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Description and technology regarding Orthodontic aligners 

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Description and technology regarding Orthodontic aligners 

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Orthodontic aligners are custom-made, removable thermoplastic trays that progressively move teeth by applying controlled forces. Each aligner is worn for 1-2 weeks and has a digital plan for the tooth movement stages. It works by exerting planned pressure from the plastic on the tooth surface. Treatment accuracy depends on material, attachment design, staging, and patient compliance. They are best suited for adults/teens with mild to moderate crowding, spacing, and certain bite issues.

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Description and information regarding Artificial Intelligence (Dentrix Detect AI)

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Description and information regarding Artificial Intelligence (Dentrix Detect AI)

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Dentrix Detect AI is an analysis tool that provides clinicians with clinical decision support when reviewing X-rays. I will help the clinician by flagging potential issues such as caries, bone loss, periapical problems, and calculus. It is fully embedded into Dentrix, so there is no need to take the images to another platform. With this being said, it also allows for better patient education by highlighting areas of concern.

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This article showed the accuracy of printed models by looking at different types of intraoral scanners and 3D printers. It resulted in all groups being similar. Printed and plaster models had some loss in trueness from the reference model, but it was within acceptable limits. The type of printer that was used resulted in the loss of the trueness, rather than which scanner that was used. It does support the use of the technology since it is able to produce those dental models accurately. It is just important that they pick a good printer.

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Description and information regarding Oral Irrigation

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Description and information regarding Oral Irrigation

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Oral irrigation uses a stream of pulsating water to clean between teeth and below the gumline. This helps flush away food debris and loose plaque. It also helps reduce gingival bleeding and inflamation. Oral irrigation improves compliance and comfort compared to traditional flossing. Oral irrigators are very useful for those who have periodontal diseases, orthodontic patients, patients with restorations, and those with limited dexterity.

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Description and Information Regarding Oral Microbial Testing (Oral DNA)

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Description and Information Regarding Oral Microbial Testing (Oral DNA)

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Oral microbial testing allows the dental team to test the patient’s saliva to see if there is disease present by looking at the different levels of bacteria present. Doing so allows the clinician to create a more tailored care plan for the patient to help the patient achieve a healthy level of bacteria in the oral cavity.

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This article compared three 3D printing techniques, which were SLA (stereolithography), DLP (digital light processing), and PolyJet. It resulted in all three printing models being clinically acceptable. PolyJet had the smallest deviation. This article supports the use of this technology since the 3D printing of the models from intraoral scanners was accurate enough for dental practices.

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This article used 256 volunteers and with the microbial testing they were able to distinguish the difference between health and diseased. With that being said, this article supports the use of oral microbial testing.

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Description and Information Regarding the NOMAD. 

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Description and Information Regarding the NOMAD. 

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The NOMAD is a handheld, portable X-ray system that allows for greater mobility between office locations, unlike traditional wall-mounted units. It lacks the traditional safe zone that a wall-mounted unit offers; so, the NOMAD features a built-in shield and backscatter guard to protect the operator from radiation exposure. To ensure the operator receives the maximum protection possible, additional training is beneficial. The devices also eliminates tube head movement and reduces patient movement, therefore reducing the number of retakes required and decreasing the amount of radiation the patient receives. There are also safety features in the devices to stop accidental exposures. The devices must be carefully handled, as they cannot be left on the charger after they are fully charged. Additionally, they must be inspected if dropped.

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https://pmc.ncbi.nlm.nih.gov/articles/PMC7985112/pdf/11282_2020_Article_434.pdf

The study's goal was to determine if the NOMAD was able to acquire comparable images to those of wall-mounted units. The result of this study was that the NOMAD was able to achieve images comparable to those from a wall-mounted unit. Although, the article did mention a learning curve associated with using a handheld X-ray unit.

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Summary: This study assesses the operator's radiation exposure when using the Normad Pro 2. They measured scatter radiation to determine the Control Area (CA) where exposure risk is significant. The CA was smaller then standard-regulated areas. A compact CA makes it easier to maintain safe operator stance. The Nomad Pro is safe for operator use when following protocol. Device handling, proper posture, and shield positioning are important to minimize exposure.

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Summary: This study is meant to evaluate the image quality between the Nomad Pro 2 and a standardized wall-mounted X-ray unit. It did state that there was no signifcant differences in the diagnostic clarity, contrast, or spatial resolution between them. I found this information valuable since it is good to know that the image quality was comparable and that both are able to take diagnostic bitewings.

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Description and information regarding  myofuntional therapy and myobrace

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Description and information regarding  myofuntional therapy and myobrace

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Myofunctional therapy is a rehabilitative exercise-based therapy for the muscles of the face, tongue, lips, and oropharynx. It works by targeted daily exercises and re-educates breathing and swallowing patterns. Myobrace is designed to work early in mixed dentition to intercept developing malocculsions. This can help correct bad oral habits and guide jaw/arch development. It can be worn overnight and for a couple of hours during the day. By correcting these habits early, one reduces the forces that cause malocclusion.

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1.) Fewer retakes due to the elimination of tube head movement and a lower chance of patient movement.

2.) The device is portable, so it allows movement from operatory to operatory or even to different offices. With this being said, it can be more cost-effective because it eliminates the need to install wall-mounted units in every office/location.

3.)It has safety measures installed to stop accidental triggering of image capturing.

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1.) Loss of protective zone from radiation if the device is not parallel to the patient.

2.) Unable to leave the device on the charger after it is fully charged.

3.) Need for careful handling and moving because if the device is dropped, it has to be sent in for inspection to make sure the device is not damaged.

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The NOMAD Pro 2 costs around $6,000 (less or more, depending on sales and where the device is purchased from). You may also buy accessories, such as positioning aids and stands, but they are not necessary for the device's function.

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This article was a systematic review that looked at the salivary biomarkers of periodontal disease to look at how accurate they were at predicting disease. It concluded that there is a benefit in using salvia to find biomarkers to help better determine disease activity and progression. This review does support oral microbial testing, although it does state that it is only preliminary and needs further validation before study can completely be done at a clinical level.

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This study compared two different salvia test for bacteria. One that measures live bacteria and the other that measured all bacteria. The test concluded that that the test that measured live bacteria had clear indicators that periodontal therapy was working. With this being said, a test that is measuring live bacteria is more beneficial to help the clinician know if the treatment is working for the patient.

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1.) It allows the dental team to make a more personalized treatment for the patient. This is because the test enables the clinician to identify the specific microbes involved, which in turn allows for a more tailored treatment for the patient.

2.) It is highly beneficial to patient education because it allows the patient to have a representation to understand better the microbes in the mouth and how they are involved in other systemic conditions, what their current levels are, and how the dental team can help them manage the microbial levels.

3.) It can also help with disease management. This is because it allows the clinician to see if the microbial levels are decreasing or not.

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1.) It is not always necessary and realistically would only be a necessary tool to use for uncontrolled periodontal disease. This is because more traditional methods like SRP and perio maintenance may be all the patient needs to control the disease. For patients with unmanaged periodontitis, this tool enables clinicians to better understand the microbes involved in the disease.

2.) These results are not done in the office, so there will be a few days until the results are ready to be interpreted.

3.) Cost will have to be considered because it is around $100 and will either have to be expended by the office or the patient.

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This study is trying to determine the loss of dimensional accuracy between CBCT, intraoral scanning, and model scanning. The model scanner and intraoral scanner provided accurate data with small shrinkage. CBCT does have a larger loss of dimensional accuracy and should be used with caution. This article supports the use of intraoral scanners since both the intraoral scanner and model scanner were reliable enough when doing implant-guided surgery.

