disease, cardiovascular disease and diabetes. In fact, per a study released at the American Academy of Neurology’s 51’st Annual Meeting in April 1999. People with periodontal disease were more likely to have thickened carotid arteries, which can lead to stroke and heart disease. For this study, 52 people who had never had a stroke where given dental examinations and an ultrasound tests to determine the thickness of their carotid arteries. The people with the most periodontal disease had the most thickness of the arteries. The carotid artery wall was thicker in the group with the most periodontal disease than in the group with less periodontal disease.
The relationship between periodontal disease and the formation of an atheroma is caused by the endotoxins from the cell wall of gram negative bacteria present in periodontal diseased pockets which causes the release of inflammatory mediators, which then can result in the formation of atheroma’s and subsequent atherosclerosis.
Atherosclerosis is a common form of arteriosclerosis in which deposits of plaque or atheroma’s containing cholesterol, lipid material, and liphage’s form within the tunica intima of arteries. These lesions cause the inner wall to become roughened and the muscular wall to become inelastic and hardened. The narrowing of the lumen and hardening of the muscle decreases the rate at which blood can flow through the vessel leading to ischemia of tissues, development of clots or aneurysm within the muscle wall. The eventual outcome of the atherosclerotic process can be stroke or myocardial infarction.
The exact cause of atherosclerosis is unknown. It appears to stem from a combination of factors including heredity, hormones and diet. Hypertension accelerates the process because of the stress on the lining of the vessels. Patients with diabetes mellitus tend to develop atherosclerosis earlier in life. Hyperglycemia is another factor closely associated with atherosclerosis. Cardiovascular diseases, including atherosclerosis, coronary thrombosis and ischemic heart disease are all major causes of death in the Unitized States today.
Radiographs taken at routine dental visits can reveal much more than the simple signs of decay. Dental radiographs can also reveal signs of Bone Loss, Osteoporosis, Diabetes, many different pathological signs such as abscesses, supernumerary teeth, and many different types of cancer. Extra-oral radiographs such as the dental panoramic or Ceph. can even reveal blockage in the carotid artery. Blockages in this area can increase risk for stroke and heart problems. We as dental professionals can take one significant step forward, by using the information we must help our patients become more aware of their risk for heart attacks, strokes and other systemic diseases.
It has recently been found that these calcified plaques can be identified on the corners of a panoramic radiograph. The carotid artery calcifications have been located within the soft tissues of the neck. Studies have shown that the presence of these plaques observed on the panorex’s have been consistent with the follow-up diagnostic tests using ultrasounds showing restricted blood flow to the brain. In all the patients used in these studies, none had any symptoms of having arteriosclerosis, thrombus, or stroke prior to having the panorex. However, these radiopacities overlying the carotid artery bifurcation seen on the panoramic radiograph can have other diagnoses, including thyroid cartilage calcifications, calcified stylohyoid ligament, triticeous cartilage calcifications, or calcified lymph nodes.
Because the first clinical manifestations of Carotid Artery Stenosis, Theromas, and Heart Disease findings can be seen in the mouth by signs of periodontal disease and the presence of plaque calcifications on the carotid artery found in the dental panorex, these are appropriate and life saving treatment. Maintaining adequate health and medical history of your patients of top priority, previous health changes and hormonal changes play a significant role in the oral health as well as the overall health of the patient. It is very important to note that panoramic x-rays should not be exposed for the sole purpose of looking for carotid artery plaque. Therefore, it is important for all of us, as dental professionals to study the previous radiographs and look for any potentially harmful changes in the films from year to year. If by any chance any plaque deposits appear, a referral to the patient’s physician is mandatory for further evaluation.
We as dental professionals need to remember that we are not only concerned about the health of the oral cavity, but of the overall health of our patients. It is so important to make the dental team aware that there is additional information that can be obtained during periodontal screenings and radiographs. Dental examinations reveal more about your health than just the status of your teeth. We need to look beyond the confines of the teeth and periodontal conditions. We hope that by treating the whole body, not just the oral cavity, we will be able to continue giving our patients the life and smiles that they deserve.