March 10, 2014
Dr. Kimberly Ebner
Name: Patient: Amy Von Wincklemann DOB: 10/23/38
Dear Dr. Ebner:
The patient was referred for Cone-Beam CT (CBCT) dental imaging, performed on 03/03/14, and the data provided by Dr. Kimberly Ebner, Pasadena, CA for a radiographic report.
Examination of the anatomical volume: Evaluation of the CBCT anatomical volume is intended as an overall review for pathology and abnormalities not directly associated with dental and periodontal conditions best imaged by conventional dental radiography. All viewed structures determined to have no significant findings are reported as no abnormalities detected. The purpose of this report is to provide a requested evaluation of the anatomical volume not directly involved with the specific intent of the imaging examination. This is a consultative report only, not intended to be a definitive diagnosis or treatment plan. Specific recommendations for referral will be made only when the finding could have an immediate and direct impact on the patient's health.
Findings:
Paranasal Sinuses: No abnormalities detected.
Nasal Cavity: The nasal septum is deviated slightly to the right.
Airway: No abnormalities detected.
Osseous Structures: No abnormalities detected.
Temporomandibular Joints: The TMJ condyles and related bony structures are interpreted as normal.
Dental Findings: Several teeth are missing. Tooth #9 has had a partial RCT. There is moderate to advanced horizontal bone loss in the remaining posterior dentition.
Other Findings: There are significant, bilateral calcifications of the internal carotid arteries in the parasellar segments. These are suggestive of MAC (medial arterial calcinosis) seen in uncontrolled or undiagnosed type II diabetes mellitus often at ESRD (end-stage renal disease).
Impressions and Recommendations:
1. Deviated nasal septum
2. Missing teeth and RCT as indicated
3. Bone loss as described
4. Carotid plaques, internal carotid arteries in the parasellar regions
Recommendation: the patient should be referred to her primary care provider for evaluation of hypertension and stroke risk as well as possible dysglycemia and/or renal problems.
Thank you for the referral of this patient and will your confidence in our service.
______
Dale A. Miles BA, DDS, MS, FRCD(C)
Diplomate, American Board of Oral Diplomate, American Board of Oral and Maxillofacial Radiology
Patient: Amy Von Wincklemann DOB: 10/23/38
Patient: Amy Von Wincklemann DOB: 10/23/38
Carotid Plaques
Cervical carotid artery atherosclerosis, a major cause of stroke (cerebrovascular accident, CVA), commonly occurs in older individuals with a history of hypertension and smoking. These atheromatous plaques, when calcified, may be imaged on conventional panoramic dental radiographs. Dentists caring for "at-risk patients" must be able to identify these lesions and to differentiate them from anatomical and other pathological radiopacities frequently observed in the carotid artery territory. Prompt referral of these individuals to a physician may preclude a stroke.
FriedlanderAH: Panoramic radiography: the differential diagnosis of carotid artery atheromas, Spec Care Dentist;15(6):223-7, 2003.
Medial arterial calcification (Monckeberg’s calcinosis)
Vascular calcification is associated with metabolic syndrome, diabetes, hypertension, atherosclerosis, chronic kidney disease, and end stage renal disease. Each of the above contributes to an accelerated and premature demise primarily due to cardiovascular disease. The above conditions are associated with multiple metabolic toxicities resulting in an increase in reactive oxygen species to the arterial vessel wall, which results in a response to injury wound healing (remodeling). The endothelium seems to be at the very center of these disease processes, acting as the first line of defense against these multiple metabolic toxicities and the first to encounter their damaging effects to the arterial vessel wall.
From:
Hayden MR, Tyagi SC, Kolb L, Sowers JR and Khanna R: Vascular ossification – calcification in metabolic syndrome, type 2 diabetes mellitus, chronic kidney disease, and calciphylaxis – calcific uremic arteriolopathy: the emerging role of sodium thiosulfate, Cardiovascular Diabetology 2005, 4:4pp 1186/1475-2840.
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