Did you know?

- 3 Canadians die every day from oral cancer and 10 per day are diagnosed with oral cancer

- If  we use visual exam alone, 70% of oral cancer lesions will be detected at stage III or IV and these stages are associated with only 59% 5-year survival rate with poor quality of life (missing tongue or part of the tongue, tasting problems, debilitating appearance, speech problems to name a few obstacles)

- More than 25% of oral cancer victims don't use tobacco.  So if you are not a smoker...you are still a potential victim.

 

Why is Dr Julie so concerned about oral cancer?

"Oral cancer is a very sensitive subject for me.  A close friend of mine was diagnosed with tongue cancer in her early 30s.  "What? in her 30s?  She must have been smoking and drinking a whole lot" you probably think... Hum Hum, you are wrong!  What if I told you she is very healthy, non-smoker, drinks a few glasses of wine occasionally, exercises regularly, on top of being young, smart and beautiful.  She ended up getting surgery on her tongue and neck, not once but twice because of relapse 4 years later (yes, they removed part of the tongue...)   After 2 surgeries, an incredible amount of stress, courage, hope and support later and way more worries that we can even imagine (chosing to not start a family is one of them..needless to say more about this devastating decision), she's cancer-free today and is grateful for every single day life grants her with.  But the fear stays forever...

 

Oral cancer: the facts and the recommendations

Like many other victims of oral cancer, my friend was probably part of the 25% non smoker oral cancer victims possibly affected by the HPV virus (Human Papillomavirus).  This is the exact same virus that has been linked to cervical cancer and for which our young daughters are now being offered the new Gardasil vaccination program.  Research has shown that cells found in the vaginal lining and the oral epithelium are very similar, therefore at risk to be attacked by the same kind of viruses.  It is now clear that anyone who is between the age of 18-39 and who is sexually active presents with increased risk of contracting the HPV-16 or HPV-18 virus, automatically becoming at risk for oral cancer.  That being said, the highest risk for oral cancer still goes to anyone over 40 y.o with lifestyle risk factors like tobacco and alcohol use or with an history of oral cancer.

We have Pap smears for cervical cancer, mammograms for breast cancer and PSA testing for prostate cancer but no testing has been made publically recommended for oral cancer.  Bizarre considering the fact that, all stages combined, breast cancer has a 88.2% 5-year survival rate, cervical cancer a 77.3% rate, prostate cancer a 99.8% rate and oral cancer only 59.4% rate (SEER, 1975-2002, Division of Cancer Control and Population Sciences, Nation Cancer Institute, Bethesda, MD 2005)

Let’s put things into perspective:

In 2006, about 1350 new cervical cancer diagnosis were made from which we estimate the number of death at 390.  In the same year, about 3500 new oral cancer diagnosis were made and about 1100 died from it. That is 3X then incidence and 2X the death rate!!  So why aren’t we as aggressive at testing for oral cancer than we are at testing cervical cancer?

Well, at Milltown Dental, we certainly think that you deserve the opportunity to be screened early and regularly and that everyone should receive the highest standards of care.  That’s why we offer the ViziLite Plus wtih TBlue test, the only FDA-cleared technology of its kind.

 

Milltown Dental’s Comprehensive Oral Cancer Screening Protocol

1-      At each of your recall visits, you will get a conventional visual oral exam.  We palpate, we look and we screen for lumps and bumps and abnormal  looking tissue.

  2-       In many offices, that’s where it ends but at Milltown Dental, we also propose an annual screening with ViziLite Plus for all adults (age 18+).  Both the dentist and the hygienists are trained to administer the test but Dr Julie will always be part of it as she and only she can make the final assessment.

     Note:  The ViziLite Plus test is now part of the Milltown Dental Office protocol and is automatically offered to every new adult patient who joins the practice. Should you elect to forgo the test, you will kindly be asked to sign a waiver certifying that you consented to declining the highest standards of care recommended by Dr Julie and that, despite the education received on the subject of oral cancer, you assume the risks of that decision.

 

What is the ViziLite Test exactly?

  ViziLite Plus is performed immediately following a regular visual examination

  •   First, you will be instructed to rinse with a cleansing solution.  It tastes like raspberry vinaigrette and will make your mouth feel slightly dry.
  •   Next, the overhead lighting will be dimmed.
  •   Then, your dental professional will examine your mouth using ViziLite Plus, a specially designed light technology.

  As ViziLite Plus passes over oral tissue that has been treated with the rinse solution, normal healthy tissue will absorb the light and appear normal,   abnormal tissue will appear unusually white.

The purpose of using ViziLite Plus is to identify tissue changes at their earliest stage; once abnormal tissue has been identified it is up to your dental professional to determine what the appropriate next steps are: not every lesion showing up with ViziLite is cancer. 

 

 

Is a positive ViziLite Plus result bad news?


