OBJECTIVE: The objective of this study was to determine the utility of panoramic radiographs for detecting extracranial calcified carotid atheroma and carotid luminal stenosis. STUDY DESIGN: Panoramic radiographs were obtained on 52 adult participants who had carotid ultrasound examination. Extent of carotid calcification and stenosis was determined by a cardiologist from ultrasound reports, which were considered gold standard assessments. A trained and calibrated oral and maxillofacial radiologist interpreted the radiographs for presence or absence of carotid calcifications. We examined the utility of panoramic radiographs to diagnose any carotid artery changes (diagnostic scheme 1) or only moderate to severe changes (scheme 2). Generalized estimating equations were used to account for clustering of observations within subjects. RESULTS: Under diagnostic schemes 1 and 2, radiographs had low sensitivity to detect carotid calcifications (31.1% and 25.0%, respectively) and stenoses (22.7% and 21.4%, respectively). CONCLUSIONS: When compared to ultrasonography, panoramic radiography is not a reliable means to detect carotid artery calcifications or stenoses.