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Lab fee - $100 ($20 discount if there is a post test within 365 days). Most offices are charging around $150-$200. The coverage from insurances are limited.

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This article compares once-daily water jet flossing and interdental flossing. Both groups showed significant improvements in gingival bleeding and plaque accumulation. They recommend further research on long-term oral benefits for orthodontic patients. This article supports the use of water jet flossing since it supports it being an effective adjunct compared to interdental flossing.

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This article compares the daily use of an ultrasonic water irrigator versus dental floss. This article concludes that both the ultrasonic water irrigator and dental floss are effective adjuncts to brushing in reducing plaque, bleeding, and gingival inflamation. The water irrigator was able to significantly improve gingival inflamation and bleeding by week 4. This article supports the use of oral irrigators. It shows evidence of using an ultrasonic water irrigator is better in terms of reducing gingival inflammation and bleeding.

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Int J Dental Hygiene - 2024 - Bissett - An Evaluation of a New Ultrasonic Water Irrigator in the Management of Gingival

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This article compares the effectiveness of a water flosser versus an interdental brush, both used with manual toothbrushing. Those who have moderate gingivitis, water flossers are proven to be more effective than interdental brushes at reducing both marginal and pocket bleeding over 4 weeks. This article supports the use of water flossers as a potentially superior adjunct to brushing compared to interdental brushes.

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Int J Dental Hygiene - 2024 - Mancinelli‐Lyle - Efficacy of a water flosser compared to an interdental brush on gingival

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1. It is easier for patients with limited dexterity. It can be helpful for those who have arthritis, braces, or difficulty with flossing. There are pressure settings that can be adjusted for sensitive gums. Some may find it more comfortable and less irritating compared to string floss.

2. It reduces gingival bleeding and inflammation. Oral irrigation can reduce gingival inflammation and bleeding compared to brushing alone. The water can reach up to subgingival areas, flushing the bacteria out that string floss can't always reach.

3. It has periodontal and orthodontic benefits. It is beneficial for periodontal maintenance patients since it can flush out bacteria from hard-to-reach areas. For orthodontic patients, it can effectively remove food and plaque around bands, brackets, and wires.

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1) Patients may be concerned with the cost or messiness of an oral irrigator. It can be more expensive than buying regular floss. Tips also need to be replaced every 3-6 months. Using it can be messy when the technique isn't right or the pressure is too high.

2) There is limited reach in very deep pockets. It can penetrate 50% depth of pockets.

3) The water can flush the debris and reduce bacteria in the mouth. It does not scrape plaque off tooth surfaces the way floss or interdental brushes do.

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$40-$100+

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There are lots of water flosser options. There are some on amazon, walmart, target, etc. They can vary in water pressure and settings. There is more advanced pulsation technology on some higher-end devices. There are cordless ones or countertop flossers as well.

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How to Use the Waterpik™ Ultra Water Flosser

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1.) Improves patient comfort by eliminating the need to take impressions.

2.) Allows for better storage by being able to store the models digitally rather than having to store physical stone models.

3.) Reduces the amount of time the clinician needs to spend to produce a model.

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1. Initially, purchasing the scanner, printer, and necessary materials to make the models is expensive.

2. You need to have additional training for the staff to use both the scanner and the printer effectively.

3. Maintenance for both the scanner and the printer can be expensive and may disrupt clinic workflow.

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An intraoral scanner ranges from around $5,000 - $50,000, depending on the brand and features they offer.

A 3D Printer ranges from around $2,500 - $25,000, again depending on the brand and features they offer.

Other materials like resin cost around $80 - $800 per liter, depending on the type you may need for what is being done in the office. With this being said, it will cost an office around $2 - $10 per model.

Additional items like a washer and a curing unit may be needed. A washer costs around $100 - $5,000, depending on the brand and features; and a curing unit costs around $100 - $30,000, depending again on the brand and features it has to offer.

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Description and Information regarding Intraoral scanners and 3D printers

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Description and Information regarding Intraoral scanners and 3D printers

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An intraoral scanner is a handheld device that is used to create 3D models of a patient's teeth, oral structures, and gingiva by capturing images and projecting light. Key features include a structured light and high-resolution, colored 3D images. This is the alternative to using impression materials like alginate to create 3D models. It is more comfortable for patients and provides immediate visualization for treatment planning.

3D printers use digital impression information that is typically from an intraoral scanner. Then the 3D printer uses either a light or laser to cure the liquid resin, which can help build the model one layer at a time. They are typically used for study models, restorations, orthodontic devices, surgical guides for implant placement, and denture bases. 3D printers have high accuracy, faster production, and digital storage.

Overall, intraoral scanners are used to capture the patient's mouth int a 3D model and 3D printers use that digital data to create dental restorations and appliances.

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1. The myobrace can help correct tongue posture, swallowing, and mouth breathing.

2. It is not as invasive as traditional orthodontics.

3. It can be started earlier than traditional orthodontics, which can help guide jaw growth helping reduce the need for future orthodontic intervention.

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1.) It requires a lot of patient compliance, this is because of the time the device must be worn and the exercises that must also be completed.

2.) The device is not as accurate or quick in tooth movement as traditional orthodontics is. With this being said, some patients may still need orthodontic intervention in the future.

3.) This device has a limited availability as many orthodontist and general dentist are not trained in how to use the myobrace.

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This article is a systematic review that examined various articles to assess the benefits of Myobrace. This review found that the Myobrace could be used to help treat malocclusion in children. It also showed benefits in helping to correct overbite, overjet, crowding of the upper and lower anterior teeth, sagittal molar relationships, lip seals, and facial asymmetry. With that being said, this article does support the use of the Myobrace, but more so for children rather than adults.

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Management of Malocclusion in Children Using... | F1000Research

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Class II malocclusion is common in children, and early intervention can be more effective during their growth phase. Myofunctional appliances like Myobrace and Twin-Block are used to correct Class II. This article aims to compare the effectiveness of both Myobrace vs Twin-block in children. Both of them can reduce overjet significantly. Myobrace tends to work more dentoalveolarly, and Twin-Block produces greater skeletal changes. Myobrace does support the correction of Class II malocclusion for milder cases. Twin-blocks are more for people with a greater need for skeletal correction. This article supports the use of Myobrace to reduce overjet and help with profile improvements.

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This article looked at children ages 5-10 and evaluated how Myofunctional therapy and the Myobrace affected craniofacial development. It has three different groups: mouth breathers with Myofunctional therapy and Myobrace, mouth breathers with no treatment, and nasal breathers with no treatment. This study found that the patients with no treatment experienced increased lower facial height, more forward-tilted incisors, overjet, overbite, and malocclusion that worsened over time. In patients with Myofunctional therapy and the Myobrace saw improved tongue/lip posture, nasal breathing, overjet described, overbite increased, the jaw grew forward, and maxillary width improved. What this means is that the Myobrace and exercises helped children who were mouth breathing grow more normally.

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The cost of the Myobrace in Minnesota is around $2,500 - $5,500 for the patient. The price varies depending on the office and the complexity of the case.

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Description and information regarding Oral Cancer Screening Devices

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Description and information regarding Oral Cancer Screening Devices

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The VELScope is a handheld device that emits blue-violet light. Normal oral mucosa contains NADH, FAD, and collagen that fluoresce green under this light. The diseased tissue/early cancer often shows that it appears darker because of structural changes. This is used as an adjunct to Conventional Oral Examination. If there are positive findings, then they should be documented, monitored, and referred to be biopsied. The procedure is quick and painless.

