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- Gustafsson, Nils, 1990-
(författare)
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Calcified carotid artery atheromas in panoramic radiographs : diagnostic reliability and association to cardiovascular disease, diabetes and periodontitis
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Objective: Incidental findings of Calcified Carotid Artery Atheromas (CCAA) on Panoramic Radiographs (PRs) of the jaws can be a risk marker for cardiovascular disease. The objectives for the thesis were to investigate the association between CCAA and 1) Myocardial Infarction (MI), 2) periodontitis, 3) diabetes and 4) estimated cardiovascular risk. Also 5) if patients with both CCAA and periodontitis have a higher risk of MI. The final objective was to study 6) General Dental Practitioners (GDPs) ability to detect CCAA on PRs and if a short training programme can improve their diagnostic accuracy.Materials and methods: Paper I-III were part of the Swedish, multicentre (17 hospitals) case- control study Periodontitis and Its Relation to Coronary Artery Disease (PAROKRANK). The study included 1610 individuals, 805 cases (151 women) diagnosed with first acute MI, and 805 controls matched for age, sex and residential area. Seventeen participants were not examined with PR and an additional 111 were excluded due to inadequate quality. As a result, 90 participants lost their match. Paper I and II had a case-control design that only included matched cases (n = 696) and controls (n = 696). Paper II and III used a cross-sectional design to evaluate all included cases (n = 738) and controls (n = 744) separately. All participants in PAROKRANK went through a detailed medical and oral health examination, including e.g., oral glucose tolerance, an extensive blood panel, and 4-point pocket probing. All PRs were assessed both for the presence of CCAA and signs of poor oral health, including marginal bone loss. The results from the medical examination were used to estimate risk of future cardiovascular events and death using Systematic COronary Risk Evaluation (SCORE) and Framingham Risk Score (FRS). The results from the oral health examination were used to classify the degree of periodontitis both according to bone loss and clinical periodontal disease index (CPDI). Paper IV used a pre-post design to evaluate 14 GDPs diagnostic accuracy regarding assessment of CCAA on PR before and after participation in a short training programme. The GDPs were evaluated at baseline, 2 weeks and 1 year after training. Comparisons were made with the consensus of 2 experienced oral and maxillofacial radiologists.Results: Paper I: CCAA on PRs was more common among cases with recent first MI, (33.8% with CCAA), compared to controls (27.6%; P = 0.012). Paper II: CCAA and CPDI were associated among cases (OR 1.51; 95% CI, 1.09 to 2.10; P = 0.02) and controls (OR 1.70; 95% CI, 1.22 to 2.38; P < 0.01). No association was found between CCAA and the degree of bone loss on PR. MI had a stronger association to CCAA combined with periodontitis, than to either condition alone (OR 1.75; 95% CI, 1.11 to 2.74; P = 0.01). Paper III: Elevated risk of a future cardiovascular event estimated with FRS was associated with CCAA, both among cases (OR 1.89; 95% CI: 1.31–2.73, P = 0.001) and controls (OR 1.64; 95% CI: 1.03–2.64, P = 0.04). Elevated risk of cardiovascular death according to SCORE was associated with CCAA among controls (OR 1.58; 95% CI: 1.12–2.23, P < 0.01) but not among cases. Diabetes was more common among controls with than without CCAA (18.0% vs. 11.7%), but this association was not statistically significant after adjustments. Paper I-III included a sex- stratified analysis revealing that the results were mainly applicable on men. Paper IV: An improvement in diagnostic accuracy was observed among GDPs after a short training programme for diagnosing CCAA on PR. The sensitivity increased (41.8% to 55.7%, P = 0.02) without a decrease in specificity. The kappa values also increased (0.66 to 0.71, P = 0.04). At 1 year follow up, the improvements compared to baseline remained.Conclusions: There is an association between CCAA on PR and MI. Clinically diagnosed periodontitis is associated with CCAA on PR, and among participants with both periodontitis and CCAA there is a higher probability of having had MI than among participants with either condition alone. An increased estimated risk of future cardiovascular events and death according to FRS and SCORE is associated with CCAA on PR. These conclusions are mainly applicable on men. Diabetes was not independently associated with CCAA on PR, possibly due to selection bias. A short training programme can significantly and sustainably improve GDPs diagnostic accuracy regarding CCAA. This indicate that GDPs could contribute to prevention of cardiovascular events and death by detecting CCAA on PR and, should be encouraged to refer patients without previous treatment of cardiovascular disease for further medical attention, and if other cardiovascular risk factors are identified, necessary treatment.
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| 2. |
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| 3. |
- Barut, Oya, et al.
