Background. Periodontitis is a chronic inflammatory disease with a microbiologicaletiology affecting the supporting tissues of the tooth. The diseaseaffects approximately 50% of the adult population. The prevalenceof periodontitis increases with age. The complex bacterialinfection, as well as an exaggerated host inflammatory reaction,may trigger subclinical atherosclerosis. Aims. The overall aim of the present thesis was to study the associationsbetween periodontitis, cardiovascular diseases and mortality. Thespecific aims were: I) to evaluate the use and value of panoramicradiographs in assessing carotid calcifications in relation to otherused methods (gold standards) and to assess the literature on carotidcalcifications defined from panoramic radiographs and concurrentdiagnosis of stroke and periodontitis, II) to evaluate if periodontitisis associated with the presence of carotid arterial calcificationsdiagnosed on panoramic radiographs in an elderly population,III) to assess if carotid calcifications detected on panoramicradiographs are associated with future events of stroke, and/or ischemicheart diseases over 10–13 years in individuals between 60and 96 years, IV) to assess if individuals ≥ 60 years of age with periodontitisare more likely to develop stroke or ischemic heart diseasesor are at higher risk of death over a period of 17 years. Methods: A literature review based on peer-reviewed studies was performedevaluating the use of panoramic radiographs in assessing carotidcalcifications compared to other methods. In study II, III, IV olderindividuals, 60 years and older participating in the Swedish NationalStudy of Aging and Care (SNAC) were included in the studies.A dental hygienist performed a dental clinical and radiographicexamination. Probing depths (PD) and bleeding on probing (BOP)was registered. From radiographic panoramic images, the distancesbetween the alveolar bone level and the cement enamel junction(CEJ) were measured. In study II, a diagnosis of periodontitis wasdeclared, using a composite definition; if a distance between the alveolarbone level and the CEJ ≥5 mm on panoramic radiographs at>10% of sites and PD ≥5 mm at one or more teeth and with BOP>20% of teeth. In study IV, an indicator of a history of periodontaldisease was declared if a distance between the alveolar bone leveland the CEJ ≥5 mm on panoramic radiographs at ≥30% of sites. Evidence of a radiopaque nodular mass in the intervertebral spaceat or below the vertebrae C3-C4 was identified as carotid calcification.In addition, a medical research team performed the medicalexaminations, and a medical doctor (JB) reviewed all medical recordsfor information about events of stroke and ischemic heart diseases.Stroke and ischemic heart diseases were registered accordingto the ICD 10 codes: ICD 60-69 for stroke and ICD: 20-25 for ischemicheart diseases. Study I was a review of the literature, instudy II, a cross-sectional study design was employed. In studies IIIand IV, a longitudinal prospective study design was used. Results: On the use of panoramic radiographs in assessing carotid calcificationsin relation to other used methods, the sensitivity and specificityvaried between studies published. Furthermore, only a smallnumber of studies were found concerning carotid calcifications andstroke. These studies were primarily retrospective. Four studieswere found on the association between periodontitis and carotidcalcification. Study II identified that older individuals with periodontitis had asignificantly higher prevalence of carotid calcifications than individualswho did not have a diagnosis of periodontitis. In study III,a significant association was found between carotid calcificationson panoramic radiographs and 13- year incidence of stroke using alogistic regression analysis adjusted for confounders (BMI, diabetestype 2, hypertension) in the 60-72 years. A statistically significantcrude association between radiographic evidence of carotid calcificationsand incidence of ischemic heart diseases was found in individualsbetween 60-72 years. Such an association was, however,not identified among individuals older than 72 years. In study IV, Cox regression analysis was used, adjusted for confounders(age group, BMI >30, diabetes type 2, gender, hypertension,history of AMI, history of stroke, periodontitis, smoking) andwith a definition of periodontitis as having a distance between thealveolar bone level and the CEJ ≥5 mm in panoramic radiographsat ≥ 30% of sites. Periodontitis increased the risk for ischemic heartdiseases in all individuals, in women and in the 78-96 years agegroup (OO). Associations between periodontitis, and mortalitywere found in all individuals, in men and in the 60-72 years agegroup (YO) in the long term follow-up. Conclusions: 1. 1.Study I identified that there are studies which have assessed thevalue of panoramic radiographs in relation to other used methods(gold standards). The sensitivity and the specificity varied, with thespecificity being more often higher. Few studies have consideredthe relationship between radiographic evidence of carotid calcificationsand stroke. Four studies identified a relationship between adiagnosis of periodontitis and carotid calcifications on panoramicradiographs. 2.Study II identified a significant association between periodontitisand carotid calcification in individuals 60-96 years. 3.Study III identified that signs of carotid calcifications assessed frompanoramic radiographs from the 60-96-year-old individuals wereconsistent with an incident of stroke and/or ischemic heart diseasesover 13 years follow-up.4.Study IV identified that periodontitis was associated with futureischemic heart diseases in all individuals, in women and in the 78-96 years age group. Periodontitis was associated with mortality inall indviduals, in men and in the 60-72 years age group.