Oral cancer kills 7,000+ Americans each year but, like many cancers, can often be treated if caught early.
Where Oral Cancer Strikes
Oral cancer can occur in any part of the mouth, including your lips, gums, tongue, salivary glands, and throat.
Signs of Oral Cancer
Cancer can often be difficult to detect in its early stages. However, some signs may be indicative of cancer –– though certainly not always –– and include:
- Mouth pain
- Sores or lesions in the mouth
- Jaw movement difficulty
- Chewing and swallowing difficulty
- Throat pain
- Unexplained bleeding in the tongue, cheeks, or gums
- Specific numb areas of the mouth
Treating Oral Cancer
The first step in treatment always includes regular dental screenings and checkups. Finding a problem early improves your treatment and outcome options.
If a problem is discovered, your dentist and doctor can examine the affected area and may take a biopsy to determine whether it is cancer.
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One method used by dentists to detect Oral Cancer is the VELscope. Crown Council member Dr. James Sanderson has provided the following information about this terrific tool.
VELscope… what is it? Why would you like to have your dentist use it for you?
The VELscope is an aid to the dentist and or his team members who have always been looking for abnormal tissue in your mouth….
Are we looking for cancer? The answer is MAYBE….
What we are looking for is something that does not look normal….
Then our job is to figure out what that abnormal tissue might be…
The VELscope helps us to see things that we might not otherwise be able to see with our own eyes. It ALSO helps heighten our awareness as we look in the mouth under regular lights…
This is a technical explanation of what we are using…
The VELscope is based on direct visualization of human tissue fluorescence as an aid to identifying disease. It exploits the properties of naturally occurring fluorophores to characterize biological tissues. Changes in the tissue’s "optical signature" as cancer progresses is distinct from healthy tissue. VELscope assists in early visualization leading to diagnosis and treatment of diseased (precancerous and cancerous) tissue that may otherwise go unnoticed.
To use the VELscope your dentist will usually follow a protocol similar to this….
1. Obtain a complete medical record on the patient.
2. Determine any region of concern and document all relevant information.
3. Complete a thorough Oral Cancer Screening Exam under White Light.
4. Complete a thorough VELscope exam of all of the oral cavity.
5. Document the findings.
The surgical biopsy is the gold standard for diagnosis once it is determined that a biopsy must be performed…
The National Institute of Health does not normally issue press releases on products. VELscope has changed that; the NIH issued a press release on one of the clinical studies on VELscope.
The objective of this study, which was published in the Journal of Biomedical Optics, was to assess the ability of VELscope to help visualize cancerous and precancerous lesions. The results showed a 98% sensitivity and 100% specificity when discriminating pre-identified severe dysplasia, Carcinoma In Situ, or invasive Cancer with VELscope.
There are many other studies showing how well VELscope works at helping visualize these lesions, which may sometimes not be apparent to the naked eye. These can be viewed on the VELscope website: http://www.VELscope.com.
Based on the results from some of these clinical studies, LED Dental Inc. has received clearance from the U.S. Food and Drug Administration to expand the indications for use of VELscope. The two expanded indications involve the ability to help detect lesions that may not be visible under traditional white light examinations, including precancerous and cancerous growths, and the ability to help surgeons ensure that all diseased tissue is successfully removed when excising cancerous lesions.
According to the indications for use recently cleared by the FDA, "VELscope is intended to be used by a dentist or health-care provider as an adjunct to traditional oral examination by incandescent light to enhance the visualization of oral mucosal abnormalities that may not be apparent or visible to the naked eye, such as oral cancer or pre-malignant dysplasia.
VELscope is further intended to be used by a surgeon to help identify diseased tissue around a clinically apparent lesion and thus aid in determining the appropriate margin for surgical excision
These institutions are using the VELscope…
British Columbia Cancer Agency (BCCA) Loma Linda
MD Anderson Cancer Center Nova Southeastern College of Dentistry
University of Texas Austin Cancer Center University of Indiana School of Dental Medicine
University of Washington Medical College of Georgia
New York University University of Minnesota
University of Illinois University of Pacific
University of Chicago UCLA
University of Texas – Houston USC
University of Pennsylvania Harvard University
Tufts University UCSF
2007 Statistics
34,360 New Cases of Oral Cancer
11,150 New Cases of Cervical Cancer
Estimated U.S. deaths from Oral Cancer in 2007: 7,550
Compared to 3,670 estimated deaths from Cervical Cancer in 2007
25% of Oral Cancer patients have no risk factors
The greatest increase of new Oral Cancer patients has occurred in patients under age 40
There has been nearly 5-fold Increase in this age group
Great majority have no risk factors
Majority of these problems occur on the tongue
The nearly 5-fold increase in young oral cancer patients under the age of 40, many with no traditional risk factors, underscores the need for thorough examination of all patients and increased awareness of this devastating disease.
