Fluorescence Visualization in
the “Normal” Mouth
Understand what a normal oral cavity looks like
•
under VELscope to best appreciate what may be
abnormal.
The attached gingiva and anterior tonsillar
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pillars, for example, often have a naturally
darker appearance.
Pigmented tissue appearing dark under white
•
light usually also looks dark under VELscope Vx.
Inflammation typically appears darker under
•
VELscope due to the excess blood content.
The oral cavity is naturally exposed to varying
•
degrees of chronic irritation and mild inflammation.
Due to inflammation, the buccal mucosa,
•
lateral surfaces of the tongue and hard palate
may sometimes show darker areas typically
characterized by poorly-defined borders.
Hyperkeratosis may often appear bright under
•
VELscope because of strong keratin fluorescence.
Blanching
Observe the suspicious, typically darker, area
•
through the VELscope Handpiece while applying a
light amount of pressure with the back side of an
explorer or similar instrument in a sweeping motion
to diffuse any blood from the area.
If the normal green fluorescence returns with this
•
pressure, then the lesion may have an inflammatory
component.
For some important considerations when
•
interpreting the effects of blanching, see the
VELscope Vx Training DVD.
Follow-up
If a suspicious area cannot be ruled out as benign,
•
it is usually appropriate to perform a follow-up
examination (typically in 2 weeks).
At this time, evaluate whether the suspicious area
•
has changed, especially if the presumed causative
agent has been removed.
If the suspicious area has not cleared up after
•
this follow-up time, use your clinical judgement
and proceed with further investigation according
to the regular standard of care (e.g. referral to a
specialist, etc.)
Surgical Biopsy – The Gold Standard
Remember: the gold standard for diagnosing
•
precancerous and cancerous lesions in the soft
tissues of the oral cavity is surgical biopsy.
A biopsy showing dysplasia is NOT a “false
•
positive”; discovering lesions early in the disease
development process allows for the highest
probability of a favourable treatment outcome.
Figure 1. VELscope Vx examination: The clinician shines the
blue excitation light into the patient’s oral cavity and looks
through the VELscope Handpiece
VELscope Vx Step-By-Step
Examination Guide
Characteristics that Increase Suspicion
of Dysplasia and/or Oral Cancer
Highly darkened appearance—strong loss of
•
fluorescence
High-risk location (e.g., lateral/ventral tongue)
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Unilateral presentation
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Asymmetry and/or irregular shape
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Extension over more than one kind of oral structure
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