ENHANCED ORAL ASSESSMENT

LOOK AGAIN

Neoplastic Lesions

Normal

Epithelium

Hyperplasia Dysplasia Carcinoma

In Situ

Invasive

Carcinoma

Squamous

Metaplasia

Stage I - IV

ORAL CANCER &

DYSPLASTIC PROGRESSION

Mild

Dysplasia

Moderate

Dysplasia

Severe

Dysplasia

Potentially Malignant Disease Stages

Ideal time for

discovery & intervention is in the Premalignant stages

Squamous Cell

Carcinoma

(SCC)

Carcinoma-In-Situ

(CIS)

TISSUE FLUORESCENCE AND

DYSPLASTIC PROGRESSION

Florescence intensity decreases with dysplastic progression.

Breakdown of Collagen Matrix

(prelude to invasion)

Collagen cross-links ↓

Micro-Vascularization

(recruitment of new blood

supply)

Inflammation

Blood absorption ↑ Nuclear back-scattering ↑

Fluorophores excited ↓

Metabolic Activity ↑

FAD ↓

Fluorescence ↓

Fluorescence ↓

Fluorescence ↓

Fluorescence ↓

PHOTO DOCUMENTATION SOLUTIONS

Digital Camera with Adaptor

SLR Camera with Adapter

VELscope Vx Camera System

SEE PREVENTION IN A NEW LIGHTVELscope Vx Camera System

• 12 megapixel Canon® digital camera

• USB cable for seamless connection to MAC and PC systems

• Memory card, battery charger and battery pack

• Quick twist on connection to VELscope Vx handpiece

• Preconfigured settings for hassle free start up

NORMAL FLOOR OF THE MOUTH

BILATERAL PRESENTATION

IS A GOOD THING

DYSPLASIA & ORAL CANCER

Images courtesy of the British Columbia Oral Cancer Prevention Program.

FLUORESCENCE VISUALIZATION

Copyright ® 2002-2007 by Oral Health Study, Oral Oncology/Dentistry, BCCA

Clinical Appearance

(Visible Under White Light)

Loss of Fluorescence

Carcinoma-In-Situ

(CIS)

PRE-CLINICAL DISCOVERY

Images courtesy of the Dr. Samson Ng.

Clinical Appearance

(Visible Under White Light)

Loss of Fluorescence

34 year-old male presents with ‗funny‘ feeling on palate

DYSPLASIA & ORAL CANCER

Images courtesy of the British Columbia Oral Cancer Prevention Program.

Clinical Appearance Loss of Fluorescence

Region of CIS is now clearly visible

Mild dysplasia

CIS

Mild dysplasia

SEVERE DYSPLASIA

ON ALVEOLAR RIDGE

Images courtesy of the University of Washington Oral Medicine Program.

Clinical Impression: Denture Trauma?

Inflammation resolved in 2 weeks

after removal of denture

Excisional Biopsy: Severe Dysplasia

Visible Leukoplakia Irregular, Dark Area

Images courtesy of the University of Washington Oral Medicine Program

Visible Leukoplakia Normal Fluorescence Pattern

Patient referred for biopsy.

Result: Negative.

Patient referred for biopsy.

Result: Severe dysplasia.

VELscope CAN ALSO

DISCOVER THESE CONDITIONS: • Lichen Planus

• Lichenoid mucositis

• Squamous Papillomas

• Candidiasis

• Viral and bacterial infections

• Inflammation from a variety of causes (e.g. trauma)

• Salivary gland tumors

Inflammatory Response & Trauma

Non-cancerous lesions where biopsy is

recommended for definitive diagnosis:• Erosive Lichen Planus

• Benign Mucous Membrane Pemphigoid (BMMP)

• Pemphigus Vulgaris

• Erythema Multiforme

• Non-resolving Traumatic Ulcer

• Tuberculosis Lesions

• Histoplasmosis

• Necrotizing Sialometaplasia

• Squamous Papilloma

• Verruca Vulgaris

• Verruciform Xanthoma

• Condyloma Acuminatum

• Focal Epithelial Hyperplasia

• Foreign Body Gingivitis

• Plasma Cell Gingivitis

• White Sponge Nevus

• Chronic Hyperplastic Candidiasis

• Actinic Chelitis

• Pyogenic Granuloma

• Peripheral Giant Cell Granuloma

• Peripheral Ossifying Fibroma

• Fibroma

• Epulis Fissuratum

• Mucocele

• Ranula

• Parulis

• Actinomyosis

• Lipoma

• Hemangioma

• Lymphangioma

• Neuroma

• Neurofibroma

• Lymphoid Hyperplasia

• Oral Lymphoepithelial cyst

• Gingival Cyst

• Chelitis Glandularis

• Benign Salivary Gland Neoplasm

• Drug-induced gingival hyperplasia

• Leukemic Gingival Infiltrate

• Kaposi‘s Sarcoma

• Melanocytic Nevus

• Melanotic Macule

19 OF THE 20

PATIENTS SHOWED

DYSPLASIA OR

CANCER BEYOND

THE CLINICALLY

VISIBLE LESION

Images courtesy of the British Columbia Oral Cancer Prevention Program.

