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Methods: In the multicentre, multidisciplinary PAROKRANK study, 805 patients with a first myocardial infarction (MI) and 805 matched controls without MI were recruited at 17 hospitals in Sweden. At baseline, the participants were examined with panoramic radiography, and in 737 patients and 739 controls, the carotid artery region was assessable. CCAAs were identified in 251 (34%) patients and 205 (28%) controls at baseline. The primary endpoint was defined as the first occurrence of all-cause mortality, non-fatal MI, non-fatal stroke, or hospitalization following heart failure after a mean follow-up of 10 years. The risks of cardiovascular events and death were evaluated using event survival analysis and regression models.

Results: Participants with bilateral CCAAs, regardless of whether they were patients or controls, had significantly higher mortality and morbidity than those without CCAA (P < 0.001). The risk of cardiovascular events was increased in the presence of bilateral CCAAs among both controls (hazard ratio, 1.96 [95% confidence interval : 1.21–3.16], P = 0.006) and patients (1.67 [1.15–2.43], P = 0.007).

Conclusion: Bilateral CCAAs on PRs were an indicator of an increased risk of future cardiovascular events and early death among both controls and patients in the PAROKRANK study. Therefore, dentists can detect CCAA on PR and contribute to identifying individuals in need of medical attention and treatment of cardiovascular disease to prevent morbidity and early death.

Objectives: The aim of this study was to investigate whether any feature of carotid artery calcification (CAC) detected on panoramic radiographs (PRs) is associated with more severe signs of cardiovascular disease (CVD), as assessed by carotid ultrasound (CUS) including multi-view assessment of carotid intima media thickness (cIMT).

Methods: The present investigation was a retrospective sub-study of the randomized controlled trial visualization of asymptomatic atherosclerotic disease for optimum cardiovascular prevention (VIPVIZA), which included 60-, 50-, and 40-year-old inhabitants of V & auml;sterbotten County, each of whom underwent CUS. The present sub-study included 135 participants who had undergone PR for odontological indications within 18 months before or after CUS examination. Findings of CAC on PR were compared with CUS findings of cIMT and carotid plaque. CAC features were categorized into 4 types: single, scattered, vessel width-defining, or vessel-outlining.

Results: Compared to participants without CAC on PR, those with any CAC type on PR exhibited significantly more carotid plaque (80.9% vs 43.2%, P < .001) and a higher average cIMT score (0.83 vs 0.77 mm, P = .013) on CUS. The vessel-outlining CAC group exhibited the most pronounced cIMT and carotid plaque occurrence (P = .011).

Conclusions: All CAC types detected on PR were associated with CVD on CUS, and vessel-outlining CAC indicated more severe CVD. By detecting CAC on PR, especially vessel-outlining CACs, dentists could contribute to the early identification of patients with asymptomatic CVD, and recommend that these patients seek medical attention for preventive treatment.

Advances in knowledge: All types of CAC detected on PR-particularly the vessel-outlining type-are associated with carotid ultrasound findings, including carotid intima media thickness, indicating CVD and increased risk of stroke and myocardial infarction. Thus, dentists can identify patients at increased risk of cardiovascular events by detecting CAC on PR, with higher diagnostic reliability in cases with vessel-outlining calcification.

Objective: Bitewing radiographs are essential for caries and marginal bone diagnostics. Diagnostic quality depends on operator technique. This study evaluated patient-level diagnostic quality of sensor-based bitewing examinations to identify operator-related deficiencies.

Material and Methods: In this retrospective, cross-sectional study, 962 bitewing examinations from 31 Swedish public dental practices were randomly selected and evaluated for caries and marginal bone level diagnostic image quality, according to European guidelines. Available panoramic/periapical images acquired in connection with the bitewing examinations were included in a second quality assessment. Recorded deficiencies included sensor placement, collimation artifacts, and insufficient biting on the sensor holder. Associations between diagnostic quality and sensor size, number of images, age group, jaw, side, and sex were analyzed using χ² test and logistic regression. Three calibrated examiners performed the evaluations.

