The Study of carotid artery atherosclerosis Prevalence on Panoramic Radiography and Its Related Factors for smokers Admitted in Private Clinic

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International Research Journal of Applied and Basic Sciences 2016 Available online at www.irjabs.

1 International Research Journal of Applied and Basic Sciences 2016 Available online at ISSN X / Vol, 10 (6): Science Explorer Publications The Study of carotid artery atherosclerosis Prevalence on Panoramic Radiography and Its Related Factors for smokers Admitted in Private Clinic Golnaz Malihi Post-Gradute Student,Department of Pediatric Dentistry,Faculty of Dentistry,Mashhad University of Medical sciences,mashhad, Iran. Corresponding author MalihiG921@mums.ac.ir ABSTRACT: The survey is descriptive and the society under study were smokers between the ages of admitted to private clinic for panoramic radiography. The sampling method is purposive performed on 85 patients. Further, the selected variables were qualitative and quantitative and chisquare test (chi-square) and Fisher's exact test were considered for statistical analysis. In this survey, it was found that carotid artery atherosclerosis prevalence was 38.8 percent which meant that the inflicted were not at higher risk in terms of gender, diabetes, high cholesterol and high triglycerides yet faced 3.5 times more the amount with higher blood pressure in comparison with non-afflicted (OR-3.5) also obesity was statistically shown significantly in correlation with atherosclerosis (OR-2.2). In addition, atherosclerosis inflicted were 3.9 times more in exposure in comparison with non-afflicted since these smoked more than 20 cigarettes per day; those who had smoked more than 27 years were 4.3 times more in exposure as compared to non-afflicted. The obtained results indicated that smokers were at higher risk of carotid artery atherosclerosis prevalence based on panoramic radiography. The dentists were to accurately study smoker patients radiography, identify them and refer these to specialists so that in case necessary take therapy measures. Key words: carotid artery atherosclerosis, panoramic radiography and smokers INTRODUCTION An issue and prevalent concern of various societies and in particular the developed countries is CVA (Cerebrovascular Accidents) such that this is the third largest known cause of death in Australia. Each year approx cases of brain stroke are reported from Australia where cases lead to death. Nearly 65 percent of cerebral infarction are caused by atherosclerotic lesions at bifurcation of the carotid artery and smoking is one of the most common factors of strokes. For the first time in 1981 Dr. Arthur H. Friedlander et. al commenced practice of carotid artery atherosclerosis diagnosis through panoramic radiography. (Friedlander et al,2000) If dentists fail early diagnosis of carotid artery atherosclerosis on panoramic radiographs calcified plaque build up in the context of inland vessels followed by many other complications and consequences like TIA (Transient Ischaemic Attack) one-sided motor and sensory disabilities, aphasia, full brain stroke and death. (Kumagia et. al, 2007) Panoramic radiography is a prosperous method and at the same time not so costly in carotid artery atherosclerosis diagnosis for patients of brain stroke exposure without symptoms. Therefore, certainly the significance in the obtained results is that it can prevent harmful irrecoverable effects and at the same time educate general dentists to diagnose carotid artery atherosclerosis on panoramic radiography specially those at high risk which is quite significant. In view of the prevalence and increasing trend of atherosclerosis and in spite of previous researches it was clearly shown that by radiography is early atherosclerosis is detected. (Lange et. al, 2015) For this reason, a survey was carried on smokers admitted to private clinic for examination of carotid artery atherosclerosis prevalence by panoramic radiography and the related factors in In this investigation, in

