Looking Beyond Teeth: Dental X-Rays and Carotid Artery Health

Published 2 September 2026
Reviewed by Dr. Advaitha Anand, BDS MDS (Conservative Dentistry & Endodontics)

Examining Dental X-Rays for Signs Beyond Oral Health

Routine dental imaging plays a central role in evaluating the teeth, jawbone, and surrounding structures. However, panoramic dental X-rays—which capture a broad view of the entire mouth and lower face—sometimes capture areas outside the immediate dental arches, such as the carotid arteries located on either side of the neck.

A cross-sectional study evaluated how findings on panoramic radiographs, specifically severe gum disease and visible mineral deposits in the carotid arteries, correlate with ultrasound evidence of cardiovascular disease. The research analyzed data from 410 adults participating in the Malmö Offspring Dental Study to understand whether dental imaging findings reflect broader arterial health.

What the Study Investigated

The study evaluated 410 participants who had a mean age of 53.0 years (with a standard deviation of 7.8 years). Each participant underwent three distinct diagnostic examinations:

Carotid artery ultrasound imaging, which provides detailed measurements of arterial plaque and vessel narrowing.
Panoramic dental radiographs (broad dental X-rays).
Intraoral radiographs (detailed X-rays taken inside the mouth).

Researchers examined the panoramic X-rays for two primary features:

Marginal bone loss: The loss of bone surrounding the teeth, which serves as a marker for current or past periodontitis (advanced gum disease).
Carotid artery calcifications: Hardened mineral deposits visible in the tissue area corresponding to the carotid arteries in the neck, categorized by their presence and shape.

The carotid ultrasound imaging measured three specific indicators of cardiovascular condition:

Total plaque area: The total physical surface area covered by fatty plaque deposits along the artery walls.
Number of plaques: The total count of distinct plaque formations observed in the carotid vessels.
Lumen reduction: The degree to which plaque buildup narrows the interior opening (lumen) of the blood vessel.

Participants were divided into groups based on whether they had stage III or IV periodontitis, carotid artery calcifications, or both, and these groups were compared against the ultrasound measurements after statistical adjustments for relevant covariates.

Key Research Findings

The statistical analysis revealed significant differences among the participant groups:

Combined Findings: Participants who presented with both stage III-IV periodontitis and carotid artery calcifications (regardless of calcification shape) showed significantly higher total plaque area, a greater number of arterial plaques, and more pronounced lumen reduction on ultrasound scans compared to individuals without these conditions (p < 0.001).
Increased Odds of Arterial Plaque: Compared to participants who had neither periodontitis nor carotid calcifications on their X-rays, those with combined periodontitis and carotid calcifications had a 13.7-times higher probability of having arterial plaques confirmed on their ultrasound scan.
Calcifications Alone: Participants who had carotid calcifications on their panoramic X-rays without advanced periodontitis still had a 7.65-times higher probability of plaque detection on ultrasound compared to those with neither finding.
Specific Calcification Shapes: When analyzing a specific “vessel-outlining” shape of calcification combined with periodontitis, the measures of vessel narrowing and plaque were more severe, though this specific sub-group comparison did not achieve statistical significance.

Study Limitations

While these results highlight important patterns, the study has clear boundaries that must be considered:

Observational Design: As a cross-sectional study, the research evaluated participants at a single point in time. Consequently, it can identify statistical associations between dental X-ray findings and ultrasound measures, but it cannot prove that gum disease causes arterial plaques or vice versa.
Sample Population: The study analyzed 410 individuals from a specific population group within the Malmö Offspring Dental Study. Results from this cohort may not fully represent populations in other geographic regions or with different demographic characteristics.
Diagnostic Focus: Panoramic radiographs are designed for oral health evaluation, not primary vascular screening, meaning direct ultrasound imaging remains the definitive tool for assessing arterial health.

What This Means for Patients

This research shows that findings noted on routine dental panoramic X-rays—such as evidence of severe past or present gum disease and visible carotid calcifications—are associated with a higher likelihood of arterial plaque identified through specialized medical ultrasound.

For patients, these findings highlight the value of maintaining routine dental checkups and diagnostic X-rays. While dental X-rays are taken to assess teeth and supporting bone, they occasionally reveal incidental features in nearby tissues. When dentists spot potential signs of carotid calcification along with advanced periodontitis, they may suggest that patients share these findings with their physician for a comprehensive cardiovascular risk evaluation and preventative medical guidance.