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Game-Changer in the Operatory: How VELscope is Revolutionizing Oral Cancer Screening
The Wake-Up Call We All Need Let’s face it: oral cancer statistics are sobering. With a five-year survival rate hovering around 50% overall—and dropping as low as 15% depending on the stage at diagnosis—we’re dealing with a serious public health challenge (Tiwari et al., 2019). What’s particularly frustrating is that “oral squamous cell carcinomas often are diagnosed at an advanced stage of disease,” which clearly indicates “the need for improving the clinical oral examination (COE) and for developing adjuncts to help detect and diagnose oral mucosal lesions” (Epstein, 2012). That’s where VELscope comes in—and where my perspective as a hygienist becomes crucial. We’re often the first line of defense in oral health, spending more time with patients than any other member of the dental team. If we can enhance our ability to detect potentially dangerous tissue changes early, we can literally save lives. My Lightbulb Moment I’ll never forget the case that made me a true believer in this technology. I was examining a PMV patient. Her palate looked completely normal under conventional lighting. No discoloration, no unusual texture, nothing that would raise any red flags during a traditional visual and tactile examination. But I continued with my new personal protocol to check every patient with the VELscope, even though everything “looked” normal. When I switched on the fluorescence light, what I saw stopped me cold: a perfect textbook example of loss of autofluorescence (LOF) right there on the palate. Dark, well-defined, exactly what we’re taught to look for in VELscope training. It was like seeing a completely different mouth. I’ll be honest that I lost contact with this patient and am unsure of the final outcome. We were able to refer her out to an oral surgeon though, and I can rest easier knowing that I caught something that may have continued progressing without the aid of that VELscope. The Science Behind the Magic The technology itself is elegantly simple yet remarkably sophisticated. VELscope uses a specific wavelength of light (375-440nm) that causes healthy oral tissues to fluoresce with a natural pale green glow. When tissue becomes dysplastic or malignant, this autofluorescence is lost, appearing as dark areas against the green background (Srubar et al., 2021). Recent research has been incredibly encouraging. A 2021 study in the Journal of Morphological Sciences found that VELscope demonstrated a sensitivity of 92.86% and accuracy of 86.67% in patients with highly suspected oral cancer lesions (Nikolovski et al., 2021). These aren’t just numbers on a page—they represent real patients and real outcomes. Beyond the Binary: It’s About Better Clinical Decisions Here’s what I love most about VELscope: it’s not trying to replace clinical judgment—it’s enhancing it. The device “is intended to be used as an adjunct to a clinical examination and not as a stand-alone diagnostic tool” (Bhatia et al., 2014). My role isn’t necessarily to diagnose dysplasia, but “to make appropriate clinical decisions and referrals to a specialist centre where the patient can be diagnosed and managed appropriately.” A landmark Australian study really drives this point home. When researchers compared conventional oral examination alone versus VELscope alone versus a combined approach with a structured decision-making protocol, the results were striking:
But here’s the kicker—the combined approach maintained an impressive 98% specificity, meaning we’re not just catching more potential problems, we’re making smarter decisions about what actually needs further investigation (Bhatia et al., 2014). The Cost of Not Using Adjunctive Screening The medicolegal implications of missing oral cancer are significant. A comprehensive review of malpractice cases related to head and neck cancer found that “the most common allegation of malpractice claims in patients with HNC is delay in diagnosis” (Epstein et al., 2015). As healthcare providers, we have an obligation to use the best available tools to serve our patients. But beyond legal considerations, there’s a moral imperative here. There’s a case study from the Czech Republic where clinicians found what appeared to be a benign “smoker’s lesion” that had seemingly regressed after smoking cessation. Under conventional examination, “no white plaque was found at the location of the lesion and no clinically observable marks of malignity or any other disorder were present.” Only the “striking loss of fluorescence” detected by VELscope led to the biopsy that revealed