All of the technologies on the market today to help look at these issues are designed to do one thing. They are designed to help someone who is not used to looking at cancer be better at looking at or for cancer….. THIS IS THE BIGGEST KEY!!!!!!The other leading examination tool on the market the Vizilite Plus
Vizilite requires a 1 minute rinse with 1% Acetic Acid then an evaluation with a specific light in a darkened room. If an area shows up potentially positive, your dentist would use Toluidine Blue which appears to be attracted by the nuclear uptake of the die to the potentially dysplastic tissue. The results with Toluidine Blue today seem to be better than previous studies indicated.
The ViziLite Plus patient charge to the patient is usually between $50.00 to $65.00. The VELscope patient costs are $20.00 to $65.00 per evaluation. The main reason for the difference is the smaller ongoing cost to the practice for the VELscope disposable materials…
What do we do in our office?
Listen to the patient to determine interest or need of the exam
Obtain complete history… medical, social, family
Oral Cancer Screening in white light then with VELscope (FEEL & LOOK!) LOW LIGHT best when we are using the VELscope!
Our Hygienists do the initial screening. If they see area of concern, hey take the next steps. Regardless I always do white light visual and a physical exam as well…
The next steps include photos, video (4 handed procedure if needed… patient may come back to get their teeth cleaned and follow up)
Document findings and course of action recommended
A two-week follow up can be all the treatment needed. Many times we will bring them back to clean their teeth instead of doing it that day because once we find a positive reading we take more time to evaluate that and that will then keep us from staying on time for the rest of the patients scheduled that day…
The VELscope Handpiece emits a safe blue light into the oral cavity, which excites the tissue from the surface of the epithelium through to the basement membrane (where premalignant changes typically start) and into the stroma beneath. This excitation causes the naturally occurring fluorophores in the tissue to fluoresce. The clinician is then able to immediately view the different fluorescence responses to help differentiate between normal and abnormal tissue.
Under VELscope examination, abnormal tissue typically appears as irregular, dark areas that stand out against the otherwise normal, green fluorescence pattern of surrounding healthy tissue. This is primarily due to a decrease in the concentration of the FAD in the epithelium and a breakdown of stromal collagen cross-links that accompany dysplastic progression.
Cases performed by Dr. Scott Benjamin
Total # of Patients Examined: 1317
Total # of Exams: 3952
Patients with Documental Soft Tissue Areas (All Types): 460
Lesions of Dysplastic Nature (Histopathology confirmed): 21
Cases in our practice the first 6 months
Total # of Patients Examined: 285
Patients with Documented 28 (10%)
Soft Tissue Areas Lesions referred to Oral Surgeon or office bx 8 (3%)
Lesions of Dysplastic Nature 4 (1%) (Histopathology confirmed)
Dr. Ed Truelove from The University of Washington told me based on his experience with his residents and using the VELscope he had similar numbers to mine but he had larger numbers for the same period of time.
We believe that the use of the VELscope is highly likely to improve the clinical suspicion that a lesion has increased potential for undergoing premalignant or malignant transformation.
We do not know the rate at which cytological abnormalities progress, regress, or persist
Some lesions must progress and based on general findings some must regress.
"Adding the VELscope® to our diagnostic Protocol has resulted in the detection of dangerous lesions that would have otherwise been undetected."
Dr. Edmond Truelove, DDS
Professor & Chairperson, Department of Oral Medicine
University of Washington, School of Dentistry
Respectfully submitted:
James L Sanderson Jr. DMD LLC
Fellow of The Academy of Laser Dentistry
Laser Assisted Comprehensive Dentistry
Hoover, Alabama
V 205-979-6005