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Description and information regarding Oral Cancer Screening Devices

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1. It is non-invasive and quick to apply in chairside screening.

2. It helps detect areas that may be missed on regular screenings.

3. Enhance early detection of oral cancer and other tissue abnormalities.

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1. It is not lesion-specific so inflammation, trauma, and benign lesions can mimic loss.

2. It does not replace biopsy/histopathology for diagnosis.

3. It shows that interpretation is subjective and show exams can vary.

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VELscope Vx- $2,300-3,000 for a new unit, OralID- $995. Cost per patient is typically $15-$65. There are also separate costs for disposables, training, and maintenance.

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This review shows that adding autofluorescence to a standard oral exam can increase how many suspicious lesions you detect. It is more likely that you will end up getting false positives like benign tissues that is flagged as suspicious. This technology is better thought of as a tool to help guide us during exams. We must still rely on our clinical judgement and pathology. This article does support the use of this technology since it makes it clear that it should be used as an adjunct tool and not replacing an oral exam or biospy.

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1.) Improves detection for things like caries, calculus, periapical radiolucency, and bone loss. It will help reduce the risk of the clinician from missing things and help stop overdiagnosing.

2.) It helps with patient communication because it highlights the findings so the patient can visually see and understand.

3.) It helps remove subjectivity because it can help the dentist confirm if they are unsure.

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1.) It is not able to diagnose on its own, and clinical judgement is still needed, as it is not 100% accurate.

2.) If the X-rays have a poor image quality, it can reduce how accurate the software is.

3. Patients may not trust AI in assessing their X-rays.

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The purpose of this article is to quantify the diagnostic accuracy of autofluorescence imaging for oral lesions. Autofluorescence imaging has a good potential as a screening tool for detecting lesions early and helping rule out diseases. It is not good enough to replace histopathology or clinical examination since the positive findings don't always indicate disease. These tests encourage further standardization, better training, and can combine with other imaging devices to improve specificity. This article supports the use of the AF imaging since it shows that it is more useful in settings with well-controlled conditions.

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Abstract

Presently, various studies had investigated the accuracy of autofluorescence in diagnosing oral squamous cell carcinoma (OSCC) and oral potentially malignant disorders (OPMD) with diverse conclusions. This study aimed to assess its accuracy for OSCC and OPMD and to investigate its applicability in general dental practice. After a comprehensive literature search, a meta-analysis was conducted to calculate the pooled diagnostic indexes of autofluorescence for premalignant lesions (PML) and malignant lesions (ML) of the oral cavity, lung, esophagus, stomach and colorectum and to compute indexes regarding the detection of OSCC aided by algorithms. Besides, a u test was performed. Twenty-four studies detecting OSCC and OPMD in 2761 lesions were included. This demonstrated that the overall accuracy of autofluorescence for OSCC and OPMD was superior to PML and ML of the lung, esophagus and stomach, slightly inferior to the colorectum. Additionally, the sensitivity and specificity for OSCC and OPMD were 0.89 and 0.8, respectively. Furthermore, the specificity could be remarkably improved by additional algorithms. With relatively high accuracy, autofluorescence could be potentially applied as an adjunct for early diagnosis of OSCC and OPMD. Moreover, approaches such as algorithms could enhance its specificity to ensure its efficacy in primary care.

The global incidence rate of oral cancer is 8.2 per 100,000 annually for males and 2.8 per 100,000 annually for females ¹. More than 90% of oral cancers are oral squamous cell carcinomas (OSCCs), which are one of the most common malignant tumors and are more prevalent in South-Central Asia and in Central and Eastern Europe¹,². Owing to the unapparent symptoms in early stages and delayed diagnosis³,⁴, OSCC tends to be detected at advanced stages with high mortality, accounting for approximately 300,000 cases of OSCC and 145,000 deaths in 2012¹². Despite treatment advancements, the 5-year survival rate for OSCC patients has remained poor over the past three decades⁵. However, if OSCC is diagnosed early (stage I-II) and effective treatment is administered, a 5-year survival rate of approximately 80% is obtainable compared with only 20% for those detected at advanced stages (stage III-IV)⁵. Therefore, early detection is crucial to help improve the survival rate of OSCC⁶.

Usually, patients initially present to general dental practice when they have oral discomfort. Thus, as frontline health workers, general dentists bear the responsibility for early screening of oral abnormalities⁶. Furthermore, dental practitioners play a vital role in making correct decisions about the lesions, by which unnecessary or delayed referrals could be avoided and the mortality of OSCC could be considerably reduced⁵,⁷,⁸. In most cases, OSCC is preceded by oral potentially malignant disorders (OPMD) such as oral leukoplakia and oral submucous fibrosis⁹,¹⁰, so the early detection and management of epithelial dysplasia in OPMD is an important preventative step against malignant transformation¹¹; Moreover, since dysplastic and neoplastic lesions of the oral cavity are readily accessible and the mucosal changes are frequently visible, OSCC and dysplasia are both promising candidates for routine screening⁵. According to one large population-based study in India, periodic visual screening of the oral cavity has contributed to a reduction of 32% in mortality during a period of 9 years. Therefore, dentists are encouraged to commit to OSCC screening as a routine daily practice¹².

The current guideline for detecting OSCC and OPMD recommends a conventional oral examination (COE), which involves visual examination and tactile palpation under white light¹¹. A Cochrane review stated that insufficient evidence was suggested for the application of COE in OSCC screening programs within a low-risk population¹³; a systemic review also illustrated the ineffectiveness of COE in detecting dysplasia and OSCC¹⁴. One main limitation is the possible inability of general dentists to differentiate between benign and high-risk lesions, as early stage of advanced lesions may not present with typical features⁷. Apart from COE, tissue biopsy is only suggested for clinically suspicious lesions¹⁵. Although histological biopsy is recognized as the gold standard for the diagnosis of OSCC and dysplasia in OPMD, it is invasive, time-consuming and painful¹⁶.

Given the concerns about COE and biopsy, alternative methods should be developed for the early identification of OSCC and OPMD, particularly for the primary care⁵,¹⁷. As is reported, the wide application of exfoliative cytology in the early diagnosis of cervical cancer has decreased its mortality remarkably¹⁸. Hopefully, analogous early diagnostic tools with high accuracy could be applied to relieve the global disease burden of OSCC. Currently, various non-invasive diagnostic methods have emerged⁸. As a novel approach for early cancer diagnosis and a representative light-based detection system, autofluorescence is a non-invasive, convenient and real-time device¹⁶,¹⁹.

In an attempt to apply autofluorescence in the inspection of premalignant lesions (PML) and malignant lesions (ML), understanding the biological basis of autofluorescence is indisputably essential. In brief, the diagnostic potential of autofluorescence lies in the ability to probe alterations in tissue structure and metabolism that occur during malignant progression¹⁰. When normal tissue is illuminated by the excitation light of certain wavelength, some molecules in the tissue, called fluorophores, would absorb photons and emit lower energy photons that could be detected as fluorescence from the mucosal surface²⁰. And the dominant fluorophores, responsible for autofluorescence signals, include reduced nicotinamide adenine dinucleotide (NADH) and flavin adenine dinucleotide (FAD) in the epithelium together with collagen matrix and elastin in the stroma²⁰. However, in PML and ML, loss or weakening of autofluorescence would appear, mainly attributed to the breakdown of collagen matrix and elastin and the altered metabolism (decrease of NADH and FAD) during neoplastic progression¹⁰. Further, other metabolic or structural alterations in PML and ML are also associated with the loss or alteration of autofluorescence. Specifically, accumulated porphyrins might lead to an increased red fluorescence in addition to changes in the green one²⁰; besides, massive heme formed by the porphyrins, and the structural changes (epithelial thickening, increased nuclear size, hyperchromatin and increased microvascularity) would contribute to the increased absorption and/or scattering of light, eventually reducing the detectable autofluorescence¹⁰,¹⁹,²¹.