stage 1 squamous cell carcinoma (Srubar et al., 2021). The five-year follow-up? No recurrence. Early detection saved that patient’s life. Integration Into Daily Practice Incorporating VELscope into my hygiene appointments has been surprisingly seamless. It takes just a couple of minutes and patients are generally fascinated by the technology. I’ve found it’s actually a great patient education tool—when I share what I’m looking for and explain how, it really drives home the importance of regular screenings. I often use it as a segway into discussions about oral cancers, risk factors, prevention, or about how H&N cancers are the most disfiguring and costly. The best part is when patients tell me that they’ve never had such care taken to ensure their health and that they’ve never deeply appreciate that I’m being thorough with my screenings. This helps create trust, which we all know translates into patients’ openness to our other recommendations. The decision-making protocol is straightforward:
The Evidence Keeps Growing Recent research continues to validate what we’re seeing clinically. The most recent JAMA study demonstrated that when VELscope is used to assist with surgical margin determination during cancer removal, there’s “a substantial reduction in the recurrence of oral cancer” based on “the ability to see areas that cannot be seen with the naked eye” (Turner, 2025). This surgical application represents another frontier—it’s not just about detection anymore, it’s about ensuring complete removal and improving long-term outcomes. Looking Forward As dental hygienists, we’re uniquely positioned to make a difference in oral cancer outcomes. We see patients regularly, often before they’re symptomatic, and we have the time and training to conduct thorough examinations. Adding VELscope to our toolkit doesn’t complicate our workflow—it enhances our clinical capabilities and gives us confidence in our screening protocols. The technology isn’t perfect, and it’s not meant to be. It’s an adjunct that, when used thoughtfully as part of a comprehensive examination, significantly improves our ability to detect tissue changes that warrant further investigation. In a field where early detection can mean the difference between life and death, that’s not just valuable—it’s essential. We are prevention specialists after-all. Every day I use the VELscope, I’m reminded of that patient with the normal-looking palate. How many other “normal” examinations might tell a different story under fluorescent light? It’s a question that drives my commitment to comprehensive screening and reminds me why I chose this profession in the first place: to make a real difference in people’s lives, one patient at a time. Visit https://velscope.com/doctor/ if you want to look into VELscope more. Stephen Quimby, RDH, BSDH | MBA '25 To return to the September issue of The Monthly Incisor, click here.
References Bhatia, N., Matias, M. A. T., & Farah, C. S. (2014). Assessment of a decision making protocol to improve the efficacy of VELscope in general dental practice: a prospective evaluation. Oral Oncology, 50(10), 1012-1019. Epstein, J. B. (2012). Oral cancer and precancer: The importance of early detection and the role of the dental profession. Journal of the American Dental Association, 143(12), 1332-1342. Epstein, J. B., Güneri, P., Boyacioglu, H., & Abt, E. (2015). Head and neck, oral, and oropharyngeal cancer: a review of medicolegal cases. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, 119(2), 178-185. Nikolovski, B., Dimova, C., Popovska, M., Ristoska, S., Stojanovska-Naumovska, S., Alili, A., & Mijoska, A. (2021). Tissue fluorescence imaging for quick non-invasive diagnosis in oral and maxillofacial surgery. Journal of Morphological Sciences, 38(1), 1-13. Srubar, J., Uhrikova, T., & Delongova, P. (2021). Atypical carcinoma detected after regression of a “benign” oral white lesion. A case report. Biomedical Papers, 165(2), 229-232. Tiwari, L., Kujan, O., & Farah, C. S. (2019). Optical fluorescence imaging in oral cancer and potentially malignant disorders: A systematic review. Oral Diseases, 25(6), 1417-1436. Turner, E. (2025). Email correspondence regarding VELscope clinical applications and recent research findings. |
As practicing dental hygienists, we have seen countless technological advances that promise to revolutionize patient care. But few have made as profound an impact on my daily practice as the VELscope optical fluorescence device. What started as curiosity about this “blue light” technology has evolved into an essential part of my oral cancer screening protocol—and quite honestly, I can’t imagine practicing without it anymore.