Dr. Robert Axelrad Dental Office

Making Brampton Smile Since 1997

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Can You see What I See? A Case Study

Posted on by Dr. Axelrad

In this blog we will look at some life-saving information that can be seen on a panorex. On the panorex we will be able identify calcified carotid artherosclerotic plaques often seen in patients who are at risk of stroke.

Let’s Go Back….What is Artherosclerosis?

It is a chronic disease in which atheromatous plaques are deposited on the inside of arterial walls resulting in their thickening and loss of elasticity. Arteries respond to plaque buildup by becoming inflamed. This in turn results in the formation of other cells in the affected area, further narrowing the artery.

What is an Arethoma?

This is a calcified plaque composed of lipids and fibrous tissue that deposit on the inner walls of the blood vessels. Atherosclerosis is a chronic inflammatory disease.

Risk factors For Atherosclerosis

1) Diabetes Mellitus – A disease in which the body doesn’t make enough insulin or use the insulin it produces (or both). Insulin is needed to bring glucose (energy) into the cells.
2) Arterial Hypertension – Is a form of high blood pressure. Occurs in the pulmonary arteries….these are the arteries in which blood courses from your heart to your lungs.
It is a life-threatening condition that gets worse over time. The tiny arteries in your lungs become narrow and blocked. It’s harder for blood to flow through them and this raises the blood pressure in the lungs: your heart has to get blood to flow through these tiny arteries and overtime the heart muscle weakens.
3) Improper foods eaten – i.e. fried and fatty food loaded with saturated and trans fat. These raise blood cholesterol concentrations that contribute to clogged arteries.
4) Smoking – The chemicals in tobacco smoke are harmful to your blood cells. These chemicals can also cause damage and affect the proper functioning of your heart in addition to the structure and function of your blood vessels. This damage increases your risk of artherosclerosis.
5) Alcoholism – chronic use of alcohol can affect proper functioning of the heart.
And additional risk factors have been added:
6) Periodontitis – See the blog “Periodontal Disease…..What Exactly is it?” posted on March 2nd, 2012.
7) Chronic Renal Disease. This is the gradual loss of kidney function over time. An increased rate of atherosclerosis has been observed in the early stages of renal dysfunction.
8) Menopause – This is the absence of menstrual periods for nine to twelve months. Prior to menopause, women are protected from heart disease by estrogen, the reproductive hormone produced by the ovaries. Estrogen helps keep arteries free from plaque by improving the ratio of LDL (low density lipoprotein) and HDL (high density lipoprotein) cholesterol: Estrogen increases the amount of HDL cholesterol which helps to clear arteries of LDL cholesterol, the kind that most contributes to plaque buildup.

Atherosclerosis can affect both the arteries of the heart and brain.

When it affects the carotid arteries, the result can be a stroke.
When it affects the coronary arteries, there can be the possibility of a myocardial infarction (heart attack)
A myocardial infarction is the irreversible death (necrosis) of heart muscle due to a lack of oxygen supply.

The Role of the dentist

Although difficult, it is possible to identify (on a panorex), atherosclerotic lesions (plaque) present in the carotid artery.

A dentist may be able to identify that a plaque is present, but the question is whether it is a true atheromatous lesion…it is easily confused with triticeal cartilage when it is calcified. The triceal cartilage is the lateral thyroid ligament. At times the triceal cartilage may develop cartilaginous nodules (sometimes boney) which may appear radiopaque and therefore confused with carotid artery plaque.

What do we see on the panorex?
It may appear as one or more irregular opacities about 2.5 cm posterior and inferior to the angle of the mandible adjacent to the space between vertebra C3 and C4.

In Conclusion

The dentist’s role in identifying carotid artery plaques on an x ray would be to refer the patient to a qualified doctor for further evaluation.

The analysis of whether a plaque is present would need to be taken to the next level with the help of other diagnostic criteria.

If noted on a panorex, then this is just a bonus in helping to diagnose and refer the patient before the possible occurrence of a stroke.

Yours in good dental health!

Dr. Robert Axelrad, Brampton Dentist

About Dr. Axelrad
Practicing dentistry for over 23 years, Dr. Robert Axelrad owns and manages his own dental practice in the heart of Brampton, Ontario. Affectionately known as ‘Brampton’s Gentle Dentist‘, patients include children, adults and seniors. Dr. Axelrad recently moved his practice to its current, state-of-the-art dental office at Bestgate Professional Center in Brampton, Ontario, Canada in 2002 to accommodate his growing list of happy patients.


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We're getting very excited about returning to work and seeing patients again!  The green light has yet to come from the government, but we are ready now.  Being ready means being safe.  The following safety measures have been put in place to protect patients and staff.

Safety Measures:

  • A plexiglass barrier stands on the front desk in the waiting room.
  • All patients will have their temperature taken with a non-touch digital infra-red thermometer.
  • All staff will wear a mask, gloves, gown, bonnet, goggles and face shield.
  • Hand sanitizers will be readily available for staff and patient use.
  • Patients will wait outside or in their car until their appointment time.
  • No visitors are permitted in the office.
  • Social distancing will remain in effect in the office.
  • Patients experiencing influenza-like-illness (fever with a cough, sore throat or muscle aches) should not come to the office.

We really look forward to seeing everyone again!

Until then, please stay safe and healthy.