Over the past three decades, the accuracy of autofluorescence has been widely evaluated in the diagnosis of OSCC, lung cancer (bronchiogenic carcinoma), esophageal cancer, stomach cancer, colorectal cancer and PML¹⁶,²²,²³,²⁴,²⁵, with PML representing dysplastic or neoplastic lesions²¹,²⁶,²⁷. After confirmation of its reliability, some autofluorescence technology such as LIFE has been used for routinely endoscopy²⁸. However, inconsistent conclusions have been reached in various studies exploiting different autofluorescence technology.

In previous studies, Lane et al. had achieved relatively high diagnostic accuracy of autofluorescence when used a simple device for visualisation of oral-cavity fluorescence²¹, while Farah et al. obtained an opposite result aided by a representative of autofluorescence termed the Visually Enhanced Lesion Scope (VELScope; LED Dental, Vancouver, BC, Canada)²⁹. Interestingly, Roblyer et al. developed an algorithm with autofluorescence to detect OSCC and OPMD with ideal sensitivity and specificity, implying the potential role of an additional algorithm for improving the accuracy of autofluorescence²⁰. One systemic review on the use of autofluorescence to diagnose OPMD and OSCC has implied that it was more suitable for specialist clinics than for primary care³⁰. In addition, a recent Cochrane review appraised the diagnostic accuracy of light-based detection for OPMD and OSCC, and its sensitivity and specificity were estimated as 0.91 and 0.58, respectively. They reported that there was a lack of evidence to support the replacement of histological biopsy by light-based detection combined with COE³¹. However, only 5 of those studies were about autofluorescence and their inclusion criteria was different from our study.

Thus far, although community dentists are in greater need of a screening tool for OSCC and OPMD, a limited number of studies have been performed to evaluate autofluorescence for routine screening based on the general population. Huff et al.³², as the first to report the efficacy of autofluorescence for screening in a community practice setting, showed that there was higher yield of mucosal abnormalities for VELscope than COE, and 83% of these abnormalities found by VELscope were epithelial dysplasia. Conversely, McNamara et al.³³ concluded that COE was more valid than the VELscope findings since the FP of VELscope remain a concern in general practice. Nevertheless, several studies have demonstrated the effectiveness of autofluorescence in discerning OSCC or dysplastic lesions from clinically innocuous lesions that were missed by COE²⁹,³⁴. Moreover, aiming at overcoming the low specificity of autofluorescence, two studies have integrated autofluorescence into decision-making protocols for general dentists with encouraging outcome¹⁷,³⁵.

As distinct conclusions are made by numerous studies about the accuracy of autofluorescence for OSCC and OPMD and its applicability in general practice, a more thorough study is needed. In this study, based on a meta-analysis and the u test method, by making a comparison with other common aero-digestive PMLs and MLs and calculating the pooled diagnostic indexes of autofluorescence for the 5 aforementioned parts, we attempted to evaluate the overall diagnostic accuracy of autofluorescence for OSCC and OPMD and discuss its applicability as an adjunct in general dental practice. Further, a contrast of using autofluorescence alone or with proper algorithms for OSCC and OPMD was performed to appraise the impact of additional algorithms. To the best of our knowledge, no study on this issue has been previously conducted.

Materials and Methods

Search strategy and study selection

Two reviewers (X. Luo and H. Xu) independently conducted a literature search using the electronic databases PubMed, Ovid Medline and Embase (updated to November 18, 2015). There was no language restriction, and we mainly focused on English literature. The search terms were listed below: "Autofluorescence" or "spectrometry, fluorecence" or "VELscope"and "Leucoplakia, Oral" or "precancerous conditions" or "Mouth Neoplasms", "Autofluorescence" or "spectrometry, fluorecence" and "precancerous conditions" or "lung neoplasms" or "stomach neoplasms" or "esophageal neoplasms" or "colorectal neoplasms". The reference lists of all of the included studies were also searched for possible inclusion. The inclusion criteria used in the selection of literature for our study were as follows: (1) Adopting VELscope or other autofluorescence tools alone or with algorithms as diagnostic tools of OPMD and OSCC, and utilising autofluorescence tools alone or with algorithms for the diagnosis of PML and ML of the lung, esophagus, stomach, or colorectum; (2) lesions of the study population were clinically diagnosed as PML or suspicious ML of the oral cavity, lung, esophagus, stomach, or colorectum; (3) histological results are the gold standard for diagnosis, and positive histological findings should include mild to moderate to severe epithelial dysplasia or mucosa low-grade to high-grade neoplasia, carcinoma in situ, or a malignant tumor. Otherwise, these results should be defined as negative histological results; (4) only original clinical trials of human would be included; (5) providing sufficient data to construct a 2 × 2 table to calculate the sensitivity and specificity.

Data extraction and quality assessment

Data extraction was performed by the same reviewers ((X. Luo and H. Xu)) independently. Any discrepancies were resolved by discussion with a third author (Q. Chen). The following data were collected from each study: First author's name, publication year, country, tumor type, sample size, true positive (TP), false positive (FP), false negative (FN), true negative (TN), sensitivity, and specificity. Initially, the standards for reporting diagnostic accuracy (STARD) is utilised to evaluate the methodological quality of the included studies³⁶,³⁷. Moreover, the quality assessment for studies of diagnostic accuracy (QUADAS-2) tool, as another powerful quality-assessing tool, was applied to evaluate the risk of bias and applicability concerns of these included studies in 4 key domains of patient selection, index test, reference standard, and flow and timing³⁸,³⁹.

Statistical analyses

The standard statistical methods, recommended for meta-analysis of diagnostic test evaluations, were used for assessing the accuracy of autofluorescence for detecting PML and ML of the oral cavity, lung, esophagus, stomach and colorectum and evaluating the accuracy of using autofluorescence alone or with algorithms for OSCC and OPMD. Upon TP, FP, FN, TN results derived from each original study, the following indexes regarding the diagnostic accuracy of autofluorescence for PML and ML of a certain area of the body were calculated for the according study: sensitivity (Sen), specificity (Spe), positive likelihood ratio (PLR), negative likelihood ratio (NLR) and diagnostic odds ratio (DOR)⁴⁰. Then, aimed to calculate the pooled estimates of sensitivity and specificity, together with their 95% confidence intervals (CI), and present sensitivity and specificity more intuitively, the forest plots were plotted, each segment representing the effect size and confidence intervals of every study in the coordinate system⁴⁰. Similarly, the pooled PLR, NLR and DOR were computed by depicting their forest plots. The threshold effect, usually arising when different cut-off points are applied to define a positive result of a diagnostic test among the included studies, was detected by calculating the Spearman's correlation coefficient based on the aforementioned sensitivity and specificity, with p < 0.05 indicating existence of threshold effect⁴⁰. If threshold effect is implied, Hierarchical summary receiver operating characteristic (HSROC) curves, based on sensitivity and specificity of autofluorescence for every site, could be depicted, with a hope to characterize the overall diagnostic performance of autofluorescence for each anatomical site by computing the area under the curve (AUC)⁴¹. Moreover, the wind rose, a frequently used chart in meteorology, was taken as a reference to reflect the overall diagnostic accuracy of autofluorescence among PML and ML of the oral cavity and the other 4 parts more intuitively, containing the 6 indexes (pooled Sen, Spe, PLR, NLR, DOR and AUC) calculated above. Besides, the maximum values of the 6 indexes were all standardized as 1 to allow a plain understanding of these results. Specifically, in terms of each diagnostic index except for NLR, farther distance from the center of the wind rose means higher accuracy, while it is just the opposite for NLR. To contrast a certain index of autofluorescence among PML and ML of the 5 body parts and to compare the diagnostic index of applying autofluorescence alone or with algorithms, a u test was administered⁴². Then, Bonferroni was adopted as a correction to reduce I type error, and the inspection level was 0.0125 and 0.05, respectively⁴³.

