PULP STONES AS A POTENTIAL ORAL BIOMARKER OF CARDIOVASCULAR DISEASES: A NARRATIVE REVIEW OF CURRENT GENETIC, RADIOGRAPHIC, AND MOLECULAR EVIDENCE

Abstract

Background: Pulp stones are calcified masses within the dental pulp, frequently identified as incidental findings on routine dental radiographs. Emerging evidence suggests that these calcifications may reflect broader systemic calcific and inflammatory processes, including those implicated in cardiovascular disease. Because many cardiovascular conditions remain clinically silent in their early stages, radiographic detection of pulp stones may offer a simple, non-invasive avenue for opportunistic cardiovascular risk assessment.

Objective: This review aims to synthesize the genetic, molecular, and radiographic evidence supporting pulp stones as a candidate oral biomarker of cardiovascular disease, with particular attention to their diagnostic relevance in dental imaging.

Methods: Current evidence on pulp stone formation, the molecular pathways shared with cardiovascular calcification, and the clinical-radiographic associations between pulp stones and cardiovascular disease was reviewed, with particular emphasis on studies employing panoramic radiography and cone-beam computed tomography for the detection of pulp calcifications.

Results: Pulp stone formation is driven by chronic inflammation, oxidative stress, dysregulated calcium-phosphate metabolism, and osteogenic signaling pathways—including RUNX2, BMP, Wnt, and inflammatory cytokine-mediated mechanisms—that substantially overlap with those implicated in vascular and valvular calcification. Radiographic studies have consistently reported a higher prevalence of pulp stones among individuals with coronary artery disease, hypertension, hyperlipidemia, and other cardiovascular conditions. Panoramic radiography remains the most practical screening modality given its routine use, low cost, and wide availability, whereas cone-beam computed tomography offers greater sensitivity and three-dimensional localization.

Conclusion: Pulp stones should not be regarded as diagnostic markers of cardiovascular disease; however, their radiographic detection may serve as an adjunctive indicator of systemic calcification risk. Standardized radiographic criteria and prospective studies are needed to establish their clinical utility.