CHAIR SIDE OPTICAL DIAGNOSTIC PROCEDURES/ dental implant courses

CHAIR SIDE OPTICAL
DIAGNOSTIC PROCEDURES
INDIAN DENTAL ACADEMY
Leader in continuing Dental Education
www.indiandentalacademy.com

• Early detection of pre-malignant lesionsand
malignant tumorsmay reducepatient morbidity and
mortality becausetreatment at alessinvasivestageis
moresuccessful, and thereforeisof great clinical
importance.
• Unfortunately, (pre-)malignant lesionsof theoral
mucosafrequently go unnoticed.

• Optical diagnostic procedureshavebeen studied asnon-invasive
in vivo toolsfor thedetection of (pre-)malignant tissuealterations.
• Theseincludes
1.Chemiluminiscence
2.Fluroscencespectroscopy
3.Micro endoscopy

Chemiluminiscence
• Refers to the transmission of light from a chemical
reaction which is of varying degrees of intensity with
colors that span the visual spectrum.
• A+B ----- [ I ]* ---- products + Light.
• [ I ]* is the highly energetic intermediate compound

• First reported in 1669 by a German physician HENNING BRAND
• Termed coined by EILHARDT WIEDMANN in the year 1888.
• “VIZILITE” is a recently introduced commercially available
diagnostic tool devised for early detection of oral cancer which is
based on the principle of chemiluminiscence.

ViziLite kit consists of
ViziLite 1% acetic acid solution
Capsule retractor
User instructions
TBlue630™ Oral Lesion Marking System
Reproducible patient consent/waiver form with exam
documentation map and instructions.

• Lumenoscopy

TBlue®
Oral Lesion Marking System
• Patented, pharmaceutical-grade toluidine blue-based metachromatic dye used to
further evaluate and closely monitor changes in ViziLite-identified lesions. It
selectively stains the acidic tissue components, sulfates, carbonates and
phosphate radicals such as DNA & RNA.
• Packaged in an easy to use 3-swab system, provides the deep blue staining that
allows ViziLite-identified lesions to be seen clearly under normal light.

Steps involved in procedure
•Step 1
•Present consent form and place signed
form in patient chart
•Conduct routine visual exam, noting any
lesions
•Have patient rinse with ViziLite Pre-Rinse
Solution for 30-60 seconds

•Step 2
•Bend flexible outer light stick,
breaking brittle inner vial
(which mixes both chemicals,
acetyle salicylic acid &
peroxide)
•Shake vigorously to mix
contents of light stick

•Step 3
• Insert light into the
open end of the retractor
and assemble
• Dim room lights

•Step 4
•Re-examine the oral cavity
using ViziLite. (The open retractor
window must face the tissue being
examined)
• Document any abnormalities on
the mouth map located on back of
consent form

•Step 5
•Apply swab #1 (acetic acid solution) to
the entire area of the lesion
• Swab for 20 seconds
•Direct the patient to rinse with water and
expectorate
•Step 6
•Apply swab #2 (TBlue blue dye) for
20 seconds
• Direct the patient to expectorate the
dye solution

•Step 7
•Using conventional lighting, apply
swab #3 (acetic acid solution)
•Completely cover area where any
blue stain appears. Swab for 20
seconds (This step may be repeated
to remove any excess dye)
•
•Direct the patient to rinse with water
and expectorate

How ViziLite Plus
Looks Clinically
Lesion observed in conventional
lighting
Lesion observed using ViziLite

TBlue Stained Lesion
Before: Indistinct margin with lack
of surface architecture
After: Lesion is easy to view,
document and evaluate
Measure the stained lesion and document the staining pattern

Advantages
•Indicates area for biopsy
•Low cost
•Non-invasive (no local anesthetic, suture, virtually
pain free)
•Disposable device (no cross-contamination)
•100% Sensitivity for pathology
•Patient is aware he or she received an oral cancer
examination

Disadvantages
•Taste!
•TBlue stain can remain in mouth 4-6 hours
•Specificity – Not meant to be a diagnostic tool;
it is a screening device only

Fluroscencespectroscopy
• When cells interact with light they become excited and re emit light
of varying colors ( Fluorescence ) and this can be detected by
sensitive detectors.
• All tissues fluoresce due to the presence of fluorescent fluorophores
with in them ( AUTOFLUORESCENCE )
• Florescence spectroscopy and imaging can detect these substances
and provide characteristic spectra that reflects biochemical changes
occurring within tissues.