The chi-squared-based Q test and the inconsistency index I 2 were used to calculate the inter-study heterogeneity⁴⁴,⁴⁵. Heterogeneity among studies would be suggested when the Q test was significant ( p < 0.05) or I 2 > 50%; thereafter, the random-effect model (DerSimonian-Laird method) would be chosen to conduct the meta-analysis. Otherwise, the fixed-effect model would be selected⁴⁴,⁴⁵. Meta-regression was then administered to investigate the source of observed heterogeneity⁴⁰.

Besides, Begg's funnel plot and Egger's test were used to test publication bias and each circle in the funnel plot means one study, with symmetrical inverted funnel in the chart representing none publication bias and asymmetrical one signifying publication bias⁴⁶,⁴⁷.

All of the analyses were performed using the following statistical software programs: STATA 11.0 (Statacorp, Texas, USA) and Revman 5.0 (The Cochrane Collaboration). All tests were two-sided, and p  < 0.05 was considered statistically significant.

Results

Quality of reporting and study characteristics

We found 194, 197, 61, 46, and 117 articles that applied autofluorescence to diagnose OSCC, lung cancer, esophageal cancer, stomach cancer and colorectal cancer, respectively, with an available PML. After identifying the titles and abstracts, a full-text assessment, and strict filtering according to the inclusion criteria, the corresponding numbers of included studies were 24,¹⁶,¹⁹,²⁰,²¹,²⁹,⁴⁸,⁴⁹,⁵⁰,⁵¹,⁵²,⁵³,⁵⁴,⁵⁵,⁵⁶,⁵⁷,⁵⁸,⁵⁹,⁶⁰,⁶¹,⁶²,⁶³,⁶⁴,⁶⁵,⁶⁶ 25,²²,⁶⁷,⁶⁸,⁶⁹,⁷⁰,⁷¹,⁷²,⁷³,⁷⁴,⁷⁵,⁷⁶,⁷⁷,⁷⁸,⁷⁹,⁸⁰,⁸¹,⁸²,⁸³,⁸⁴,⁸⁵,⁸⁶,⁸⁷,⁸⁸,⁸⁹,⁹⁰ 12,²³,⁹¹,⁹²,⁹³,⁹⁴,⁹⁵,⁹⁶,⁹⁷,⁹⁸,⁹⁹,¹⁰⁰,¹⁰¹ 9,²⁴,¹⁰²,¹⁰³,¹⁰⁴,¹⁰⁵,¹⁰⁶,¹⁰⁷,¹⁰⁸,¹⁰⁹ and 19,²⁵,¹¹⁰,¹¹¹,¹¹²,¹¹³,¹¹⁴,¹¹⁵,¹¹⁶,¹¹⁷,¹¹⁸,¹¹⁹,¹²⁰,¹²¹,¹²²,¹²³,¹²⁴,¹²⁵,¹²⁶,¹²⁷, respectively. The search and selection process were described as a flow diagram in Fig. 1 and Supplementary Fig. S1. A summary of the main characteristics of the included diagnostic studies was presented in Table 1 and Supplementary Table S1. All of the research that used autofluorescence for OSCC and OPMD were prospective studies, while for studies detecting the PML and ML of the lung, esophagus, stomach and colorectum, only 1, 1, 1, and 1 study was found to be a retrospective study⁹⁰,⁹⁹,¹⁰⁵,¹²⁵. Most of the studies treated autofluorescence loss or color change as a positive result, whereas 8, 5, 4, and 9 studies on the detection of PML and ML of the oral cavity, esophagus, stomach and colorectum, respectively, applied algorithms to discriminate positive or negative results.

Figure 1. Flow diagram shows the selection process of eligible articles that applying autofluorescence to diagnose OSCC and OPMD.

OSCC: oral squamous cell carcinoma; OPMD: oral potentially malignant disorders.

As for the reporting quality of the diagnostic studies, the STARD scores of the corresponding 24, 25, 12, 9, and 19 studies were all ≥17 and were of relatively high quality. Aimed to further assess the quality of the diagnostic trials, the QUADAS-2 tool was used. Based on these studies, each of the 7 components was graded as "low risk of bias" (LR), "unclear risk of bias" (UR), "high risk of bias" (HR) and "low concern" (LC), "high concern" (HC), and "unclear concern" (UC). Among the 24 studies for OSCC and OPMD, HR results of patient selection were yielded in 8 studies, 6 of the 8 reports were associated with high-risk patients who were histologically diagnosed as OSCC¹⁶,²¹,⁵⁰,⁵³,⁵⁷,⁶⁰. In terms of the remaining 6 components for OSCC and OPMD, LR, UR, LC and UC were generally displayed. Overall, the qualities of these studies were shown in Table 2 and Supplementary Table S2.

Diagnostic accuracy of autofluorescence for OSCC and OPMD

To assess the diagnostic accuracy of autofluorescence for OSCC, lung cancer, esophageal cancer, stomach cancer and colorectal cancer and their PML, Fig. 2 and Supplementary Fig. S2 showed the forest plots of the pooled sensitivity and specificity of the corresponding 24, 25, 12, 9, and 19 studies; moreover, the forest plots of sensitivity and specificity on the use of autofluorescence alone or with algorithms for OSCC and OPMD were also depicted in Supplementary Fig. S3 and S4, respectively. Analogously, the pooled PLR, NLR and DOR were achieved by the same methods.

Figure 2. Forest plots of sensitivity and specificity of studies that employing autofluorescence in the diagnosis of OSCC and OPMD.

The solid circles indicate estimates of sensitivity and specificity for each study, and the size of each solid circle represents the sample size of each study. The error bars are 95% confidence intervals. OSCC: oral squamous cell carcinoma; OPMD: oral potentially malignant disorders.

Comprehensive evaluation of diagnostic performance of autofluorescence for OSCC and OPMD

After computation of Spearman's correlation coefficient upon the sensitivity and specificity of according studies, existence of threshold effect (all p < 0.05) was generally revealed in studies with regard to diagnosis of the 5 various body sites. Thus, the HSROC curves were depicted in Fig. 3 and Supplementary Fig. S5. As a descriptive index of the HSROC curve, AUC, pertaining to the overall diagnostic accuracy of autofluorescence for the various area of body, were computed based on the curves.

Figure 3. Hierarchical summary receiver operating characteristic curve (HSROC) of studies utilising autofluorescence for the detection of OSCC and OPMD.