Results: The requirements were fulfilled in 5% and acceptable in 43% of the bitewing examinations, increasing to 7% and 45% when including panoramic/periapical images. Quality was better with larger sensor sizes (p < 0.001), more exposures (p < 0.001), panoramic/periapical images (p < 0.001), age ≥12 years (p < 0.001), and in the maxilla (p < 0.001). Common errors were incorrect sensor placement (94%), collimation artifacts (57%), and insufficient biting (15%). No differences were found between side or sex. Inter-observer agreement was substantial (Fleiss' kappa = 0.61; Gwet's AC1 = 0.62); intra-observer agreement was almost perfect (Cohen's kappa = 0.88).

Conclusions: Most bitewing examinations, especially in children, fail to meet diagnostic requirements due to deficient operator performance and quality assessment. Panoramic/periapical images may improve diagnostic quality but should not replace optimized bitewing examinations. Targeted continuing education is required.

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.

Purpose: To investigate the frequency of CBCT scans, the exposure settings, volume sizes and the patient demographics (age and sex) of patients undergoing CBCT scans in university-based dental hospitals in different European countries over a one-year period.

Method: Eight University Dental Hospitals from eight countries in central and northern Europe agreed to collect data from their CBCT-databases. Exposure data including field of view (FOV), dose area product (DAP) and optimization settings plus (anonymous) age and sex of the patients were collected for the entire year 2023. In addition, centre- and healthcare-system- related characteristics were assembled. Data were statistically evaluated using R Statistical Software.

Results: A total of 7320 CBCT-scans from eight centres and eight different CBCT-machines were evaluated. DAPs ranged between 34 and 4390 mGycm2 (mean: 700.8 mGycm2), kV between 60 kV and 120 kV. Patient age (range 4 yrs to 97 yrs) differed significantly between the centres, yet with a cumulative peak between 10 and 20 yrs. Optimization protocols were observed for all centres, depending on their centre- and also healthcare-characteristics. 21 % of the scans applied some sort of special dose reduction means.

Conclusions: The overall age-peak between 10 and 20 yrs highlights the need to optimized maxillofacial CBCT-protocols. The differences between the centres seem to be mainly related to healthcare-system and centre-related characteristics, which differ largely between the eight centres.

Background and Aim: The study ‘Periodontitis and Its Relation to Coronary Artery Disease’ (PAROKRANK) reported an association between periodontitis (PD) and the first myocardial infarction (MI). This follow-up study aims to test the hypothesis that those with PD—compared to periodontally healthy individuals—are at increased risk for cardiovascular (CV) events and death.

Methods: A total of 1587 participants (age <75 years; females 19%) had a dental examination including panoramic radiographs between 2010 and 2014. PD was categorized as healthy (≥80% alveolar bone height), mild/moderate (79%–66%) or severe (<66%). A composite CV event (first of all-cause death, non-fatal MI or stroke and hospitalization following to heart failure) was investigated during a mean follow-up period of 9.9 years (range 0.2–12.5 years). Participants were divided into two groups: those with and without PD. The primary event rate, stratified by periodontal status at baseline, was calculated using the Kaplan–Meier method and Cox regression.

Results: The number of events was 187 in the 985 periodontally healthy participants (19%) and 174 in the 602 participants with PD (29%; p < 0.0001). Those with PD had a higher likelihood for a future event (hazard ratio [HR] = 1.26; 95% CI: 1.01–1.57; p = 0.038), following adjustment for age, smoking and diabetes.

Conclusion: The PAROKRANK follow-up revealed that CV events were more common among participants with PD, which supports the assumption that there might be a direct relation between PD and CV disease.

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.

Aim: Periodontitis proxy variables enable an expansion of periodontal research. The study aimed to estimate the validity of questionnaire items and registry data in relation to Stage III–IV periodontitis and having 50% bone loss.

