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Brandy Dicke and Ashley Mayeux

Instructor Lori Rogers
Contemporary Dental Hygiene Care
17, April 2014

What we hope to accomplish by this research is to educate clinicians on new dental
related technologies that they can apply to their dental hygiene practice. Clinicians have a
responsibility to provide their patients with the best care possible, and early detection of oral
dysplasia and malignancy could save a patients life. We will provide information on a new
technological tool called VELscope that uses auto fluorescence as an adjunct to the traditional
oral cancer screening method. Early cancerous lesions are often asymptomatic and lack visual
clues detectable to the naked eye which makes the aid of additional diagnostic tools crucial to
the diagnosis of oral cancer before it advances to a more serious stage.
Head and neck cancer is one of the most frequently developing cancers with an
overwhelming diagnosis and mortality rate. Its treatment can produce major disfigurement,
changes in speech, chewing, swallowing and oral health, which in turn can affect the social life
and self-esteem of the affected person (Videira, MD by ISCS-Sul, and Arajo, RDH, BS,
VELscope is a non-invasive oral cancer-screening device). With 30,000 patients being
diagnosed with oral cavity and oral pharyngeal cancer yearly, 40% of these patients will die
within 5 years of their diagnosis (Lopez-Jornet, and De la Mano-Espinosa 97). Although oral
pharyngeal cancer diagnosis has been declining in recent years, cancer of the oral cavity
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including the tongue, oropharynx, and tonsils are still increasing (ebnem Eralk Yalnkaya, A
Light Based Screening Method on Tissue Auto fluorescence for Oral Precancerous Lesions: A
Clinical signs may vary between benign, pre-malignant and malignant oral cancers. For
example, most oral squamous cell carcinomas will exhibit one or more of the following clinical
signs; induration, persistent ulceration, tissue proliferation or destruction, red or white in color,
lack of mucosal mobility, progressive growth or enlargement of the affected site, pain or
dysesthesia, paresthesia and cervical lymphadenopathy (ebnem Eralk Yalnkaya, A Light
Based Screening Method on Tissue Auto fluorescence for Oral Precancerous Lesions: A
Review). The problem is that most oral cancers in their earliest stages are symptom free, and
show minimal to no clinical signs upon visual examination. Here in lies the reason why most
oral cancers are not caught until the later stages of their progression.
Clinicians are highly educated in the appearance of normal, healthy tissue, and are
trained to recognize any change or abnormality that could precede a more serious issue such as
oral cancer. The traditional method of oral cancer examination, the standard for oral cancer
screenings, has not changed much in the past several decades. The clinician uses white light
and direct vision to view and palpate the patients oral cavity, head, and neck for anything
abnormal. It is also important to educate the patient on how to perform a routine self-
examination to be able to recognize red flags to report to a professional for further evaluation.
Since oral cancer is usually undiagnosed until a later more serious stage in its
progression, it is imperative that patients receive a routine screening in order to detect any
change in their oral cavity that could be a precursor to a diagnosis. If oral cancer is caught in
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stage 1, the patient has a greater possibility of winning the fight for their life. As healthcare
professionals, we are always looking for advancements in our field that could be beneficial to
our patients. Oral cancer screenings are one of the most important aspects of our job, and it is
our duty to provide this service at the best of our ability to our patients.
A little over 30 years ago, it was determined that tissue fluorescence could be used for
cancer detection (Lopez-Jornet, and De la Mano-Espinosa 98). Auto fluorescence was first used
in endoscopic instruments for bronchoscopy, esophageal examination, colonoscopy, and skin
evaluation. It has been used for early cancer screening and diagnosis of the lung, uterine,
cervix, skin, and most recently, the oral cavity. Clinical practice for non-invasive imaging of the
oral mucosa has become a recent growing interest (ebnem Eralk Yalnkaya, A Light Based
Screening Method on Tissue Auto fluorescence for Oral Precancerous Lesions: A Review).
There are many different methods used for oral cancer detection and tissue auto
fluorescence is one of them. It is self-induced fluorescent lighting used to detect lesions in
natural tissues within the body. The pattern of auto fluorescence is modified by absorption and
scattering (ebnem Eralk Yalnkaya, A Light Based Screening Method on Tissue Auto
fluorescence for Oral Precancerous Lesions: A Review). The idea behind tissue auto
fluorescence is that changes in the structure and metabolism alter their interaction with light.
In other words, the epithelial and stroma changes can alter the distribution of tissue
fluorophores, and as a consequence, the way they fluoresce after stimulation with intense blue
excitation light. This is defined as the process of auto fluorescence (Lopez-Jornet, and De la
Mano-Espinosa 98).
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There is a variety of options for light-based oral cancer screenings in the detection for
mucosal abnormalities and suspicious lesions including, Vizilite Plus with TBlue system, Identifi,
Microlux/DL, Orascoptic DK, and VELscope. The Vizilite Plus with TBlue systems use a
chemiluminescent light stick and tissue dye. Identifi is a multi-spectral fluorescence used to
enhance visualization. The Microlux DL uses a 1% acetic acid pre-rinse for the patient and
diffused blue-white LED light source. The Orascoptic DKs method also uses a 1% acetic acid
pre-rinse and an LED light source to illuminate the mirrors reflection.
VELscope, otherwise known as Visually Enhanced Lesion scope, was developed in
British Columbia, Canada by the British Columbia Cancer Agency in collaboration with MD
Anderson Cancer Center and was FDA approved in November 2011 (Paulis, RDH, BS 135). It is a
cordless, lightweight, handheld device with a lens for viewing inside of the mouth. There is also
a photography package which includes a digital camera that attaches to the VELscope device,
and allows the operator to take fluorescent light photos (Emmott, DDS, Emmott on
Technology: Cutting Edge Oral Cancer Screening with VELscope Vx). These photos can be
useful in documentation for the patients file and in tracking the progression of the lesion.
The purpose of VELscope is to detect possible pre-cancerous or cancerous lesions in the
oral cavity by a non-invasive procedure that detects changes of the tissues by self-fluorescence
(Videira, MD by ISCS-Sul, and Arajo, RDH, BS, VELscope is a non-invasive oral cancer-
screening device). It is an oral cancer screening device that is used as an adjunct to the
traditional oral cancer screening, not a replacement. The way VELscope works is through
stimulation of the oral soft tissues with a blue-white light. When the clinician looks through the
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lens, the healthy oral tissues will appear green. If the tissues are abnormal, they will appear as
an irregular, dark area (Emmott, DDS, Emmott on Technology: Cutting Edge Oral Cancer
Screening with VELscope Vx).
There are many advantages of the VELscope technology including, but not limited to a
cordless, lightweight device that uses no rinses or dyes, providing a non-invasive procedure
with an easy set up and use, and it can easily provide photo-documents for future reference.
The screenings are affordable for patients ranging from $0 to $15, and its use reinforces the
idea of the caring dental practice. Most importantly, it could potentially save a patients life.
Disadvantages consist of the device being expensive, it does not provide a diagnosis alone, only
helps with detecting concerning lesions, and patient discomfort from excessive heat in a close
tissue examination is possible (Efthimiadis, Oral cancer velscope).
In conclusion, oral cancer screenings are extremely beneficial for our patients and as
hygienists, it is our duty to provide this service to the best of our ability. We should be
knowledgeable about emerging technologies and any efforts made to improve our practice.
Using VELscope in combination with the traditional screening method can aid in detecting oral
cancer in its earliest stages. This in turn has the possibility of saving a patients life.