Each empty circle represents one study, and the size of every circle indicates the sample size of each study. OSCC: oral squamous cell carcinoma; OPMD: oral potentially malignant disorders.

Afterwards, pooled estimates of the 5 indexes (Sen, Spe, PLR, NLR and DOR) and AUC of these studies regarding utilising autofluorescence in the detection of PML and ML of 5 body sites were shown in Table 3. Furthermore, the 6 indexes on the application of autofluorescence alone or with algorithms for OSCC and OPMD were also separately displayed in Table 4.

To seek a comprehensive evaluation of these 6 indexes regarding the diagnostic value of autofluorescence for PML and ML of the 5 anatomical areas from another perspective, a wind rose picture derived from meteorology was depicted ( Supplementary Fig. S6). It indicated that the AUC of PML and ML of the 5 areas were all relatively high, among which, the overall diagnostic accuracy of autofluorescence for OSCC and OPMD was slightly inferior to colorectal cancer along with its PML, but was superior to the PML and ML of the other 3 areas, whereas the values of the other 5 indexes varied in terms of PML and ML of diverse sites. Particularly, optimal specificity and PLR were suggested when autofluorescence was applied to detect OSCC and OPMD.

U test of 6 diagnostic indexes

A u test of the 6 indexes (pooled Sen, Spe, PLR, NLR, DOR and AUC) that implied the diagnostic accuracy of autofluorescence among PML and ML of the 5 areas was conducted, indicating that statistical significance only lies in the comparison of the AUC between detecting PML and ML of the oral cavity and esophagus. Subsequently, another u test result concluded that a significant difference could be observed in Spe, PLR, DOR and AUC ( Table 4), suggesting that better accuracy for detecting OSCC and OPMD could be achieved with the use of algorithms rather than autofluorescence alone.

Heterogeneity test

Autofluorescence was used to diagnose PML and ML of 5 anatomic sites. Thus, we divided this study into 5 sections. The I 2 of the 6 indexes including Sen, Spe, PLR, NLR, DOR and AUC of all 5 sections was greater than 50%, and all Q test results were p < 0.05, which implied a significant heterogeneity across the included studies for all 5 sections. The random effects model was chosen to calculate the 6 pooled indexes. A meta-regression analysis was performed to identify the possible cause of heterogeneity according to the following study characteristics: population characteristics, study design, sample size, threshold effect and lack of blinding. However, none of the above analysed factors were significantly different (all p  > 0.05).

Evaluation of publication bias

The Begg's funnel plot and Egger's test were selected to explore publication bias of the 5 sections, and all results of the Egger's test were p > 0.05, each funnel plot manifesting as symmetrical inverted funnel-shaped figure. Both analyses indicated insignificant publication bias ( Fig. 4 and Supplementary Fig. S7).

Figure 4. Begg's funnel plot for the evaluation of potential publication bias of studies that applying autofluorescence to diagnose OSCC and OPMD.

Each solid circle indicates one study; OSCC: oral squamous cell carcinoma; OPMD: oral potentially malignant disorders.

Discussion

Presently, early diagnosis is supposed to improve the outcome of OSCC by general dentists. While COE, as an available method, seems to be helpless particularly for inexperienced dental practitioners¹²⁸. Thereby, adjunct diagnostic aids are desperately needed by primary care workers to facilitate the early detection of OSCC and dysplasia. Over the past three decades, the diagnostic performance of autofluorescence has been explored in OSCC and OPMD in several studies with conflicting results, also in 4 common aero-digestive lesions⁵⁹,⁶⁰,⁶¹. Therefore, our study was conducted to further investigate its overall diagnostic accuracy and to discuss its application stability in 5 anatomic parts in the hope of recommending it as a diagnostic aid in general dental practice. After calculating the pooled diagnostic indexes of autofluorescence for OSCC and OPMD along with the PML and ML of the lung, esophagus, stomach and colorectum, an overall good accuracy of autofluorescence for detecting OSCC and OPMD was indicated, with a pooled sensitivity and specificity of 0.89 and 0.80, respectively. In addition, the relatively preferable accuracy of autofluorescence for all of the 5 anatomical parts has implied its application stability and potential role in primary care. As our included studies were generally based on non-primary care settings, autofluorescence is presently more proper for specialists. However, based on our included studies, proper algorithms could be combined with autofluorescence to enhance its specificity for its promising use in primary care.

Aiming at initially evaluating the accuracy of autofluorescence for OSCC and OPMD, we calculated its pooled Sen, Spe, PLR, NLR and DOR. According to the forest plots, the pooled sensitivity of autofluorescence for detecting OSCC and OPMD is as high as 0.89, which is better than PML and ML of the esophagus and stomach, slightly worse than that of the colorectum and equal to that of lung, although no statistically significant difference was found. In addition, the pooled specificity of autofluorescence for detecting OSCC and OPMD was 0.8, although not high enough to reach statistical significance, it is optimal among the 5 areas. Besides, when the pooled sensitivity and specificity of using autofluorescence alone or with algorithms were separately computed, an encouraging result was indicated, presented as 0.88 and 0.62, 0.92 and 0.95, respectively.

PLR and NLR are more clinically significant and practical for the measurement of diagnostic accuracy. In this study, the PLR and NLR values for detecting OSCC and OPMD were 4.54 and 0.14, respectively, suggesting that patients with OSCC or dysplastic lesions have about a 4.54-fold higher chance of being autofluorescence-positive compared to those without them, while the chance of having OSCC or dysplastic lesions in autofluorescence-negative patients is theoretically 14%. The PLR of the autofluorescence for detecting OSCC and OPMD is optimal, although it is not statistically significant. The NLR of autofluorescence for detecting OSCC and OPMD is better than PML and ML of the lung, esophagus and stomach, and slightly inferior to the colorectum, with no statistical significance indicated. DOR has combined sensitivity and specificity into a single number, with higher values represent better diagnostic performance¹²⁹. In our study, the DOR for detecting OSCC and OPMD is 32.37 with good accuracy, slightly lower than PML and ML of the colorectum and greater than the other 3 areas. Additionally, a significant increase can be observed in the PLR, DOR of autofluorescence for identifying OSCC and OPMD assisted by proper algorithms, displayed as 17.28 and 194.11.

According to the AUC values of the HSROC curves, a better overall diagnostic accuracy of autofluorescence for PML and ML of the oral cavity and colorectum was revealed compared to the lung, esophagus and stomach, and a statistically significant difference was only indicated between the oral cavity and esophagus. Although the diagnostic accuracy of autofluorescence for OSCC and OPMD was slightly less than colorectal cancer and its PML, the AUC of the former was also greater than 0.9, which represents relatively good overall diagnostic accuracy. Further, the AUC of applying autofluorescence alone or with algorithms were individually estimated as 0.85 and 0.98 with statistical significance.

Aiming at understanding our results more vividly, the wind rose picture was delineated, revealing that the overall diagnostic accuracy of autofluorescence for OSCC and OPMD is superior to PML and ML of the lung, esophagus and stomach and is only inferior to the colorectum. In addition, the sensitivity and specificity for the 5 body parts fluctuated between 0.78 to 0.91 and 0.63-0.80, respectively. The stable and relatively high accuracy of autofluorescence across the five parts has confirmed its efficacy under diverse conditions, suggesting its potential role in primary care.

