Radiologists who overlook teeth on head CT could be missing critical diagnoses

Though routine head CTs can often recognize or predict dental disease in the periphery of images, doctor’s aren’t reporting complications that could raise a patient’s risk of coronary artery disease, stroke and some cancers, according to data out of Boston hospitals.

CT exams of the head are typically performed for dedicated imaging of the brain and posterior fossa-intracranial structures, but the scans can also inadvertently pick up dental pathology, first author Khaled Hammoud, MD, and colleagues wrote in Academic Radiology. And since periodontal disease has been proven an independent risk factor for a handful of cardiovascular conditions and can increase a patient’s risk of developing certain cancers, identifying dental abnormalities could improve survival rates—but that isn’t happening, Hammoud et al. said.

“Although routine head CT examinations should not include the level of the teeth based on ideal protocol parameters, the teeth—typically maxillary but possibly both maxillary and mandibular—may be inadvertently included in the scanning field,” the authors wrote. “Thus, dental disease may be incidentally seen on routine head CT examinations performed for various indications, other than dental complaints, such as headache, syncope and trauma.”

Hammoud and co-authors said it’s “imperative” for radiologists to draw a patient’s attention to any dental problems, even if the patient is presenting for other reasons, and recommend follow-up evaluation and treatment if necessary.

The authors designed a trial in which 100 head CTs were retrospectively, blindly assessed by two neuroradiologists. The CT results were pulled at random from all exams that took place six months before and six months after the study hospital added a dental disease field to its standardized head CT reporting template.

As expected, Hammoud et al. found that while incidental dental disease was common, it was frequently underreported. In the study, 33 percent of randomly selected head CTs included the level of the teeth, and dental disease was present in around 40 percent of those cases. Still, just 11 percent of initial reports mentioned dental disease, and adding a dental disease field to the head CT template didn’t seem to change reporting rates.

“Dental disease is prevalent and economically burdening,” the authors said. “By incorporating evaluation of the teeth, if visible, into their respective search patterns on routine head CT examinations, radiologists may improve their diagnostic capabilities and potentially help prevent disease progression and possible costly endodontic repairs."