Thursday, September 12, 2013
Have you ever watched a CSI type TV show where the daring crime scene detective shines an eerie blue light over the scene looking for clues? What they are doing is using an alternative light source or natural fluorescence to reveal details that are hard to detect with normal white light. The same kind of technology is behind the VELscope Vx.
VELscope produces a specific blue light that the dentist or hygienist shines on the oral soft tissues. The tissues are then viewed through the VELscope handpiece which filters out most of the ambient reflected light. What the user sees through the handpiece is the natural fluorescence of the mucosal tissue. Damaged tissue, inflammation and lesions of all kinds, including early dysplasia, look different than healthy tissues. They usually have reduced fluorescence.
Some people think the VELscope is specific for cancer diagnosis. The fact is it is not truly a diagnostic device and it is not specific to oral cancer.
“VELscope is not a magic cancer wand,” says Dr. David Morgan the Chief Science Officer of LED Dental. “It does not replace the traditional head, neck and oral soft tissue exam. VELscope is an adjunct that assists practitioners by enhancing their ability to see subtle tissue changes that might otherwise be overlooked. The skill, training and experience of the health care professional remain the foundation for enhanced oral examination and proper diagnosis.”
The best way to think of VELscope may be to compare it to a radiograph. A radiograph does not diagnose disease. It is merely a tool to help practitioners see the tissues in a way that is not possible with normal vision. To the untrained eye a radiograph is a jumble of black, white and gray. To use it effectively as a diagnostic aid the practitioner needs to learn what normal tissue looks like and then to detect often subtle changes in those normal images.
VELscope shows the user tissue fluorescence but it does not tell you what is normal and what is not. For that you need training and experience. For example the tonsilar pillars are naturally less fluorescent than buccal mucosa. However, just like a slight change in the interproximal radiolucency indicates dental caries, a change in tissue fluorescence indicates a soft tissue abnormality.
If the dentist did not use radiographs he or she would eventually be able to detect the interproximal decay visually. But by then it will be much larger, harder to repair and have more potential complications. Early detection and intervention is always better than neglect.
It is the same with a soft tissue lesion. Eventually it will be obvious and easy to detect visually. However with enhanced vision using the VELscope the dentist can detect lesions at an earlier stage and treat them appropriately.
A new camera attachment has been developed that easily attaches to the VELscope and allows users to take good fluorescent light photos. These are important for documentation, follow up and referral.
A quick outline of a diagnostic protocol using VELscope:
- Observe the oral soft tissues during routine head and neck exam using VELscope as an adjunct.
- If a suspicious area is observed apply conventional thinking to develop a preliminary differential diagnosis. If the patient relates a recent history of pizza burn the diagnosis may be rather simple. Clinical judgment is still required. VELscope won’t tell you if the lesion is a pizza burn or a squamous cell carcinoma.
- If warranted by your observations and history document the lesion with a VELscope image, a white light photo and written description. If it highly suspicious, perhaps a red and white lesion on the floor of the mouth with distinctive lack of fluorescence you may want to skip the follow up and go directly to a referral.
- Follow up as indicated depending on your preliminary differential diagnosis and treatments and re-examine. Compare the lesion to the documented images and description.
- If indicated re-document changes and refer the patient to an appropriate specialist for consultation and possible biopsy.
Three things to keep in mind:
- When referring it is almost always better to ask for a consultation and diagnosis as needed than to directly ask for a biopsy. Use the specialist’s training and experience.
- VELscope cannot provide a definitive diagnosis. For that a biopsy is still needed.
- Surgeons find the VELscope image very helpful in detecting the location and margins of the lesion during biopsy or excision.
Although it is not just for oral cancer, the fact is the VELscope can help you detect dysplasia and early cancerous lesions. It could literally save your patient’s life.
VELscope VX is a cordless hand held device and a re-charging base. The manufacturer’s suggested retail price is $2,749.The upgraded optional camera attachment is $599.
High tech dentistry is not just about computers. In the future new diagnostic techniques will continue to help us treat our patients better. The future is coming and it will be amazing!