Across our included literatures, the sensitivity of autofluorescence for detecting OSCC and OPMD ranged from 30% to 100%; high sensitivity was indicated in the majority of studies except for low values in 3 studies²⁹,⁶⁰,⁶². Conversely, low specificity varying between 15.3% to 63% was implied in 10 of our included studies from 2009 to 2014¹⁹,²⁹,⁵⁸,⁵⁹,⁶⁰,⁶²,⁶³,⁶⁴,⁶⁵,⁶⁶. Other studies also reported low specificity by emphasizing its inability to discriminate benign lesions from malignant or premalignant mucosal conditions as well as a high rate of false positive results¹¹,⁶³,¹³⁰. Meanwhile, Balevi et al. stated that adoption of autofluorescence as a cancer-screening device for general dentists was presently premature¹³¹. In addition, as all of our included studies regarding identifying OSCC and OPMD are based on non-primary care settings and 6¹⁶,²¹,⁵⁰,⁵³,⁵⁷,⁶⁰ of these studies are on high-risk patients who were previously diagnosed as OSCC in the cancer clinics, the extrapolation of autofluorescence alone to the care remains a significant concern, and it is thought to be more valuable in the hands of specialists by most studies³⁰,³¹,¹³¹. In specialist clinics, Poh et al. used it in the identification of tumor margins during the operation¹⁶. Kois et al. suggested that autofluorescence could assist in deciding the best biopsy area¹³⁰. However, such a tool caters more to dental practitioners to uncover early OSCC and dysplasia in clinically innocuous lesions⁶.

Despite the fact that it seems unlikely to be widely applied in general dental practice mainly due to low specificity, fortunately, some available approaches could be combined with autofluorescence to facilitate its application within the primary care environment. Of the 24 studies regarding the use of autofluorescence for diagnosing OSCC and OPMD, 8 studies incorporated proper algorithms into the analysis of autofluorescence²⁰,⁴⁹,⁵⁰,⁵²,⁵³,⁵⁴,⁵⁵,⁵⁷, with a pooled sensitivity and specificity estimated to be 0.92 and 0.95, respectively. However, after separately calculating the diagnostic indexes of the remaining 16 studies, sensitivity and specificity were found to be 0.88 and 0.62, respectively. Thereby, the method of combining algorithms with autofluorescence could be generalized to low-risk groups to improve accuracy, and more similar studies in general dental settings are needed to warrant its efficacy.

Although inconsistent sensitivity and specificity of autofluorescence for OSCC and OPMD were presented in our included studies, primarily depending on both the different excitation and emission properties of the fluorophores and the diverse ability to discriminate PML and ML from normal regions based on the utilisation of various wavelength of excitation/emission light and algorithms, optimal accuracy were obtained in some of our included studies, either using autofluorescence alone or with proper algorithm. Thus, it indicates the potential of seeking a more suitable wavelength of excitation/emission light and algorithm, even individually designed for benign, dysplastic and malignant oral lesions, on the basis of these previous studies, to significantly enhance the accuracy of autofluorescence for detecting OSCC and OPMD. For instance, Pavlova I et al. proposed that in their study, excitation wavelengths in the UV range may improve the accurate diagnosis of PML and ML of oral cavity¹³².

Additionally, as the first to introduce autofluorescence into community dental practices, Laronde et al. devised a stepwise protocol, including patient history, visual screening examination, lesion risk assessment and direct fluorescence, to guide 18 general dentists to apply autofluorescence in their offices. Besides, a return for a 3-week reassessment was emphasized to reduce FP results on initial visits. Finally, it highlighted that combination of this protocol and autofluorescence could significantly help community clinicians in making wise decisions¹⁷. Subsequently, a similar prospective study was conducted by Bhatia et al. in general practice, in which a more detailed decision-making protocol was designed, including background information, COE, autofluorescence examination, combined examination, review appointment and referral appointment. Consequently, the combination of autofluorescence with COE achieved a dramatic increase in sensitivity and specificity compared to autofluorescence alone, as 73.9% and 97.9% rather than 64% and 54.3%, respectively. However, as it was only a single-center study, multi-center research on this protocol is needed to further verify its potential³⁵.

Moreover, diascopic fluorescence has been shown to decrease the FP results caused by inflammation in previous studies²⁹. Farah et al. found that complete blanching appeared in 10 dysplastic lesions and 1 OSCC, but the pressure and tool were both to blame²⁹. In Bhatia's study, they used diascopic fluorescence in general practice firstly and suggested that the back of a periodontal or sickle probe may be more proper for the test and that these lesions of partial blanching had the highest rate of referrals³⁵.

The limitations of this study are as follows. First, failure to include letters to the editors and ongoing studies may cause publication bias. Second, as our included studies applying autofluorescence for the diagnosis of OSCC and OPMD were based on patients of superior clinics rather than primary care, overestimation of its diagnostic accuracy may be a concern. More well-designed clinical trials about its application in general practice are strongly encouraged to support its use by general dentists. Third, owing to the lack of necessary data in our included studies, we are unable to perform a subgroup analysis about whether factors such as age, race were the possible cause of heterogeneity. Lastly, with the advent of various non-invasive diagnostic tools, including chemiluminescence, oral CDx brush biopsy, toluidine blue and narrow band imaging (NBI) being used in oral clinics for OSCC and OPMD¹⁰, it may be necessary for us to compare the accuracy of autofluorescence with those approaches in the future, significant to help select more efficacious early diagnostic tool for OSCC and OPMD.

In conclusion, autofluorescence is a promising non-invasive tool with relatively high accuracy for the early diagnosis of OSCC and OPMD. It also presents with good application stability for detecting lesions of 5 anatomical parts. In light of its medium specificity when used alone, it is more reliable to serve as an adjunct in the hands of oral specialists. However, in an attempt to facilitate its use in primary care to improve the survival rates of OSCC, some promising approaches could be adopted, including its use in combination with proper algorithms.

Additional Information

How to cite this article: Luo, X. et al. Accuracy of autofluorescence in diagnosing oral squamous cell carcinoma and oral potentially malignant disorders: a comparative study with aero-digestive lesions. Sci. Rep. 6, 29943; doi: 10.1038/srep29943 (2016).

Supplementary Material

Acknowledgments

We thank all of the authors of the original studies included in our study. This study was supported by grants from Nonprofit Industry Research Specific Fund of National Health and Family Planning Commission of China (No. 201502018) and the National Natural Science Foundations of China (No. 81321002).

Footnotes

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# data[].attributes.attachment_link.title
Accuracy of autofluorescence in diagnosing oral squamous cell carcinoma and oral potentially malignant disorders: a comparative study with aero-digestive lesions

# data[].attributes.attachment_link.description
Presently, various studies had investigated the accuracy of autofluorescence in diagnosing oral squamous cell carcinoma (OSCC) and oral potentially malignant disorders (OPMD) with diverse conclusions. This study aimed to assess its accuracy for OSCC ...

# data[].attributes.body
This article assesses how well the VELScope helps clinicians visualize oral mucosal lesions compared with the usual clinical exam. This article used 112 patients with potentially malignant oral mucosal lesions were recruited. VELScope enhanced the visibility of 41 lesions and actually uncovered 5 lesions that were not seen clinically. VELScope alone is not sufficient to determine diagnosis. The presence of loss of fluorescence cannot reliably distinguish dysplasia from benign conditions without clinical interpretation. This article states that loss of AF is not useful in diagnosing epithelial dysplasia in its own right without correlating with clinical features. This article supports the use of this technology since it improved the visibility of some lesions and detected a few that were missed. This must be interpreted in the clinical context and positive findings should lead to biopsy, not just reliance on the device.