(författare)
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Calcifications in the neck region of patients with carotid artery stenosis : a computed tomography angiography study of topographic anatomy
- 2020
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Ingår i: Oral surgery, oral medicine, oral pathology and oral radiology. - : Elsevier. - 2212-4403 .- 2212-4411. ; 129:5, s. 523-530
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: The aim of this study was to map the vertical locations of calcified carotid plaques (CCPs), osseous anatomic structures, and calcified soft tissues in the area of the carotid artery, determine to what extent CCPs are superimposed on the cervical spine in coronal images, and analyze the differences between men and women.Study Design: Computed tomography angiography (CTA) scans of 79 patients were studied. CCPs were discovered in 152 of the total 158 neck sides. Evaluations were performed by using sagittal and coronal reformatted CTA images with maximum intensity projection.Results: Most of the calcified anatomic structures studied, including the carotid bifurcation, were found in close relationship to the level of the third and fourth cervical vertebrae. In the coronal view, all or most of the areas of the CCPs were superimposed on the cervical spine in 22 of 44 (50%) neck sides with CCP in women and in 37 of 108 (34.2%) in men (P = .070).Conclusions: The carotid bifurcation is in close proximity to various calcified anatomic structures. This should be taken into account when diagnosing CCPs in panoramic radiographs. In the coronal view, CCPs and the cervical spine are often superimposed; thus, coronal images are not recommended for confirmation of putative carotid calcifications diagnosed on the basis of panoramic radiographs.
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| 4. |
- de Lange, Thomas, et al.
(författare)
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Students' perceptions of post-exam feedback in oral radiology : a comparative study from two dental hygienist educational settings
- 2024
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Ingår i: European journal of dental education. - : John Wiley & Sons. - 1396-5883 .- 1600-0579. ; 28:2, s. 377-387
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: The aim of this study was to investigate how students perceive the benefit of participating in a teacher-organised session providing feedback on exams, termed post-exam feedback, in two dental hygienist programmes.Methods: The study was based on interviews with 22 participants, including 18 students and 4 faculty teachers. The data were approached on the basis of thematic analysis, allowing us to generate insights on how the participants reflected on their participation in the post-exam feedback sessions and how they perceived this arrangement as learners.Results: The findings from the study suggest that motivated students consider post-exam feedback to be beneficial in clearing up uncertainties and deepening their understanding of issues not fully understood during the exam, as well as supporting their further learning. Less motivated students mainly consider post-exam feedback to be relevant for students who do not pass the exams.Conclusions: Organised in a student-centred way and with attentiveness to student learning preferences, the results suggest that post-exam feedback can be valuable for enhancing assessment and supporting student learning related to exams.
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| 5. |
- Garoff, Maria, 1979-, et al.
(författare)
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Bilateral vessel-outlining carotid artery calcifications in panoramic radiographs : an independent risk marker for vascular events
- 2019
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Ingår i: BMC Cardiovascular Disorders. - : BioMed Central. - 1471-2261 .- 1471-2261. ; 19:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: In odontology, panoramic radiographs (PRs) are regularly performed. PRs depict the teeth and jaws as well as carotid artery calcifications (CACs). Patients with CACs on PRs have an increased risk of vascular events compared to healthy controls without CACs, but this association is often caused by more vascular events and risk factors at baseline. However, the risk of vascular events has only been analyzed based on the presence of CACs, and not their shape. Thus, this study determined if the shape of CACs in PRs affects the risk of future vascular events.METHODS: The study cohort included 117 consecutive patients with CACs in PRs and 121 age-matched controls without CACs. CAC shape in PRs was dichotomized into bilateral vessel-outlining CACs and other CAC shapes. Participants were followed prospectively for an endpoint of vascular events including myocardial infarction, stroke, and vascular death.RESULTS: Patients with bilateral vessel-outlining CACs had more previous vascular events than those with other CAC shapes and the healthy controls (p < 0.001, χ2). The mean follow-up duration was 9.5 years. The endpoint was reached in 83 people. Patients with bilateral vessel-outlining CACs had a higher annual risk of vascular events (7.0%) than those with other CAC shapes (4.4%) and the controls (2.6%) (p < 0.001). In multivariate analysis, bilateral vessel-outlining CACs (hazard ratio: 2.2, 95% confidence interval: 1.1-4.5) were independent risk markers for the endpoint.CONCLUSIONS: Findings of bilateral vessel-outlining CACs in PRs are independent risk markers for future vascular events.
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| 6. |
- Gustafsson, Nils, 1990-, et al.
(författare)
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Association of high cardiovascular risk and diabetes with calcified carotid artery atheromas depicted on panoramic radiographs
- 2022
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Ingår i: Oral surgery, oral medicine, oral pathology and oral radiology. - : Elsevier. - 2212-4403 .- 2212-4411. ; 133:1, s. 88-99
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To evaluate whether estimates of risk of future cardiovascular events and death and established or unknown diabetes are significantly associated with calcified carotid artery atheromas (CCAAs) on panoramic radiographs (PRs). The main focus was on men and women without previous myocardial infarction (MI). Methods: The PAROKRANK (Periodontitis and its Relation to Coronary Artery Disease) study included patients with a first MI and matched control subjects. In this substudy, 738 patients (138 women) and 744 control subjects (144 women) with available PRs were assessed for CCAA. Cardiovascular risk estimates were determined according to the Framingham Risk Score (FRS) and Systematic COronary Risk Evaluation (SCORE). Established and previously unknown diabetes was also determined. Results: CCAA was detected on PRs in 206 control subjects (28%) and 251 patients (34%). FRS was significantly associated with CCAA among control subjects (P = .04) and patients (P = .001). SCORE was associated with CCAA among control subjects (P < .01) but not patients (P = .07). Among men, FRS and SCORE were associated with CCAA in both control subjects and patients. Diabetes was not significantly associated with CCAA after adjustments. Conclusions: Elevated cardiovascular risk scores were associated with CCAA on PRs among control subjects. Diabetes was not independently associated with CCAA, possibly owing to selection bias.