2 addition to existing scientific queries responses the patients at risk were then identified and referred to specialized centres. METHOD OF RESEARCH In this research the community under study comprised of smokers between the ages of admitted to private clinic on panoramic radiography. In view of the number of samples on the basis of pilot study from among twelve patients, 4 patients (33%) were inflicted with atherosclerosis where a = 0.05 and d = 0.1. z1 a2 P 1 P N d2 85 The method of sampling was purposive i.e. those who desired to tackle smoking with panoramic radiography were solely under observation; the type of study is descriptive. After the necessary permits and proper measures for attaining the needed manpower, devices, consuming materials and research support services the research was performed as per mentioned below. The community under study consisted of patients admitted to private clinic on panoramic radiograph who had still continued smoking. The case study was performed over 85 individuals by applying purposive sampling method. From smokers and those qualified under the same condition and standard, panoramic radiography were preformed in radiology centre in full compliance with reference proposed measure in reference to the following specifications: X-ray film: Kodak tmat.g 14.8*29.8; radiography: MA KV 64-7; view negatoscope: BULB 75 WATT (hot light) which were then closely observed by oral and maxillofacial surgeon and radiologist. Next, the percentage of atherosclerosis prevalence in smokers were studied using Chi-square and Fisher's exact plans. The assessment criteria of calcified carotid artery atheroma by panoramic radiography was a proposed measure by Dr. Friedlander. Findings The research was performed over 85 qualified patients; 15 female (17.6%) the rest 70 male (82.3%). The studied age ranges varied from 59 +/- 8 (years) i.e. from minimum 50 to maximum 78 years. All patients were smokers; five suffered from diabetes (5.9%) 14 from high blood pressure (16.5 %) 27 from obesity (31.8%) and 6 who had exercised regularly (7%). The average smokers smoked about 20 cigarettes per day where their average duration of smoking habit was 27 years. The results of this study in respect to carotid artery atherosclerosis prevalence is presented in Table [1] which clearly indicates that 33 people or in other words 38.8 percent individuals in the study suffered from atherosclerosis of carotid artery. In consideration of the rate of prevalence in the studied cases the actual rate of confidence-interval with probability of 95 percent was estimated from minimum 29 to 49 percent (29 49%) C.l 95 Table 1. The results of smokers exposed to carotid artery atherosclerosis admitted at private clinic in 2015 Frequency carotid artery atherosclerosis in smokers Numbers Percentage Not inflicted Inflicted Total The studied results in terms of carotid artery atherosclerosis prevalence based on related factors presented in Table [2] shows that those who were inflicted with atherosclerosis of carotid artery were less exposed to issues such as gender, diabetes, high cholesterol and triglyceride. Nonetheless, these inflicted (in the studied case 9 individuals) 27.2 percent had high blood pressure and the ones who did not have artery atherosclerosis (5 cases) 9.7 percent were at high risk of blood pressure. Hence, based on Chi-Square test this discrepancy is statistically significant (p < 0.05). Further, those who suffered from carotid artery atherosclerosis were 3.5 times more at risk high blood pressure than those who did not have artery atherosclerosis (OR - 3.5). Also, the atherosclerosis sufferers (in this case 14 individuals) 42.4 percent were also obese and the non-afflicted (13 individuals) 25 percent were also exposed to obesity; so in accordance with Chi-square test there is statistically significant discrepancy in this case (p < 0.08) yet those who had carotid artery atherosclerosis were 2.2 times more exposed to obesity as compared to non-sufferers (OR 2.2). From among those who were atherosclerosis inflicted 33 individuals had not worked out by hundred percent. Here, Fisher s exact test revealed that this 652