# data[].attributes.body
This article states that AI-assisted caries detection demonstrates a potential for clinical use. But, there is a further need of improvement to allow this to be more accurate.

# data[].attributes.body
This article concluded that AI software demonstrated it was clinically acceptable as an adjunctive tool for helping detect bone levels. With this being said, this article supports the use of AI but it should not be used as a stand alone diagnosis.

# data[].attributes.body
This article was focused on the ability of AI to detect problems on a panoramic x-ray by using the software versus dentist with 3-10 years of experience. This study concluded that the AI software was similar to even better than the dentist at detecting problems. Although, this article stated that there needs to be more studies and improvements of the software to allow it to better detect caries.

# data[].attributes.body
Base subscription is around $499 a month

One time fee if $1,000 for the set up

One time fee of $500 for training

# data[].attributes.body
Teledentistry is a form of digital communication to help provide dental care remotely. Doing so allows dental professionals to evaluate and diagnose patient without having to see the patient in office. This can be done either live (synchronous), or at both the dental professional and patients own time (asynchronous). This form of dentistry helps increase access to care for people in underserved communities, while also improving the efficacy of the dental office by freeing up chair time.

# data[].attributes.body
1.) Allows for a wider access to care for patients.

2.) Allows for more chair time for the dentist as some emergency visits can be completed online.

3.) Offers fixability for both the patient and the provider.

# data[].attributes.body
1.) Limits what the provider can do because the provider is unable to do a hands-on assessment.

2.) Patients may not have current radiographs.

3.) The image quality can be inconsistent because the patients are taking them themselves.

# data[].attributes.body
This article found that teledentistry is a transformative solution that offers improved accessibility, efficiency, and patient engagement. It also investigated other specialties in dentistry to see how it was being used and what the results are from it being used. It was found that as technology advances, teledentistry may be an alternative to a traditional dental consult.

# data[].attributes.body
This articled investigated the effectiveness teledentistry at diagnosing caries. It found that clinical examination remains the gold standard for diagnosing caries, although teledentistry is showing it is comparable to clinical exams. But, due to the lack of clear criteria there needs to be more studies done to fully validate the accuracy of teledentistry on diagnosing caries.

# data[].attributes.body
This article found that teledentistry is a practical way to screen and educate patients especially those with poor access to care. It found that it can be used to help screen patients but it can not replace in-office visits.

# data[].attributes.body
Teledentistry software platform – $100 - $500 a month

Webcam and microphone - $100 - $300

Intraoral Camera - $300 - $1,000

Cybersecurity (to help remain HIPAA compliant) - $200 - $500 a year

Electronic consent (to have a written form stating the patient consented and understood the treatment they are receiving) - $100 - $300 a year.

The cost of the visit for the patient (uninsured) - $50 - $90

This is a billable service to insurance companies - D9995 (synchronous) and D9996 (asynchronous) when being billed out codes like D0140 to signify that a limited exam has been completed.

# data[].attributes.headline
Description and information regarding Periodontal Endoscope

# data[].attributes.subject
Description and information regarding Periodontal Endoscope

# data[].attributes.body
A periodontal endoscope is a camera and a light source on a probe. The camera shows a real-time image of the subgingival root surface and pocket. This allows clinicians to see calculus, deposits, defects, soft tissue, and furcation anatomy. It is used as an adjunct to scaling and root planing. Clinicians are guided by the video image, and removes calculus by ultrasonic or hand scalers.

# data[].attributes.body
1) Useful for implant cement removal and for quality assurance.

2) It is a minimally invasive alternative treatment option to surgery for some pockets/defects.

3) It enhances visualization for a more accurate diagnosis and treatment.

# data[].attributes.body
1) Endoscope-guided debridement typically takes longer than conventional SRP.

2) It requires practice to manage the device and to interpret the findings effectively.

3) The equipment is high cost and training clinicians can be difficult.

# data[].attributes.body
A brand name periodontal endoscope unit is estimated to be $2,500-$3,000. Sterile sheath, small accessories, explorer, etc. is $30-$50 per procedure. Replacement of major parts would be around $900 assuming 70-80 uses. It will add chair time for clinics which raises labor cost.

# data[].attributes.body
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This study compares NSPT assisted by periodontal endoscopy and NSPT without endoscopy. This study concludes that periodontal endoscopy is helpful when detecting subgingival hard deposits better, but it did not produce additional clinical benefits (BOP, PD, or CAL) over 4 months compared to NSPT without endoscopy. The author suggests that the full benefit of periodontal endoscopy may manifest over longer time. This study provides evidence that the visual benefit is helpful in detecting more residual deposits. The article does support the use of this technology, but it does not show additional short-term clinical outcomes.

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This article describes a procedure combining periodontal endoscopy assistance with a non-incisional regenerative technique for the treatment of infrabony periodontal defects. They report favorable results, including clinical attachment gains, reduction of probing depths, and good defect fill in treated sites. The authors conclude that this endoscopy-aided non-incisional regenerative approach could be a less invasive yet effective alternative to conventional surgical regenerative periodontal therapy. This article supports the use of this technology, but suggest further studies are needed to confirm long-term effectiveness.

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1.) Aligners are made of clear plastic like traditional braces, making for better aesthetics.

2.) They are removable, allowing the patient to take them out when doing activities like eating and at home oral hygiene.

3.) Because the aligners are pre-made, it requires less visits to the orthodontic office allowing more flexibility for the patient.

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1.) It requirers a lot more patient compliance because they are removable. If they are not worn at all or for the correct amount of time treatment can take longer or the finial results may be different.

2.) Because they are removable, they can be misplaced or damaged causing a possible additional charge to the patient and a longer time in treatment.

3.) Because they have to be removed when doing anything other than drinking water, it requires the patient to have to clean both their teeth and aligners after every time they eat.

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This article aims to evaluate the evidence on how effectively clear aligners control various types of tooth movements in non-growing patients. They conclude that clear aligners are effective for arch alignment and level arches. They do caution that aligners are less effective for certain movements like notably extrusion, rotations, and certain root movements. Auxiliaries like attachments, IPR, and elastic auxiliaries are necessary to improve predictability. The article emphasizes the need to have more high-quality, rigorous RCTs to establish the capabilities of clear aligners. The article supports the use of clear aligners, since it is an effective tool for many movements in selected cases. It does have its limitations for more complex movements.

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This article assesses the clinical effectiveness of the Invisalign system, considering outcomes such as alignment, occlusion changes, treatment time, need for refinements, and patient satisfaction. The authors conclude that Invisalign is clinically effective for many non-severe orthodontic cases, particularly in alignment, spacing, and mild crowding. They do caution that predictability is variable for certain movements and call for more high-quality randomized trials. This article does support the use of this technology since it affirms that Invisalign has demonstrated clinical effectiveness in many cases.

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This article looked at Orthodontic patients who were treated with Invisalign versus fixed appliances and looked at reported pain levels. It found that patients treated with Invisalign reported less pain. But, the type of malocclusion was not reported which may change the results. So, because of this more research should be done to allow a better answer to this question

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Invisalign is typically $3,000-$7,000. Insurance may cover part, which is often up to $1,500-$3,000. ClearCorrect or other office-supervised alternatives are typically $2,000-$6,000, depending on the provider and complexity. Direct-to-consumer/mail-order aligners, which can range from $1,800-$2,500. Initial consult and scans can range from $0-$300, depending on in-office visits.