Using Adjunctive Devices for Oral Cancer Screening
Clinicians must reconsider the status quo to help save lives
In the February 2014 issue of Inside Dentistry, Emily Boge, RDH, BS, MPAc, and John R. Kalmar, DMD, PhD, wrote an excellent article, “Should Dental Practitioners Perform a Cancer Exam on Every Patient?” on the merits of the extra- and intraoral cancer exam. As they stated, this exam consists of visual exam with magnification and visible light, and palpation of the head and neck. Ms. Boge noted that a consistent routine is essential to be sure all structures are checked by the practitioner.
However, that is just the beginning of what a comprehensive oral cancer exam should entail. Most dysplastic and cancerous lesions that are visible to the eye are already at stage 3 or stage 4. We all know the key to the successful treatment of any cancer is early detection. Adjunctive devices, such as the VELscope® (LED Dental), OralID™ (OralID), and Identifi® (DentalEZ) systems, are invaluable to complete the examination. It is now possible to detect lesions that are not visible1 to the naked eye, that are stage 1 or stage 2, a year sooner. This can prevent the dentist from having to perform disfiguring surgeries to remove the entire lesion.
It is a dirty little secret that less than 20% of dentists in the United States even bother to perform visual and palpation oral cancer examination, and less than 2% use an adjunctive device. There is no excuse for not performing this critical part of the oral cancer screening. The whole exam, visual and with the scope, usually takes no more than 2 to 3 minutes, and in California, hygienists can do the screening. Check with your own state board to see if this is legal for you to delegate this important task to your hygienists.
As healthcare professionals, we are obligated to provide the best possible care for our patients, and we can save lives with early detection.
The Science Behind These Devices
The National Health Service of Canada devoted more than $46 million to research screening technology, originally for the detection of lung and cervical cancer. The science is relatively simple: a safe blue light is used to scan the soft tissues of the mouth. Healthy tissues produce FAD as a byproduct of the Krebs cycle, and the FAD fluoresces with the application of the light. Dysplastic and cancerous lesions do not fluoresce, and appear nearly black.
What about ViziLite® (Zila, Inc)? The FDA has not approved that technology for patients without risk factors (eg, tobacco and alcohol use, or HPV-16 and HPV-18).3 Since nearly 30% of patients who have oral cancer do not have any risk factors, it is imperative to use a device that can be used on all patients. According to the Oral Cancer Foundation, a “person dies from oral cancer every hour of every day,” 2 so we must recognize the severity of this disease. In fact, nearly three times as many patients die from oral cancer as cervical cancer. The performance of a visible light and palpation oral cancer examination is a good start, but the use of an adjunctive device is absolutely essential to provide our patients the best possible care, and to even save lives.
1. Poh CF, Zhang L, Durham S, et al. A real-time application of fluorescence visualization (FV) to identify a novel optical field for subclinical extension in high-risk oral lesions. Presented at: AAOMP Annual Meeting; June 2008; San Francisco, CA.
2. The Oral Cancer Foundation website. www.oralcancerfoundation.org. Accessed March 3, 2014.
3. Barrett S. ViziLite Screening: Does It Make Sense? Dental Watch website. www.dentalwatch.org/questionable/vizilite/overview.html. Accessed March 3, 2014.
About the Author
James A. Pasternak, DDS, is national lecturer on various topics, including the use of the oral cancer lesion detection devices, lasers, and esthetic restorative techniques for a major US dental manufacturer. Dr. Pasternak has also maintained full-time practice in the greater Los Angeles, California, area since 1977. He is a graduate of the University of Southern California School of Dentistry.
Oral Cancer By the Numbers
Approximate number of Americans who will be diagnosed with oral or pharyngeal cancer this year. Only slightly more than half of these patients will be alive in 5 years.
Number of deaths from oral or pharyngeal cancer expected this year.
of oral cancers are squamous cell carcinomas.
Amount spent in the United States on treatment of head and neck cancers in 2010.
Source: Oral Cancer Foundation.