Methods: Malmö Offspring Dental Study (MODS) participants (995) filled out questionnaires and underwent periodontal and panoramic radiography examinations. The questionnaire items, number of periodontal treatment procedures (PTP) in the Dental Health Register (DHR), and number of teeth with ≥ 6 mm probing depth in the Swedish Quality Register for Caries and Periodontal Disease (SKaPa) were evaluated as proxies for severe periodontitis. Stage III–IV periodontitis was the primary reference standard.

Results: For PTP-based severe periodontitis proxy in DHR, positive predictive value (PPV) was 88% and negative predictive value (NPV) 87% for Stage III–IV. The SKaPa-based proxy showed poor positive predictive values (PPVs, < 70%), but similar area under the curve (AUC), 0.74, compared with the DHR data (AUC 0.76). Sensitivity was < 70%, and specificity > 90% for the DHR and SKaPa proxies. Identification of cases with periodontitis by questionnaire combined with the demographic variables age, sex, smoking habits and education yielded good discriminatory ability (AUC > 0.75).

Conclusion: Register-based data can effectively identify individuals with severe periodontitis in large cohort studies, thereby advancing periodontal research.

The purpose of this study was to cross-culturally validate the Swedish version of the Gugging Swallowing Screen (GUSS-S) for use in the acute phase of stroke. Further, to evaluate the inter-rater reliability between different healthcare professionals. GUSS was translated into Swedish using a forward-backward method followed by expert rating to obtain content validity. For criterion validity, the GUSS-S score was compared with Flexible Endoscopic Evaluation of Swallowing (FEES) assessed with the Penetration-Aspiration Scale (PAS) in acute stroke patients (≤ 96 h after stroke onset). Convergent validity was calculated by comparison with the Functional Oral Intake Scale (FOIS) as per the comprehensive FEES assessment, the Standardized Swallowing Assessment (SSA), and the National Institutes of Health Stroke Scale (NIHSS). To evaluate inter-rater reliability, a nurse and a speech-language pathologist (SLP) independently assessed 30 patients. In total, 80 patients (32 women, median age 77 years (range 29–93) were included, mean 1.7 ± 0.9 days after admission. With a cut-off value of 14 points, the GUSS-S identified aspiration with a sensitivity of 100% and a specificity of 73% (area under the curve: 0.87, 95% CI 0.78–0.95). Spearman rank correlation showed very strong correlation between the GUSS-S and PAS (rs=-0.718, P = < 0.001) and FOIS (rs=0.720, P = 0.001) and strong correlation between the GUSS-S and SSA (rs=0.545, P = < 0.001) and NIHSS (rs=-0.447, P = 0.001). The inter-rater agreement for GUSS-S was substantial (Kw=0.67, P = < 0.001). The results indicate that the GUSS-S is a valid and reliable tool for the assessment of dysphagia in acute stroke patients by different healthcare professionals.

Objective: The aim was to optimize diagnostics for carotid artery calcifications (CACs) on panoramic radiographs (PRs) to identify cardiovascular disease (CVD) by investigating how 4 defined CAC shapes are associated with ultrasound (US) findings indicating CVD.

Study Design: The study included 414 participants (802 neck sides) from the Malmö Offspring Dental Study, examined with PRs. The PRs were assessed for CAC shapes stratified into 4 categories: single, scattered, vessel-width defining, and vessel-outlining. The carotid arteries were examined with US for signs of CVD: the presence of plaques, largest individual area of a plaque, number of plaques, and percentage reduction of the lumen. Associations between the different CAC categories and US characteristics were analyzed.

Results: All categories of CAC were significantly associated with a higher degree of US findings indicating CVD compared with no CAC (P < .001). The most significant differences were found for vessel-outlining CAC, with the mean of the largest individual plaque area of 17.9 vs 2.3 mm2, mean number of plaques 1.6 vs 0.2, and mean percentage reduction of the lumen 24.1% vs 3.5% (all P < .001).

Conclusions: Independent of shape, CACs detected on PRs were associated with a higher degree of US findings of CVD. This was most pronounced for vessel-outlining CAC. With refined differential diagnostics of CACs in PRs, dentists may contribute to improved identification of patients in need of cardiovascular prevention.