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Dental X-Rays Can Detect Stroke Risk

They help spot blockages in neck arteries, study says

SUNDAY, Nov. 11, 2001 (HealthDayNews) -- A routine trip to the dentist could prove to be a lifesaver for women at risk of stroke.

According to new research published in the Journal of the American Dental Association, X-ray technology that's being used by an increasing number of dentists allows for the detection of neck arteries blocked by hardened fatty tissues, or atheromas.

Such blockages often occur without symptoms and, in worst cases, can lead to stroke.

The X-ray technology in question allows for panoramic or "wide-angle radiography." Currently, about 50 percent of American dentists use this type of X-ray, according to the researchers.

For the study, the researchers reviewed the X-rays and medical records of 52 female military veterans who averaged 70 years of age. To participate in the study, the women had to have no symptoms of neurological disease or illness.

During the review, the researchers found that 31 percent -- or 16 of the women -- had atheromas in the neck.

Because they were asymptomatic, it's unlikely the women would have been diagnosed until they had developed more dangerous symptoms, says Dr. Arthur H. Friedlander, associate chief of staff and director of graduate medical education at the Veterans Affairs Greater Los Angeles Healthcare System, and lead author of the study.

"It's fortuitous that we found these on these X-rays because individuals [without symptoms] are usually not otherwise screened," he says.

There was no follow-up done on the women's conditions for the study, Friedlander says, but he knew of at least one participant who had undergone surgery to remove the blockage.

Lest patients begin asking their dentists for neck X-rays, however, Friedlander emphasizes that the technique should only be used when a patient already needs an X-ray for a justifiable dental purpose.

That's because X-rays subject patients to radiation that should only be used when necessary. Also, ultrasound screenings used by doctors are necessary to determine the nature of the atheroma, the extent of the blockage and the necessary treatment, he says.

"There are more sensitive imaging systems which can pick up much earlier lesions than we're picking up with these X-rays," Friedlander says. "So, if a person was interested in finding out whether they were at risk, they are best advised to go see a doctor first.

"We don't want dentists to take these X-rays just to look for these atheromas in the neck," he adds. "There needs to be a dental rationale and a need. Once that's been met, then since it's already there, the dentist needs to review the entirety of the radiograph and not just the teeth."

Atheromas occur more often in post-menopausal women than men as estrogen levels decline. When the blockage is less than 60 percent, the treatment normally consists of medications, such as hypertension drugs, along with lifestyle changes to treat conditions like obesity or diabetes.

More severe blockages can be treated with surgery, Friedlander says.

Some symptoms of an atheroma include short-term loss of strength in a hand, an arm, a leg or a foot, as well as short-term difficulty in speaking, says Dr. Richard Latchaw, chief of the Department of Neuroradiology at the University of Pittsburgh Medical Center.

"Those are very dangerous situations and if you have something like that, go to your doctor and have a work-up soon, even if it goes away, because that's a harbinger for an increased risk of stroke," says Latchaw, who's also a spokesman for the American Stroke Association.

Latchaw shares Friedlander's concern that the study might prompt some dentists or patients to see dental X-rays as a first-line means of detecting atheromas.

"I'm worried dentists may look at this and say, 'Hey, I've got another use for my X-ray machine.' And we're saying, 'No, don't do that,' " Latchaw says.

However, Friedlander says it behooves dentists to make a habit of looking not just at the teeth in X-Rays, but also checking for atheromas.

"If you [a dentist] happen to see the [atheroma] while looking at dental X-rays, refer the patient to a general practitioner and that doctor will hopefully just order an ultrasound to see if there is significant narrowing. And if there is, that is a patient who will go on to some kind of definitive therapy," Friedlander says.

What to Do: Visit the American Stroke Association for more information on the symptoms and treatment for stroke. And the American Heart Association has a helpful site on women and stroke.

SOURCES: Interviews with Arthur H. Friedlander, D.D.S., associate chief of staff and director of graduate medical education, Veterans Affairs Greater Los Angeles Healthcare System; Richard Latchaw, M.D., professor of radiology, and chief of the Department of Neuroradiology, University of Pittsburgh Medical Center; Journal of the American Dental Association, August 2001
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