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Objectives: Carotid artery calcification (CAC) is occasionally detected in panoramic radiographs (PRs). Bilateral vessel-outlining (BVO) CACs are independent risk markers for future vascular events and have been associated with large plaque area. If accounting for plaque area, BVO CACs may no longer be an independent risk marker for vascular events. The aim of this study was to explore the association between BVO CACs and vascular events and its relationship with carotid ultrasound plaque area.

Methods: In this cohort study we prospectively included 212 consecutive participants with CACs detected in PR that were performed to plan and evaluate odontologic treatment. Of these 212, 43 (20%) had BVO CACs. Plaque area was assessed with ultrasound at baseline. Primary outcome was major adverse cardiovascular events (MACEs) during follow-up.

Results: Vessel-outlining CAC was associated with larger plaque area on the same side (P = .03) and BVO CACs were associated with larger total plaque area (both sides summed) than other CAC features (P = .004). Mean follow-up was 7.0 years and 72 (34%) participants had more than 1 MACE. In bivariable analyses, both BVO CACs (HR 2.5, P < .001) and total plaque area (HR 1.8 per cm², P = .008) were associated with MACE. When entering BVO CACs, plaque area and other relevant co-variates in a multivariable model, BVO CACs were virtually unchanged (HR 2.4, P = .001), but total plaque area was no longer significant (HR 1.0, P = .92).

Conclusion: Present results support the contention that BVO CACs are a stronger predictor for future vascular events than carotid ultrasound plaque area.

Aims: The Education Committee of the European Academy of DentoMaxilloFacial Radiology should ‘encourage and support high levels of graduate and postgraduate education in dentomaxillofacial radiology (DMFR) all over Europe’. For this reason, the committee aimed to formulate a document describing resources allocated for undergraduate education within oral radiology in Europe today that can serve as a benchmark against which dental schools and/or countries with dentistry programmes can relate their undergraduate education.

Materials and Methods: A questionnaire addressing resources allocated for learning oral radiology was distributed to colleagues involved in oral radiology education in 117 dental schools in 29 countries in Europe.

Results: The answers represent approximately 13% of the dental schools in 40% of the countries providing dental education in Europe. There was a large variation regarding qualifications among teachers. There were also large differences in reported time dedicated to oral radiology courses, within some parts the allocated time differed by a factor 16.

Discussion: An ambition to achieve high standards in oral radiology all over Europe should, based on the results of this survey, start with an effort to attain consensus regarding the role of oral radiology in dental education. The involvement of dentists with DMFR specialist training, would support high levels of undergraduate education.

Conclusion: The results of this survey include information that educators and authorities can relate to in planning and implementation of new or revised curriculum. The ambition should be to increase teachers' competence and to work towards more harmonised and extensive courses in oral radiology.

Introduction: The aim of this study was to investigate how students perceive the benefit of participating in a teacher-organised session providing feedback on exams, termed post-exam feedback, in two dental hygienist programmes.

Methods: The study was based on interviews with 22 participants, including 18 students and 4 faculty teachers. The data were approached on the basis of thematic analysis, allowing us to generate insights on how the participants reflected on their participation in the post-exam feedback sessions and how they perceived this arrangement as learners.

Results: The findings from the study suggest that motivated students consider post-exam feedback to be beneficial in clearing up uncertainties and deepening their understanding of issues not fully understood during the exam, as well as supporting their further learning. Less motivated students mainly consider post-exam feedback to be relevant for students who do not pass the exams.

Conclusions: Organised in a student-centred way and with attentiveness to student learning preferences, the results suggest that post-exam feedback can be valuable for enhancing assessment and supporting student learning related to exams.

Objective: The aim of this case-control study was to investigate whether cognitively impaired individuals have a higher burden of calcified carotid artery atheroma (CCAA) than controls without cognitive impairment.

