###### Abstract  
Background: Atherosclerosis is the primary cause of cardiovascular death, wherein plaque accumulates in the carotid artery, resulting in the formation of carotid artery calcification (CAC). Chronic infections emulate atherosclerosis development. Periodontitis is a chronic disease commenced by biofilm aggregation on the surface of teeth, which then progresses via deregulated local and inflammatory immune responses. Aim: The aim of this study was to determine the prevalence of calcification in periodontitis patients and to determine if there is a relationship between carotid calcification and periodontitis with risk factors such as age, gender, hypertension, diabetes, smoking. Methods: The data and panoramic radiographs (PR) of 3000 patients from January 2017 to February 2022 were examined. On the basis of the inclusion and exclusion criteria, 500 patients were selected for determining carotid calcification. Non-periodontitis patients, patients <40 years of age, patients without any medical data or incomplete medical records and cases where the OPG was not clear were not included in this study. The data were analyzed using R and GraphPad Prism software version 4.1.2 and Microsoft Excel Worksheet Office 2019. Chi-square tests were used to check the dependency among the categorical variables. Mann-Whitney \(U\)-tests were used to compare the distribution of the variables across the groups, and \(p\)-values < 0.05 were interpreted as statistically significant. Result: Twenty-five (5%) patients showed carotid calcification. Carotid calcification was seen more in females than in males, which was statistically significant. Gender, percentage of alveolar bone loss and periodontal risk were found to be statistically significantly related to carotid artery calcification. Factors such as age, diabetes and hypertension were found to be statistically nonsignificant. Conclusions: More periodontal destruction was present in the CAC patients. Within the limitations of this study, it can be concluded that CAC is associated with periodontitis. Early recognition of carotid calcification is important, and patients in whom carotid artery calcification is observed via their PR should be referred to medical practitioners for further investigation and treatment care. a 2023 2  
46.9% of medial calcification [4]. In a systemic review by [PERSON] et al. in 2020, it was found that 75% of males above 75 years and 62% of females above 75 years had carotid artery calcification [5]. Calcification partially or completely reduces the lumen diameter of the coronary artery [6]. With a reduction in the vessel lumen diameter, there is a decrease in the blood and oxygen supply to the designated organs, thus endangering the life of the patient [7; 8]. There are no peculiar clinical manifestations of carotid artery calcification. CAC is associated with ischemic symptoms. The manifestations such as bumps, contralateral weakness or numbness in an extremity or face, with significant sparing of the forehead, dysarthria, aphasia or ischemic stroke, appear when the artery is partially or completely occluded. [9]. Atherosclerosis is associated with coronary artery disease (CAD) and cerebrovascular diseases [10]. CAD is one of the primary causes of death globally. According to the WHO Global Health Submit, the leading cause of death is ischemic heart disease accounting for 16% of the world's total deaths [11]. The number of deaths rose from 2 million in 2000 to 8.9 million in 2019. Stroke is the second leading cause of death, responsible for approximately 11% of the total deaths. According to the WHO, the proportional mortality rate for CVD in Saudi Arabia was 37% in 2018 [12]. In many patients, CAD can progress undetected until the late stages, resulting in morbidity and mortality [7; 8]. Therefore, it should be diagnosed as soon as possible. Various invasive and noninvasive procedures have been used to detect the presence and distribution of carotid artery calcification [13].