by Karen Kaiser
Wandering around in the house at night can be painful. A person's perception is altered when they are sleepy, and unexpected obstacles may be overlooked. While walking in the dark, a person may stub their toe on the couch, promptly followed by stepping solidly on the Lego blocks. In the dark, everyday items become distorted, cast ominous shadows, and trick the mind into not seeing objects easily seen by day. It makes sense to place a nightlight in the house to see things and avoid mishaps.
Similarly, it makes sense to use the new detection device now available to help shed light on oral cancer. Vizilite, made by Zila Inc., augments the visual exam by precisely illuminating tissues with a glowing light stick which may improve identification, evaluation, and monitoring of oral changes.
When a patient has contributing risk factors for oral cancer such as age and smoking, consider integrating Vizilite into the oral examination. When evident areas such as red or white patchy abnormalities present clinically, using Vizilite as a precise screening will have a very high prediction value. When patients are offered this service, they appreciate the assurance that the evaluation was satisfactory at that visit. Incorporating this simple device chairside is non-invasive and painless. A positive Vizilite exam can uncover minor tissue abnormalities such as aphthous ulcers, cheek bites, and hyperkeratotic oral conditions that can be effectively treated, monitored for change, or observed for healing when the conditions present clinically.
Step into the light on cancer detection
When conducting an exam, pay very close attention to all aspects of the tongue both lateral and ventral, the soft and hard palate, attached gingiva, buccal mucosa and the floor of the mouth. These oral areas have been found to be high-risk sites for squamous cell carcinoma.
Using Vizilite is simple and painless, and all the needed supplies are conveniently found in one small kit. Before the test the patient should rinse briskly with a 1 percent acetic acid solution. The solution, which is a dehydration agent, will cut down on glare and decrease the surge of saliva. The acid rinse removes the glycoprotein layer of the mucosal. While the raspberry vinaigrette flavor may make patients think of that lunch salad, don't be fooled, it is bitter! Instruct patients not to swallow the solution.
The next step is to assemble the light stick, which contains a peroxyoxalate solution which glows when activated. The flexible chemiluminescent vial, which is brittle inside, should be snapped between the fingers and shaken, similar to the glow necklaces worn by kids at a carnival. The activated capsule should be inserted into the one-time use retractor wand and will be effective for 10 minutes. With the operatory lights off or dimmed, the wand should be placed orally so the hygienist can observe areas of acetowhite lesions.
I recently used Vizilite on a patient during his regular recare visit. He presented with bilateral hyperkeratotic tissues on the lower retromolar trigones. These areas were first discovered during his hygiene oral cancer exam. Further investigation showed marked wrinkle-white patchy lesions that were not evident at the last recare. The 40-year-old heavy smoker also reported an earache in his left ear, for which he had been taking antibiotics. He also reported pain which radiated down the left side of his neck. After completing his medication, the pain in his ear had not subsided and he chalked it up to bad sinuses and did not return to his physician. Two months had passed since he had finished his medication.
Concerned, he and I discussed the situation and screened the areas using Vizilite. Upon Vizilite illumination, the tissues appeared distinctly white. Keep in mind that abnormal epithelium tissue will reflect light while normal will not. Dense molecular mitochondrial matrix is generally detected in metabolic activity from cancer cells - the light source will "bounce off" of the dense nucleus. The consensus in the office was to refer him to the oral surgeon for evaluation and biopsy. The diagnosis revealed squamous hyperplasia and hyperkeratosis, a benign appearance. The patient was extremely grateful our office discovered the condition. He now has a manageable condition which we will monitor at recare visits.
After the fortunate results from the oral surgeon, the patient gained a new perspective and changed his lifestyle. He commented that it was time to cut down or quit the cigarettes. The narrow escape was a prime opportunity for our office to offer smoking cessation support. We prescribe Nicotrol inhalers or over-the-counter Nicoderm CQ patch, Nicorette cessation gum, and Commit lozenges, which has a step program for those wishing to become smoke-free. We told him the Web site www.committed quitters.com offers psychological support, behavioral modification, and enlightening resources for the smoker. This patient took the steps needed to break his unhealthy habit.
Armed with a glowing light source, hygienists can venture boldly into a dark cavity and see oral cancer that could not be seen before. Screening patients' tongues, mouths, lips and palates with Vizilite at recare appointments will reveal areas that show oral abnormalities of the vulnerable epithelial cells. Precancerous lesions or dysplastic cells can be illuminated and treated more easily and less invasively when found early. Used as a guiding light, Vizilite enhances the visual examination, removes possible patient screening obstacles, and sheds light on potentially harmful abnormalities.
The author did not receive compensation from Zila for product endorsement. For further information visit www.zila.com.
Karen Kaiser, RDH, graduated from St. Louis' Forest Park dental hygiene program in 1994 and currently practices at the Center for Contemporary Dentistry in Columbia, Ill. She has written several articles for RDH and other publications, sits on dental hygiene panels, and is an evaluator for Clinical Research Associates. She can be contacted at [email protected].