Material and methods: The study included 154 cases with Alzheimer’s disease (n = 52), mild cognitive impairment (n = 51), or subjective cognitive decline (n = 51) diagnosed at a university memory clinic. Seventy-six cognitively healthy controls were sampled through the Swedish population register. All participants underwent clinical oral and panoramic radiographic examinations. Two oral and maxillofacial radiologists performed blinded analyses of the panoramic radiographs for signs of CCAA, which was registered as absent or present and, if present, unilateral or bilateral. Consensus assessment was used for all statistical analyses.

Results: CCAA was common (40%) in this middle-aged and older Swedish population. We found no differences in the prevalence of CCAA between cases and controls (40% vs. 42%).

Conclusion: Cognitively impaired patients do not have a higher burden of CCAA than matched controls without cognitive impairment.

Introduction: A combination of summative assessments and post-exam feedback can create a formative environment to support student learning. It remains unknown to what extent feedback sessions are conducted after exams in oral radiology courses for dental and dental hygienist students in Europe. This survey study aimed to explore whether post-exam feedback sessions were conducted, and if so, in what format.

Materials and Methods: A questionnaire was distributed to 76 dental schools in 26 countries and 34 dental hygienist schools in 14 countries in Europe. The questions addressed whether feedback was provided after exams in oral radiology, the feedback format, and whether feedback sessions were formalised or performed for other reasons.

Results: Questionnaire responses were received from 33 dental schools in 18 countries, and 20 dental hygienist schools in 11 countries. Information about grades was provided in 23–30% of the schools. Post-exam feedback sessions including opportunities for discussion was provided at 39% of the schools, all with guidelines stating that these sessions should be carried out. The remaining schools provided feedback either on request by individual students or as written examples of correct answers.

Conclusion: Almost one third of the dental schools announced grades without providing any post-exam feedback that could support learning. Two fifth utilised feedback sessions to assist students in gaining knowledge and sorting out misconceptions, all according to guidelines. Given the possible learning potential in post-exam feedback with opportunity to discuss, further studies of this format would be valuable, including the role and use of feedback guidelines.

Objective: To evaluate whether estimates of risk of future cardiovascular events and death and established or unknown diabetes are significantly associated with calcified carotid artery atheromas (CCAAs) on panoramic radiographs (PRs). The main focus was on men and women without previous myocardial infarction (MI). Methods: The PAROKRANK (Periodontitis and its Relation to Coronary Artery Disease) study included patients with a first MI and matched control subjects. In this substudy, 738 patients (138 women) and 744 control subjects (144 women) with available PRs were assessed for CCAA. Cardiovascular risk estimates were determined according to the Framingham Risk Score (FRS) and Systematic COronary Risk Evaluation (SCORE). Established and previously unknown diabetes was also determined. Results: CCAA was detected on PRs in 206 control subjects (28%) and 251 patients (34%). FRS was significantly associated with CCAA among control subjects (P = .04) and patients (P = .001). SCORE was associated with CCAA among control subjects (P < .01) but not patients (P = .07). Among men, FRS and SCORE were associated with CCAA in both control subjects and patients. Diabetes was not significantly associated with CCAA after adjustments. Conclusions: Elevated cardiovascular risk scores were associated with CCAA on PRs among control subjects. Diabetes was not independently associated with CCAA, possibly owing to selection bias.

Arthrography is an alternative technique for diagnosing soft tissue derangements of the temporomandibular joint (TMJ) when magnetic resonance imaging (MRI) is not an option. This can be due to contraindications to perform a MRI on a specific patient or when MRI is not applicable for specific diagnoses of soft tissue derangements of the TMJ. It is an invasive method and can be used not only for diagnostics but also for therapeutic injections e.g. administration of corticosteroids

