CSI in Dentistry can Save a Life

by Larry Emmott on April 29, 2014

in Diagnostics

CSIblueHave you seen the CSI type of TV shows where the valiant crime scene detective puts on some funky goggles and then 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 what is behind the new soft tissue detection systems used in dentistry.

VELscope is an instrument which produces a specific blue light something like the CSI device. 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. Dysplasia (even early dysplasia) produces chemical changes at the cellular level in both the epithelium and the underlying connective tissue which results in decreased fluorescence.

The darker low fluorescence areas are not necessarily cancer. Velscope is not a cancer diagnostic device per se. It does show areas of cell change. Areas of change that are often hard to detect with unaided vision. The dentist still needs to use clinical judgement. Some lesions just need observation others should get a biopsy. However with Velscope and the camera attachment the practitioner can take an image and observe changes over time.

There is a tendency to think that the soft tissue oral cancer exam we have been doing up to now has been good enough. That we will only need to use this enhanced protocol on high risk patients or only on patients over forty. However if you think it through that approach is flawed. Really anyone who receives a routine head and neck exam as a new patient or as a recall patient is a candidate for an enhanced examination. After all it is the routine patient with no obvious risk factors who is most likely to be missed. The protocol most often recommended is that all patients over eighteen receive a head and neck soft tissue exam at least once a year.

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