Direct Autofluorescence Visualization Technology

VELscope VX®

The VELscope VX® is a hand held device that uses an appropriate wavelength of light to excite the fluorophores that exist in living tissues causing them to fluoresce, or emit their own light. Normal, healthy tissue will appear pale green when exposed to the emitted blue light, abnormal tissue will be darker green to black. Alterations in tissue autofluorescence have been observed in OSCC. No pre-rinse is used with this adjunct. The device has been found useful especially to delineate surgical margins that may extend beyond the visible lesion margins. When there is a high degree of inflammation, such as in the case of lichen planus, mucous membrane pemphigoid, pemphigus vulgaris, lupus, varix, etc. or when an amalgam tattoo is present the tissue may appear dark; thereby, producing a false positive result. Any type of inflammatory process such as cheek chewing, etc. will also exhibit a darker color change. See VelScope.com.

OralID™

Developed in 2013, the OralId™ is a light-based diagnostic adjunct. The device is a hand-held instrument that emits a blue light which is shined directly into the patient’s mouth. The device requires goggles and other eyewear that are included. Accessories for taking clinical pictures with either cameras or cell phones can be purchased separately. The device works on the principle of autofluorescence and shows areas of abnormality as dark blue. The company purports that this device may help detect oral cancer, pre-cancer and other abnormal tissue changes at an earlier stage. No rinses or dyes are used. See OralID.com.

ViziLite Plus STM® with TBlue® (toluidine blue)

The ViziLite Plus device has several components: ViziLite® Lightstick, and TBlue® dye rinse swab. The patient rinses with one percent acetic acid for 30-60 seconds followed by the use of a chemiluminescence light. The light stick is especially beneficial in identifying white and erythroleukoplakia lesions. After the light stick is broken and shaken, it is placed next to all visible oral soft tissue surfaces. The device will cause illumination of any leukoplakia and/or erythroleukoplakia lesions causing them to appear bright white. TBlue is a part of the soft tissue management system and contains pharmaceutical grade tolonium chloride, which is a toluidine-blue dye that stains the epithelial cell’s nuclear material blue. The use of the TBlue assists in further delineating the extent or margins of any detected lesions. A complete guide to the various products can be found on the Den-Mat site using the link to ViziLite. This is an FDA approved product.

Identafi® Multi-Spectral, Oral Cancer Screening

First released to the market in 2009, now manufactured and sold by Henry Schein®, the portable AA rechargeable battery-operated Identafi aluminum plated handpiece emits safe white, violet and amber wavelengths of light into the mouth which stimulates the fluorophores (natural molecules found within tissue that emit light when exposed to specific wavelengths of light) within the superficial mucosa tissues, causing them to emit a fluorescent blue glow when viewed through glasses fit with special optical filters. The handpiece and attached angled mouth mirror are covered by a disposable plastic sheath. The light source is emitted through the plastic sheath next to the mirror. As with the VELscope®, this device allows the clinician to view the different fluorescence responses of healthy versus abnormal oral tissue. Viewed with the violet light from this system, healthy tissues will appear bright green while suspicious areas will appear dark.

The device has a white, violet and amber light setting. The white light setting is used to enhance the clinician’s normal cancer examination. When abnormalities are present the selector is then switched to amber light that enhances the normal tissue’s reflectance properties so the clinician can view the vascular architecture. Studies indicate that abnormal tissue has a diffuse vasculature as opposed to the more clearly defined vasculature of normal tissue. A combination of fluorescence and reflectance uses the body’s natural tissue properties as an adjunctive tool for oral mucosal examination. The latter wavelength, according to the manufacturer, allows the clinician to evaluate the blood vessels feeding the suspicious area to help reduce false positives. See Identifi®.

The Microlux Transilluminator

The device is used for anterior and posterior caries detection but has other attachments such as DL Oral Cancer Screener. For oral cancer screening, the patient rinses with 1% acetic acid and the Microlux DL tip is placed in the mouth. Any white or leukoplakia lesions become more visible. Brochures are available at the site. Devices are autoclavable as well. See AdDent.

DentLight D.O.E.™

The portable, lithium rechargeable battery-operated handpiece emits a safe blue wavelength of light into the mouth stimulating the fluorophores within the superficial mucosa tissues, causing them to emit a fluorescent green glow when viewed through supplied optical loupes with special flip-down optical filters. Viewed with this system, healthy tissues will appear bright green while suspicious areas will appear dark. The handpiece utilizes the manufacturer’s composite curing light (Fusion®) with a removal attachment head. Both a white light and blue light attachment come with the kit. The handpiece has a LCD display with a variable activation timer (range 5-20 seconds in 5 second increments) and a manual mode. Note: if the clinician already owns the Fusion light curing system the two additional attachments can be purchased at a reduced price. See DentLight.