3 discrepancy is statistically significant and those who suffered from atherosclerosis had not worked out far more by times than those who were non-afflicted. In addition, the ones with atherosclerosis (21 individuals) 63.7% smoked more than 20 cigarettes per day and the non-sufferers of atherosclerosis (12 individuals) 36.3 percent smoked less than 20 cigarettes per day. Hence, in accordance with Chi-square test this discrepancy is statistically significant and atherosclerosis sufferers smoked 3.9 times more than non-sufferers i.e. more than 20 cigarettes per day. Also, those with atherosclerosis (23 individuals) 69.7 percent had smoked cigarettes for over 27 years; the non-sufferers however, (10 individuals) 30.3 percent had picked the habit for less than 27 years. So, on the basis of Chi-square test this discrepancy is statistically significant; the inflicted had smoked 4.3 times more than the non-afflicted for over 27 years. According to finding parts of 17 atheroma (51.6 percent) on the right hand, 9 atheroma (27.2 percent) on the left hand and 7 atheroma (21.2 percent) bilateral could be observed. Table 2. The results of carotid artery atherosclerosis patients studies based on relevant factors for admission to private clinic Carotid artery athero- Relevant sclerosis Not inflicted Inflicted P value OR Factors N 1-52 N 2 = 33 Average Age: Gender Male: (82.7) Female: 15 9 (17.3) Diabetes: Negative: 80 Positive: 5 High Blood Pressure: Negative: 71 Positive: 14 High Cholesterol: Negative: 77 Positive: 8 High Triglyceride: Negative: 84 Positive: 1 Obesity: Negative: 58 Positive: 27 Exercise/Work out Practice: 6 No Practice: 79 Smoke Less than 20 Cigarettes Smoke More than 20 Cigarettes Smoking for Less than 27 Years Smoking for More than 27 Years 48 (92.3) 4 (7.7) 47 (90.3) 5 (9.7) 49 (94.2) 3 (5.8) (25) 6 (11.5) 46 (88.5) 36 (69.2) 16 (30.8) 34 (65.4) 18 (34.6) 27 (81.8) 6 (18.2) 32 (97) 1 (3) 24 (72.8) 9 (27.2) 28 (84.9) 5 (15.1) 33 (100) - (-) (42.4) - (-) 33 (100) 12 (63.3) 21(63.7) 10 (30.3) 23 (69.7) DISCUSSION AND CONCLUSION P < P < P < P < P < P < P < 0.05 P < P < Numerous Times In this research panoramic radiograph on 85 smokers with an average age of 59 +/- 8 admitted to a private clinic was performed for carotid artery atherosclerosis diagnosis. The atheroma calcified plaques inside the carotid artery especially in the carotid bifurcation of the carotid artery in the shape of radiopaque nodules or in the form of two vertical lines radiopaque was observed 1.5 to 2.5 below at posterior mandibular angle. Also, in this research the degree of carotid artery atherosclerosis in smokers was 38.8 percent. In another study carried by Kumagai et. al it was revealed that the degree of atherosclerosis on panoramic radiography of male smokers was 14.1 percent but it must be mentioned that in his study the correlation between cigarette smoking and atherosclerosis was not evaluated quantitatively. This is while in this research cigarette smokers were also evaluated quantitatively. The results of this research indicated that: atherosclerosis inflicted were 3.9 times more at risk than non-afflicted and they smoked more than 20 cigarettes per day. Also, the inflicted were 4.3 times more exposed as compared to non-inflicted since they had smoked for over 27 years. In another study carried by Haward it was shown that smokers had faced 50 percent increase of atheroma formation process. In a research carried by J. P. Whisant however, it was shown that the duration of smoking was considered an effective factor for existence of atherosclerosis such that if an individual had smoked for over forty years he would be 3.5 times more at a higher 653