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| 7. |
- Gustafsson, Nils, et al.
(författare)
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Associations among Periodontitis, Calcified Carotid Artery Atheromas, and Risk of Myocardial Infarction
- 2020
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Ingår i: Journal of Dental Research. - : Sage Publications. - 0022-0345 .- 1544-0591. ; 99:1, s. 60-68
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Tidskriftsartikel (refereegranskat)abstract
- Cardiovascular disease is a common cause of morbidity and premature mortality. Cardiovascular disease can be prevented when risk factors are identified early. Calcified carotid artery atheromas (CCAAs), detected in panoramic radiographs, and periodontitis have both been associated with increased risk of cardiovascular disease. This case-control study aimed to 1) investigate associations between periodontitis and CCAA detected in panoramic radiographs and 2) determine the risk of future myocardial infarctions due to CCAA combined with periodontitis. We evaluated 1,482 participants (738 cases and 744 controls) with periodontitis and CCAAs recruited from the PAROKRANK study (Periodontitis and Its Relation to Coronary Artery Disease). Participants were examined with panoramic radiographs, including the carotid regions. Associations between myocardial infarction and periodontitis combined with CCAA were evaluated in 696 cases and 696 age-, sex-, and residential area-matched controls. Periodontitis was evaluated radiographically (as degree of bone loss) and with a clinical periodontal disease index score (from clinical and radiographic assessments). We found associations between CCAA and clinical periodontal disease index score among cases (odds ratio [OR], 1.51; 95% CI, 1.09 to 2.10; P = 0.02) and controls (OR, 1.70; 95% CI, 1.22 to 2.38; P < 0.01), although not between CCAA and the degree of bone loss. In a multivariable model, myocardial infarction was associated with CCAA combined with periodontitis, as assessed by degree of bone loss (OR, 1.75; 95% CI, 1.11 to 2.74; P = 0.01). When the cohort was stratified by sex, only men showed a significant association between myocardial infarction and CCAA combined with periodontitis. Participants with clinically diagnosed periodontitis exhibited CCAA in panoramic radiographs more often than those without periodontitis, irrespective of the presence of a recent myocardial infarction. Participants with combined periodontitis and CCAA had a higher risk of having had myocardial infarction as compared with participants with either condition alone. These findings implied that patients in dental care might benefit from dentists assessing panoramic radiographs for CCAA-particularly, patients with periodontitis who have not received any preventive measures for cardiovascular disease.
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| 9. |
- Jonsson, Anton, et al.
(författare)
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Calcified carotid artery atheromas in individuals with cognitive dysfunction
- 2023
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Ingår i: Acta Odontologica Scandinavica. - : Taylor & Francis Group. - 0001-6357 .- 1502-3850. ; 81:4, s. 325-331
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The aim of this case-control study was to investigate whether cognitively impaired individuals have a higher burden of calcified carotid artery atheroma (CCAA) than controls without cognitive impairment.Material and methods: The study included 154 cases with Alzheimer’s disease (n = 52), mild cognitive impairment (n = 51), or subjective cognitive decline (n = 51) diagnosed at a university memory clinic. Seventy-six cognitively healthy controls were sampled through the Swedish population register. All participants underwent clinical oral and panoramic radiographic examinations. Two oral and maxillofacial radiologists performed blinded analyses of the panoramic radiographs for signs of CCAA, which was registered as absent or present and, if present, unilateral or bilateral. Consensus assessment was used for all statistical analyses.Results: CCAA was common (40%) in this middle-aged and older Swedish population. We found no differences in the prevalence of CCAA between cases and controls (40% vs. 42%).Conclusion: Cognitively impaired patients do not have a higher burden of CCAA than matched controls without cognitive impairment.
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| 10. |
- Levring Jäghagen, Eva, DDS, PhD, et al.
(författare)
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Arthrography of the temporomandibular joint : main diagnostic and therapeutic applications
- 2020
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Ingår i: Clinical Dentistry Reviewed. - : Springer. - 2511-1965. ; 4
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Tidskriftsartikel (refereegranskat)abstract
- Arthrography is an alternative technique for diagnosing soft tissue derangements of the temporomandibular joint (TMJ) when magnetic resonance imaging (MRI) is not an option. This can be due to contraindications to perform a MRI on a specific patient or when MRI is not applicable for specific diagnoses of soft tissue derangements of the TMJ. It is an invasive method and can be used not only for diagnostics but also for therapeutic injections e.g. administration of corticosteroids
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