Prevalence of Pulp Stones on Panoramic Radiographs in Patients with Chronic Systemic Diseases: A Cross-sectional Study

Shamimul Hasan, Tarun Sharma, Shazina Saeed, Mandeep Kaur, Virender Gombra, and Rahnuma Masood

Abstract

Introduction: Pulp stones (PS) are incidental, mostly asymptomatic, radiographic findings that may hinder endodontic therapy. They are observed as radiopaque aggregates within coronal or radicular pulp tissue on intraoral periapical, bite-wing, panoramic radiographs, and cone beam computed tomography images. This study aimed to evaluate PS prevalence in patients with cardiovascular disease (CVD), diabetes mellitus (DM), and chronic periodontitis (CP) as compared with controls, as a function of age and sex.

Material and Methods: This cross-sectional study included 200 subjects: 50 healthy controls, and 50 patients each with CVD, DM, and CP. All participants underwent digital panoramic radiograph (orthopantomogram) (OPG) evaluation for the presence/absence, number, and location of PS.

Results: Significant differences in PS prevalence were observed among the groups (P<0.01), with CVD patients showing the highest prevalence. Older individuals (>50 years) and first molars were most frequently affected. The maxillary arch showed a significantly higher prevalence than the mandible (odds ratio [OR]=1.45; 95% CI 1.22–1.72). The strongest risk factor was CVD (OR=7.38; 95% CI 5.20–10.47), followed by DM (OR=4.18; 95% CI 2.91–5.99) and CP (OR=4.16; 95% CI 2.88–6.00). Age was significantly associated with PS, while sex showed no association.

Conclusion: The presence of PS, even among healthy controls, may serve as an adjunctive radiographic marker and could also alert dental practitioners to the possibility of underlying systemic disease.

Rambam Maimonides Med J 2025;16(4):e0022