Ancillary Techniques or Devices

Figure 10. Benefits of fluorescence devices in a patient with a previous history of tongue cancer and recurrent lesions. Biopsies of dark areas showed severe dysplasia in all three sites.

On occasion the use of ancillary techniques or tools may be appropriate. Exfoliative cytology coupled with DIF may provide a rapid, painless method for identifying PV although it would not be of major benefit in identifying other mucocutaneous diseases causing DG.5,34,103 A cytological biopsy commonly referred to as a “brush biopsy” is the oral equivalent of the cervical Papanicolaou (Pap) test which normally identifies the presence of abnormal cells suggestive of premalignant or malignant changes. The brush biopsy is usually used in the oral cavity as a minimally invasive method for determining whether or not atypical cells are present and whether a biopsy is indicted. Consequently, it is rarely used in diagnosis of DG since abnormal but non-malignant cellular changes are already suspected. In most instances the need for a conventional biopsy is self-evident in patients with DG. On occasion, however, a brush biopsy may be indicated, i.e., to differentiate between white lesions caused by hyperkeratosis and those associated with the plaque form of oral lichen planus. The brush biopsy also may occasionally be appropriate for patients who refuse a traditional biopsy or for severely medically compromised individuals who may not be able to tolerate a conventional biopsy.8

The value of using autofluorescence devices (Velscope, Identifi 3000, Oral ID) as a component of general dental/oral examinations has not yet been determined. Although there is some evidence that the devices may be helpful if there is suspicion that dysplastic or malignant changes have occurred, the devices may be of little value in DG diagnosis because inflammatory lesions often result in false positive findings indistinguishable from premalignant or malignant changes.27,109