Meta-analysis finds 7% incidence of suspected carotid atheromas on dental panoramic radiographs

OBJECTIVE: Giant cell arteritis (GCA) is a granulomatous vasculitis affecting medium- and large-sized arteries, most commonly the temporal arteries. Delayed recognition can lead to severe complications, including irreversible vision loss and stroke. Dentists routinely obtain panoramic radiographs for dental assessment, where calcified carotid artery atheromas (CCAA) may appear as incidental findings in the cervical region. This study systematically evaluated the incidence of suspected CCAA detected on panoramic radiographs obtained for dental indications and considered the clinical relevance of these findings for dental practitioners. METHODS: A systematic search of MEDLINE, PubMed, and Embase databases was conducted to identify studies reporting calcified carotid artery atheromas detected on panoramic radiographs. Study selection followed PRISMA guidelines. Observational studies reporting CCAA on panoramic radiographs were included. Data extraction was performed independently, and pooled incidence estimates were calculated using a random-effects meta-analysis. RESULTS: Thirty-four cross-sectional studies met the inclusion criteria. The pooled incidence of suspected CCAA detected on panoramic radiographs was approximately 7% (95% CI 5-9%). Substantial heterogeneity was observed among studies. These findings indicate that incidental radiographic detection of cervical calcifications occurs in a measurable proportion of dental patients undergoing panoramic imaging. CONCLUSIONS: Although panoramic radiography is not a screening modality for carotid artery disease, dentists should recognize potential calcified carotid atheromas when interpreting images obtained for dental purposes. Identification of suspicious calcifications and appropriate referral for medical evaluation may support early assessment of patients with possible vascular risk factors. CLINICAL RELEVANCE: Routine dental examinations and panoramic radiography may allow early risk identification, underscoring the importance of interdisciplinary collaboration.