4 risk of atherosclerosis. In a recent investigation performed in Japan over 50 year old and above males a clear positive correlation between cigarette and carotid atherosclerosis was observed. So, in view of the obtained results in this research and others it seems that cigarette smoking increases the rate of atherosclerosis prevalence. In most articles the normal population were seen with unilateral carotid artery atherosclerosis more on the left side. In this survey atheroma was seen unilateral on the right side. Yet in the research performed by Ohbe et al. atheroma was more observed on the right side. It maybe that these differences reported on the site of arthritis sclerosis were in correlation with the studied samples. In this investigation 33 patients of carotid artery atherosclerosis 2)7 (81.8 percent) were male and 6 (18.2 percent) were female and there were no statistically significance discrepancy between males and females. The same conclusion was accomplished by Pornpransha Dam rogstn and Carter et. al in their research on the relative case. In another study performed by Tamura and Bayram et. al it was shown that the prevalence of arthritis sclerosis is trice the amount in women than men. So, it can stated that the discrepancy may be in correlation with the studied samples. The life style and some diseases such as high blood pressure, high triglyceride, diabetes, obesity, kidney issues, periodontitis, etc. are stated to be in correlation with atherosclerosis; these were also studied in this research. From among 33 individuals inflicted with atherosclerosis, 12 (36.4 percent) had high blood pressure, 5 (15.1 percent) had high cholesterol, 14 (42.4) suffered from obesity and one (3 percent) suffered from diabetes and none of the inflicted had exercised/work outs. Levis et. al had mentioned that atherosclerosis patients (77.8 percent) with blood pressure and (22.2 percent) diabetes. Cohen et al. in a study of men above fifty five on panoramic radiography 3.8 percent had atherosclerosis that (53.5 percent) blood pressure, (36.6 percent) blood fat, (22.5 percent) mellitus diabetes and (54.9 percent) were smokers although it seems that these discrepancies were considered on the basis of racial, ethnic, life style and diet factors. In this survey it was shown that high blood pressure (p < 0.05) is statistically significantly in correlation with atherosclerosis. In another investigation performed by Wenharn Wenpan in 1997 the same discovery was found (p < 0.06). In the mentioned investigation it was further found that obesity (p < 0.08) was statistically significantly in correlation with atherosclerosis. In Colle Qons and Carter investigation it was found that obesity (45.2%) was the strongest factor in correlation with atherosclerosis which is quite similar to our findings in this paper. It seems that obesity is a risk factor for other diseases such as high blood pressure, diabetes, high cholesterol and probably for these reasons is more prioritized as compared to other diseases. In this research from among 33 atherosclerosis patients five (15.1 percent) had high cholesterol and only one patient (3 percent) was diabetic; statistically there were no indications of significant correlation to atherosclerosis. Based on Dr. Friendlander research atherosclerosis prevalence on panoramic radiography for Diabetes II was further studied in Atherosclerosis prevalence in NIT patients was 24 percent and in IT patients, 66 percent. In addition, according to Dr. Freindlander s surveys on differential diagnosis of atheroma on panoramic radiography in 1995 it was proved that high cholesterol had significant correlation with atherosclerosis prevalence. But it is probable that this discrepancy might have been due to minor number of patients with high cholesterol and diabetes among existing samples of this research at the time. Besides, none of the atherosclerosis patients had exercised or worked out. The research performed by Carter et. al revealed that life style is in direct correlation with atherosclerosis. Apparently the type of life style and diet are highly effective factors on atherosclerosis. Since panoramic radiography is typically prepared in dentistry and in Department of surgery it is recommended that dentists shall wage on carotid artery atherosclerosis with panoramic radiography diagnosis to identify patients for admission in specialised centres. The results of this research indicate that atherogenesis can clearly be observed in panoramic radiography. Education of general dentists on carotid artery atherosclerosis with panoramic radiography diagnosis and specially the patients at high risk is quite significant; by early detection of lesions these shall be admitted to specialized centres without asymptomatic identifications to begin necessary therapies without delay; this way the incidences of deaths and disabilities by the effect of this disease can highly decline. REFERENCES Anderson CS, Jamrozik KD, Burvill PW, chakera TM, Johnson GA, stewart wynne EG. Determining the indence of different subtypes of stroke : result from the Perth community stroke study, Med J Aust 1993 ; 158: Djousse L, Myers RH, Province MA, Hunt S, Eckfeldt JH, Evans G et al. Influence of Apolipoprotein E, Smoking and alcohol intake on carotid artherosclerosis. Stroke 2002 ; 33 : Farman, Allan G.panoramic radiology and the detection of carotid atherosclerosis 2001 vol 1. Issue2-page 1. White and pharaoh. oral radiology principles and interpretations ch 10-page 199. Fridlander A.Identification of strok porne patients by panoramic radiography.australian Dental 1998 ;43:1. Fridman P.predictor of survival after cerebral infarction imporatance of cardiac factors.aust NZ J Med 1994 ; 24:51-4. Friedlander AH, August M. the role of panoramic radiography in determining an increased risk of cervical atheromas in patients treated with therapeutic irradiation oral surg, oral me, oral radiol endod 1998;85:

5 Friedlander AH, Garrett N, Norman DC. the Prevalence of calcified carotid atheromas on the panoramic radiographs of patients with type 2 diabetes mellitus. J A m Dent Assoc 2002 ; 133(11) : Friedlander AH, Lande A. panoramic radiographic identification of carotid arterial plaque. Oral Surg oral Med,oral pathol 1981 ; 52: Friedlander AH, Maeder LA. the prevalence of calcified carotid artery atheromas on the panoramic radiographi of with type 2 diabetes mellitus oral surg-oral med oral pathol oral radiol.2000; Georg Howard, Lynne E Wagenknecht. Cigarette smoking and progression of atherosclerosis. JAMA ; 279 : Kumagia M, Yamagishi T,Fukui N, Chiba M. long-term cigarette smoking increase the prevalence of carotid artery calcification seen on panoramic dental radiographs in male patients. Tohoku J.Exp.Med 2007 ; 212: Manzi F, Boscolo F, Maria de Almedia S, Haiter Neto F. Panormic radiography as an auxiliary in detecting patients at risk for cerebrovascular accident (CVA). Journal of oral Science 2003 ; 45 (3) : National Heart Foundation of Australia. Heart Factors 1992 Woden : National Heart foundation of Australia, 1994 : 4,31. Sisman Y, Terim Ertas E, Gokce C, Menku A, Ulker M, Akgunlu F. the prevalence of carotid artery calcification on the panoramic radiographs in Cappadocia region population. European Journal of Dentistry 2007 July ; 1: Tell GS, Howard G.Mckinney WM, Toole JF. Cigarette smoking cessation and extracranial carotid atherosclerosis. JAMA ; 261 :

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