A magic wand for the community dental office? Observations from the British Columbia Oral Cancer Prevention Program.

Oral cancer is a deadly disease. It is often diagnosed late with considerable spread, resulting in a high mortality rate and treatment-associated morbidity. New devices entering the market have stimulated a renewed interest in oral cancer screening among dental professionals. The British Columbia Oral Cancer Prevention Program (BC OCPP) is actively involved in research related to a variety of emerging technologies, including the intraoral application of devices aimed at improving visualization of oral mucosal abnormalities based on a better understanding of the molecular and pathological alterations associated with premalignancy and cancer. One of these technologies, direct fluorescence visualization (FV), has a long history of use in the detection of cancerous and precancerous tissue at several sites, including the lung, cervix and skin.1–3 In 2003, we began investigating the use of FV in the oral cavity, adapting the technology to an easy-to-use, handheld device to visualize oral mucosal change directly. A version of this technology has been commercialized by LED Dental Inc. (White Rock, B.C.) and is being marketed as VELscope. �etecting Malignancy by Fluorescence Visualization The VELscope emits a cone of blue light which, when directed into the mouth, excites various molecules (called fluorophores) within mucosal cells, causing them to absorb the light energy and re-emit it as visible autofluorescence. Alterations to tissue morphology and biochemistry, often associated with disease, result in a loss of fluorescence.4 Healthy oral tissue emits a pale green light, while altered tissues, which attenuate the passage of light, appear dark brown to black (loss of fluorescence). Thus, the device marks a change in the mucosal field that is sometimes associated with oral carcinogenesis. In our hands, it is used following completion of the health history as the second part of a 2-step clinical examination. The device is not meant to be diagnostic, but complements conventional visual and manual head and neck examination. In the hands of an experienced user, this information can help guide a decision for biopsy.