Two consecutive years of screening everyone

(over 12 yrs old) in the practice. A decidedly

low-risk population, right?

Year ONE – Visible Light only:

– ZERO pre-malignant lesions found.

– ZERO ―success‖ rate with biopsy referrals.

– 25% ―success‖ rate with brush biopsy.

Year TWO – VELscope added to protocol:

– TEN pre-malignant lesions found.

– 83% ―success‖ rate with biopsy referrals.

– 100% ―success‖ rate with brush biopsy.

WITH TEN PRE-MALIGNANT LESIONS!

Study at TATA Memorial Hospital, Mumbai

In a recent study conducted at Tata Memorial Hospital (Mumbai), Velscope® was

used to obtain fluorescence images from 261 sites in the oral cavity from 76 patients

and 90 sites in the oral cavity from 33 normal volunteers. From the results of the

study, it was concluded that the performance of Velscope® which is a

simple, objective low-cost system has the potential to improve oral screening

efforts, especially in low resource settings.

Velscope Clinical Data – Early Stage

Cancer Diagnosis

JCDA

Sept 2007, Vol. 73, No. 7

Clin Cancer Res, Cancer Prev Res

Nov 2006, Vol 12, Issue 22 2009;2(5) May 2009

General Dentistry

Jan/Feb 2009

• Impressive new findings for VELscope Vx:

– Recent 620-patient study at

University of Washington

found

that 11.1% of patients had

lesions only detected by the

VELscope exam.

• In addition to oral cancers andprecancers, VELscope Vx waspowerful in detecting:

– Viral, fungal and bacterial

infections

– Inflammation – including

lichen planus, other lichenoid

reactions

– Squamous papillomas

– Salivary gland tumors

Results from 50 biopsies taken from areas

with loss of fluorescence in 44 patients

showed a sensitivity of 98% and specificity

of 100% for discriminating normal tissue

from severe dysplasia, carcinoma in situ or

invasive carcinoma, using histology as the

gold standard.

NEW CLINICAL STUDIES

• Impressive new findings for VELscope Vx:

– Recent 620-patient study at University of Washington found

that 11.1% of patients had lesions only detected by the

VELscope exam.

• In addition to oral cancers and precancers, VELscope Vx was powerful in detecting:

– Viral, fungal and bacterial infections

– Inflammation – including lichen planus, other lichenoid reactions

– Squamous papillomas

– Salivary gland tumors

VELscope ENDORSEMENTS

• June 30, 2010 – World Health Organization recognizes VELscope Vx as ―an innovative device‖ that addresses global health concerns.

– 1 of 8 commercial devices to be so honored.

– The only dental device to be honored.

• AGD – partnership with LED Dental / VELscope

– 12 oral cancer screening courses with CDE.

– Includes advertising for VELscope Vx.

• University of Washington study led by Dr. Ed Truelove

– Impressive new findings with use of VELscope Vx by GPs.

– Clear case for expanded/routine usage in clinical practice.

• Many NA teaching hospitals and over 100 thought leaders are ―VELscope lovers.‖

VELscope Vx

• Supporting Preventive Health Care

• Preserving Quality Of Life

• Improving Clinical Decisions

• Helping Build Dental Practices

• Maybe Even Saving A Life

A “Win-Win” For The Patient And The Practice

VELscope Vx

• There are many reasons to feel good about giving your patients regular enhanced oral soft tissue exams (featuring both white light and VELscope Vx screenings)

– You‘re taking actions that most practices aren‘t.

– You‘re giving your patients—and yourself—peace of mind.

– You‘re letting patients know that you care about their health.

– It won‘t disrupt your practice.

• The two exams take 5 minutes combined.

• The VELscope Vx exam is free of rinses, dyes and discomfort.

– You‘re using a proven adjunctive technology trusted for millions of

exams

– You‘ll significantly increase your bottom line.

– You‘ll reduce the risk of lawsuit.

– YOU JUST MIGHT SAVE A LIFE OR TWO!