Pietra Rodrigues Antonello1, Thiago de Oliveira Gamba2, Heraldo Luís Dias da Silveira3. 1. Oral Radiology Division, Department of Surgery and Orthopedics, Dental School, Federal University of Rio Grande do Sul, Rua Ramiro Barcelos, Porto Alegre, RS, Brazil. 2. School of Dentistry, Caxias do Sul University, Rua Francisco, Getúlio Vargas, Caxias do Sul, RS, Brazil. 3. Oral Radiology Division, Department of Surgery and Orthopedics, Dental School, Federal University of Rio Grande do Sul, Rua Ramiro Barcelos, Porto Alegre, RS, Brazil. Electronic address: heraldo.silveira@ufrgs.br.
To the Editor,We have read with special attention one of the latest articles in the International Dental Journal entitled “Assessment of Carotid Artery Calcifications on Digital Panoramic Radiographs and Their Relationship With Periodontal Condition and Cardiovascular Risk Factors” and we would like to congratulate the authors on their study. However, there are a few concerns regarding this article that we would like to share with the authors.The first issue refers to the fact that even though the sample size of the study is consistent, there is only one examiner who performed the analysis of panoramic radiographs to identify the calcifications in the carotid artery. Therefore, even though the authors make a valid point in mentioning an experienced oral and maxillofacial radiologist made the assessments, that is not adequate. It would be preferable to have more than one trained and calibrated examiner for greater internal validity.Another point to be addressed is the detection of calcifications in the carotid artery (CAC) in 34 panoramic radiographs of which 2 are presented in the article (Figures 1 and 2). CAC, on panoramic radiography, is a curvilinear irregular parallel radiopaque mass, located inferior to the hyoid bone, about 1.5 to 2.5 cm inferior posterior to the angle of the mandible adjacent to the cervical spine or below the third and fourth cervical vertebrae., However, the radiographic images in the article show a single opacification, dense, homogeneous, and ovoid, inferior to the tip of the greater cornu of the hyoid bone. These images are suggestive of calcification of the triticeous cartilage.,Finally, we would like to comment about the accuracy of using panoramic radiography for CAC detection. Even though panoramic radiography is an important detection method used by dentists to identify calcifications, it has a low sensitivity and specificity for the analysis in question. For that reason, underdiagnosis of CAC may have occurred.,We have been enlightened by this work. The considerations above are only intended to assist in the scientific discussion.