###### Abstract
To date, sonography has been used as \"gold standard\" noninvasive techniques to determine the arteriosclerotic changes in the carotid artery [14]. Nevertheless, ultrasound examinations are not routinely used as safeguard measure in all patients. Other more time-consuming methods used for diagnosis of carotid artery calcification, such as computer tomography (CT), magnet resonance tomography (MRT) and electronic thermography (ET), as well as the invasive method of angiography, are available, but they are used for special indications and are not commonly used for the assessment of all patients [15]. Furthermore, more advanced methods such as optical coherence tomography (OCT), photoacoustic tomography and infrared thermography are also used to characterize plaques [16]. PET-CT imaging with (18)F-Sodium Fluoride is used for the detection and quantification of microcalcification in atherosclerotic plaques. Due to its association with cardiovascular risk factors, it determines the amount and severity of CAC [17; 18; 19]. Invasive and advanced methods are more expensive and time-consuming than noninvasive methods. Consequently, different diagnostic methods which are quick and economical are required. The relationship between cardiovascular disease and periodontitis is well established [20]. Periodontitis is a complex disease marked by clinical attachment loss and alveolar bone loss resulting in tooth loss if not treated at an early stage or treated unsuccessfully [21]. In 2014, the Global Burden of Disease Activity reported periodontitis as the sixth disease worldwide, affecting 743 million people, with the overall prevalence of 11.2% [22]. Inflammatory events in periodontitis occur as a result of increased concentrations of various proinflammatory cytokines as evident by increased levels found in infected periodontal tissues or in the crevicular fluid of periodontitis patients. Similarly, continuous increases in cytokines are found in atherosclerosis. [23]. Patients with periodontitis have a 1.14-time higher relative risk of developing coronary artery disease and a 25% higher risk compared to non-periodontitis patients [24; 25]. Furthermore, studies also suggest that atherosclerosis can also be amplified by periodontitis [26; 27]. Periodontal disease may stimulate endothelial dysfunction through bacterial products from _Porphyromonas gingivalis_ and _Aggregatibacter actinomycetemcomitans_ and soluble bacterial components and also via systemic inflammation [27; 28]. Endothelial dysfunction results in the release of inflammatory cytokines interleukin 1, interleukin 6 and tumor necrosis factor alpha [9]. These inflammatory cytokines promote cell adhesion,permeability and endothelial permeability. The decomposing endothelial layer results in the production of thrombin and formation of fibrinogen, which can result in thrombosis and, consequently, in cerebrovascular or cardiovascular accidents [29; 30]. When samples from carotid endarterectomies were studied in a polymerase chain reaction study, a minimum of one periodontal bacterium was found in 44% of atheroma, and _Porphyromona gingivalis_ and _Tannerella forythia_ were found in 26% and 30% of the specimens, respectively [28]. _Porphyromona gingivalis_ and _Tannerella forythia_ are the main periodontal pathogens which are associated with bleeding on probing and deep periodontal pockets [31; 32]. Panoramic radiographs (PRs) are routinely used for diagnosing periodontitis. A panoramic radiograph is an economical and most commonly used tool in dentistry for diagnostic investigation. In a panoramic radiograph, carotid artery calcification appears as an irregular, circular, linear or heterogeneous radiopaque mass located posterosuperiorly to the angle of the mandible, at approximately the inferior margin of the third cervical verteba between C3 and C4 [33; 34; 35; 36]. Various studies have shown the importance of panoramic radiographs in the identification of CAC [37; 38].