• Commonly detected endogenous fluorophores include, NADH,
COLLAGEN , ELASTIN & cofactors such as FLAVINS.
• To enhance fluorescence contrast between normal and cancerous
tissues , a topical or systemic application of 5- aminolaevulinic
acid ( ALA ) is applied which is converted into strongly RED
fluorescing ProtoPorphyrins

• “VELSCOPE” Is a revolutionary hand-held device
offering Dentists and Hygienists an easy-to-use adjunctive
screening instrument for early detection of oral cancer.
• The technology platform is based on the direct visualization of
tissue fluorescence and the changes in fluorescence that result
when abnormal cells are present.www.indiandentalacademy.com

The clinician shines the blue excitation light into the
patient’s oral cavity and looks through the Hand piece.

No apparent lesion Normal fluorescence pattern
Visible leukoplakia
Irregular, dark area visible under
fluorescence visualization. Biopsy-
confirmed moderate dysplasia

No apparent lesion Irregular, dark area visible under
fluorescence visualization. Biopsy-
confirmed Carcinoma in Situ (CIS)

• Sensitivity is 98% and specificity is 100% when
discriminating normal mucosa from severe dysplasia /carcinoma in
situ (CIS) or invasive carcinoma.
• Emits a safe blue light into the oral cavity, .
• Typically, healthy tissue appears as a bright apple green, while
the suspicious regions are identified by a loss of fluorescence,
which thus appear dark.

Micro endoscopy
• Allows in vivo examination of the epithelium to
obtain a histopathological grade image, with out
the need to remove tissue.
• Details of tissue, cells and cellular ultra structures
as well as the presence of some bacteria and
fungi are evident.

• Allows the monitoring of whole mucosal surface,
both normal and pathological and allows detection of
patterns specific for pathology like infection,
inflammation, metaplasia, dysplasia and malignancy.
• Gives immediate result and use for guide further
surgery, biopsy or simple surveillance.

• System consists of
Micro endoscope
attached via an adaptor
to a camera system, via
video recorder with out
puts to monitor and
photo print.
• Video encoding is done
by using xenon light
source attached via soft
fibro optic cable.

• Documentation
performed in form of
simple photography
as well as dynamic
documentation.
• The vital stain used
is methylene blue

conclusion
• Substantial clinical data supports the safety and
efficacy of optical diagnostics as an adjunctive
screening technology for the oral screening of
abnormalities, including pre-cancerous and
cancerous lesions.
• The punch line thus indicates that the role of oral
diagnostician to build up a oral cancer free world
is very much in its zenith and it needs further
availability, producability and encouragement to
bring these Optical techniques into lime light.www.indiandentalacademy.com

Acknowledgements
• Dr. Ravi kiran
Associate professor
• Dr.Kavitha
Reader
• Dr. Samatha
• Dr. Harsha vardhan
• Dr. Sivan Satish
Sr.Lecturers

• In June, 2004 the ADA approved a new dental reimbursement code
for oral cancer screening products. This new code, D0431, is
effective as of January 1, 2005.
• Many factors contribute to oral cancer risk. For simplicity, the
clinician should focus on the most prominent risk factors (age 40
and older; tobacco use) At minimum, a ViziLite or Velscope
examination should be offered to these patients annually , which are
already in practice by many dentists world wide

CHAIR SIDE OPTICAL DIAGNOSTIC PROCEDURES/ dental implant courses

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Viewers also liked

Viewers also liked (20)

Similar to CHAIR SIDE OPTICAL DIAGNOSTIC PROCEDURES/ dental implant courses

Similar to CHAIR SIDE OPTICAL DIAGNOSTIC PROCEDURES/ dental implant courses (20)

More from Indian dental academy

More from Indian dental academy (20)

Recently uploaded

Recently uploaded (20)

CHAIR SIDE OPTICAL DIAGNOSTIC PROCEDURES/ dental implant courses