A visit to your dentist usually results in a recommendation to floss more or to reschedule an appointment to treat a cavity, however, some patients are learning they might need to see their physician instead.  There are instances where your dentist can find evidence that you may be at risk for a stroke.

According to the American Stroke Association (ASA), every 45 seconds, someone in America has a stroke.  Stroke is the third leading cause of death in the United States today and the leading cause of serious disability.  But a trip to the dentist can reveal signs of a person’s potential risk for a stroke.

Radiographs (x-rays) help us observe the condition of a patient’s mouth.  We can see everything from decay to roots, jaw placement and overall placement of facial bones.  X-rays can precisely pinpoint the location of cavities and other signs of disease impossible to detect through a visual examination.  A panoramic x-ray is a large single image (typically not detailed enough for the visualization of decay) that allows us to see the entire structure of the mouth (from ear to ear and top of the nose to the chin).  Because of their close proximity to the mouth, the carotid arteries (located on each side of the neck) often appear in these x-rays.  The carotids are a major source of blood flow to your brain.  A disruption in the flow of blood in these arteries will often lead to a stroke.  In the panoramic radiograph we often see blockage in the arteries of patient’s who have an increased risk.  I haven’t found a lot of them over the years, but in the few patient’s we have observed them, preventive medical procedures have prevented a possible occurrence.  In a case report I was reading the other day, a dentist incidentally detected in his patient’s panoramic x-ray calcifications in one of the carotid arteries.  He referred the patient to his primary care physician for further testing and observation, revealing 80 percent stenosis (blockage).  That was a big
”Thank you Lord!”  Panoramic x-rays are extremely useful for observing a patient’s oral health, but as you can see they are also a beneficial adjunct screening tool for identifying patients at risk for stroke.  We typically take an updated panoramic x-ray every three to five years depending upon the patient’s specific needs.

If you’re aware of already being at risk, be sure to share your medical history with your dentist and ask him/her to be aware of any signs of calcifications that may show up during your regular dental check-ups.  Dentists are concerned not only with their patient’s oral health, but also their overall well-being.  There is a person tied to those teeth!

If blockage were detected on the radiograph, a patient would likely be referred for a Carotid Duplex Ultrasound.  This test uses high-frequency sound waves to view the blood vessels in the neck.  The blockage could be treated in a variety of ways including: lifestyle modification, medications such as blood thinners, surgery or other interventional procedures such as a catheter.  As with most things, prevention and early intervention is the key.  Treatable risk factors for a stroke include:  high blood pressure, tobacco use, diabetes mellitus, carotid or other artery disease, heart disease or disorders, transient ischemic attacks (warning strokes), blood disorders, high blood cholesterol, obesity and excessive alcohol use.  I hope you or someone you love never has to deal with a stroke.  Who knows – a trip to the dentist just might be one way to avoid a future concern!