Not necessarily.  ViziLite Plus identifies oral abnormalities including serious abnormalities such as oral cancer.  However, ViziLite Plus will also identify benign abnormalities, so Dr Julie will first rule out trauma (cheek bites, food irritations, pizza burn, past oral surgery like wisdom teeth removal or tonsillectomy,etc.) as a cause of the abnormality.  Sometimes, we check again 2 weeks later to ensure proper healing. 

If after 2 weeks it’s still not healed, we then apply the T-Blue test (read under for more details) which will indicate if it’s necessary to get the lesion biopsied or not for more assemssment.
 

 What would be considered abnormal?

 Most of the time, an abnormality shows up as “leukoplakia” which is “any white lesion that cannot be rubbed off or identified as any other type of lesion”.

20% of these leukoplakias have some degree of dysplasia (abnormal cells) and in the mouth, are mostly  found on the tongue and the floor of the mouth. 

About 7% of leukoplakias will become malignant but if dysplasia is found in the leukoplakia (which means that the leukoplakia is confirmed to already have abnormal cells) then the rate of malignancy climbs to 37%.

 Examples of abnormal findings

               

 

How efficient is ViziLite in detecting early signs of cancer?

ViziLite Plus has a 100% Negative Predictive Value.  This means that if your test is negative, you are for sure cancer-free.  There is no false negative with this test: if it’s negative, it’s really negative.

The sensitivity of ViziLite Plus is approximately 100% (Oral Oncology, aug. 2007).  This means that if a patient has oral cancer, the exam will be positive 100% of the time.  Basically, if something is there, the test is so sensitive that it WILL find it.  It doesn’t miss any lesion.

The downside of this is that you may end up with a false positive: the test is so sensitive that it may “catch” something  that is absolutely nothing…  Yes, this may bring stress, anxiety and a little panic to your day but as Dr Julie said it just before getting her own mouth tested:

 “I’d rather be a bit scared, get a biopsy and then be told that I’m totally fine than not doing the test, living my life thinking everything is ok and then one day be told that I have 5 years left to live before oral cancer destroys my face before killing me.  If something is growing in me, I want to know and I want to know now so I can fix it before it’s too late.  I can deal with a false alarm but I certainly cannot live with the thought that I may never see my daughter walk down the aisle?”

 Some example of people that suffered the terrible consequences of oral cancer

             

 Let's make sure this doesn't happen to you...

 

Dr Julie saw something abnormal in my mouth… Now what?

1-      First we document the clinical appearance and location of the suspicious lesion  and we take photos                                

2-      If we cannot rule out trauma or simple inflammation, we ask you to return in 2 weeks to assess healing

3-      If the lesion i s still suspicious, we apply TBlue dye, a Lesion Marking System applied with 3 different swabs (painless).  According to the manufacturer, the advantage of using the toluidine blue marking dye is that the precise location for additional examination and biopsy can be clearly noted and more accurately and quickly communicated to the oral surgeon who will then proceed with the recommended biopsy.

4-      we document our observations  thoroughly and we take new photos

5-      We refer to an oral surgeon or oral pathologist for biopsy of the suspicious area.  That we you get an accurate final diagnosis

TBlue is not perfect but it’s an extra step that can help, for example, in reducing the number of false positive.  It also give clues on the severity of the potential lesion as TBlue-stained lesions have 6X increased risk of malignant transformation (Cancer Res. 2005;65 (17))

           

 

Summary of the benefits of ViziLite Plus done yearly

-          Immediate identification of lesions with high risk of serious pathology  à we are not waiting for it to progress to a later more debilitating stage

-          Quicker referral to a specialist if needed à Avoiding major surgery, disfiguring procedures and possible death

-          Much better referral to specialist àprecise marking of the extent of the lesion, facilitating the specialist’s work and therefore improving your prognosis.

-          Your dentist will feel a lot more confident in the quality of her oral cancer screening

-          Your dentist offers you highest standards of care

 

Is ViziLite covered by my insurance?

 Some insurances cover the test, some don’t.

 It is your responsibility to know your insurance, as every single plan is different and has been negotiated by your employer for you.   

Milltown Dental kindly offers the courtesy of assignment and will gladly make your life easier by sending the claims and predeterminations electronically on your behalf but cannot possibly be expected to know the details of every insurance plan.

Should you wish to explore coverage of the ViziLite test with your insurance provider, we will gladly provide you with the necessary information and guidance.

Please feel free to contact Anita at our front desk should you have any question regarding the fees associated with the test, or any other question.  The entire team is trained to provide you with any detail you may require about ViziLite Plus.

Freezing without needles

 
 
 
 

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Other great reasons to choose Milltown Dental:

 

We speak English, French, Polish, Italian, Spanish, Japanese & Croatian for the convenience of our patients.

Plenty of parking space

TV on the ceiling in each room

Great children's play area

Comfortable modern environment

Green office... leaving a clean planet to our children (no mercury, paperless, everything digital, including the x-rays for a minimum amount of exposure)