Cardiovascular disease is a common cause of morbidity and premature mortality. Cardiovascular disease can be prevented when risk factors are identified early. Calcified carotid artery atheromas (CCAAs), detected in panoramic radiographs, and periodontitis have both been associated with increased risk of cardiovascular disease. This case-control study aimed to 1) investigate associations between periodontitis and CCAA detected in panoramic radiographs and 2) determine the risk of future myocardial infarctions due to CCAA combined with periodontitis. We evaluated 1,482 participants (738 cases and 744 controls) with periodontitis and CCAAs recruited from the PAROKRANK study (Periodontitis and Its Relation to Coronary Artery Disease). Participants were examined with panoramic radiographs, including the carotid regions. Associations between myocardial infarction and periodontitis combined with CCAA were evaluated in 696 cases and 696 age-, sex-, and residential area-matched controls. Periodontitis was evaluated radiographically (as degree of bone loss) and with a clinical periodontal disease index score (from clinical and radiographic assessments). We found associations between CCAA and clinical periodontal disease index score among cases (odds ratio [OR], 1.51; 95% CI, 1.09 to 2.10; P = 0.02) and controls (OR, 1.70; 95% CI, 1.22 to 2.38; P < 0.01), although not between CCAA and the degree of bone loss. In a multivariable model, myocardial infarction was associated with CCAA combined with periodontitis, as assessed by degree of bone loss (OR, 1.75; 95% CI, 1.11 to 2.74; P = 0.01). When the cohort was stratified by sex, only men showed a significant association between myocardial infarction and CCAA combined with periodontitis. Participants with clinically diagnosed periodontitis exhibited CCAA in panoramic radiographs more often than those without periodontitis, irrespective of the presence of a recent myocardial infarction. Participants with combined periodontitis and CCAA had a higher risk of having had myocardial infarction as compared with participants with either condition alone. These findings implied that patients in dental care might benefit from dentists assessing panoramic radiographs for CCAA-particularly, patients with periodontitis who have not received any preventive measures for cardiovascular disease.

Objectives: The aim of this study was to map the vertical locations of calcified carotid plaques (CCPs), osseous anatomic structures, and calcified soft tissues in the area of the carotid artery, determine to what extent CCPs are superimposed on the cervical spine in coronal images, and analyze the differences between men and women.

Study Design: Computed tomography angiography (CTA) scans of 79 patients were studied. CCPs were discovered in 152 of the total 158 neck sides. Evaluations were performed by using sagittal and coronal reformatted CTA images with maximum intensity projection.

Results: Most of the calcified anatomic structures studied, including the carotid bifurcation, were found in close relationship to the level of the third and fourth cervical vertebrae. In the coronal view, all or most of the areas of the CCPs were superimposed on the cervical spine in 22 of 44 (50%) neck sides with CCP in women and in 37 of 108 (34.2%) in men (P = .070).

Conclusions: The carotid bifurcation is in close proximity to various calcified anatomic structures. This should be taken into account when diagnosing CCPs in panoramic radiographs. In the coronal view, CCPs and the cervical spine are often superimposed; thus, coronal images are not recommended for confirmation of putative carotid calcifications diagnosed on the basis of panoramic radiographs.

The aim of this chapter is to describe arthrography as method for diagnosing soft tissue derangements of the temporomandibular joint (TMJ) as well as a tool for guided administration of corticosteroids. The chapter includes numerous illustrations and five videos explaining the methods of arthrography, arthrotomography and contrast-guided administration of corticosteroids. MRI is the most common method for diagnosing soft tissue derangements of the TMJ. Yet, there are situations when arthrography is useful and superior to MRI, e.g. when the patient suffers from claustrophobia, has loose ferromagnetic objects in the body or metal objects in the head and neck region causing disturbances in the images (e.g. orthodontic devices). Arthrography is also useful if there is call for diagnosing soft tissue perforations in the disc or the posterior attachment, or adherences between the disc or the posterior attachment and the bony components that can be revealed during the real-time dynamic assessment. Filling the joint compartments can contribute to loosening of adherences and the anaesthesia preceding injection of contrast media constitutes a diagnostic tool by confirming origin of pain. Follow-up of splint therapy can be included in the examination. Finally, arthrography can be used as guidance for intervention with, e.g. corticosteroids.