Wilder+Smith+ - Emerging Laser-Based Approaches To Oral...

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Emerging Laser-Based Approaches To Oral Cancer Detection - which ones are useful in real life?
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´ Why the perpetual search for new diagnostic modalities in Dentistry? Background
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Need A. As emphasis shifts from damage mitigation to (1) disease prevention or (2) reversal of very early disease increasingly sensitive and accurate detection and diagnostic tools becomes ever more important(demineralization) B. As treatment options expand and become increasingly sophisticated, we need to track potential side-effects (ortho) C. Other medical specialties are adopting non-invasive diagnostic techniques, altering patient expectations
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1. Non-invasive: no incision, no ionizing radiation, patient-friendly, repeatable as needed 2. Very sensitive to minimal changes such as - cell microanatomy e.g. nuclear/cytoplasmic ratio - redox status - expression of molecular biomarkers - tissue architecture and composition - chemical changes eg mineralization - vascularity/angiogenesis and perfusion Why Optical Diagnostics? These properties are ideal for - detection of minimal (very early) changes - repeated non-invasive monitoring of existing lesions - rapid screening
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Despite significant advances in treatment, oral cancer results in >10,000 U.S. deaths annually. Early detection of cancer and its curable precursors remains the best way to ensure patient survival and quality of life. Of all oral cancer cases documented by the National Cancer Institute Surveillance, Epidemiology and End Results Program, advanced lesions outnumbered localized lesions more than 2:1. Five-year survival rate is 75% for those with localized disease at diagnosis, but only 16% for those with cancer metastasis. Current gold standard is surgical biopsy. Background Need A modality for the - direct, non-invasive early detection, diagnosis and monitoring of oral dysplasia and malignancy - rapid screening of high-risk populations
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1. Spectroscopy 2. Autofluorescence imaging (Velscope, the FastEEM4R System, the IndentafiR and the PS2-oralR) 3. Photosensitizer-induced fluorescence (ALA and Photofrin R ) 4. In vivo Optical Coherence and Doppler Tomography 5. In vivo Microscopy 6. Chemiluminescence Optical approaches for the in vivo detection and diagnosis of oral dysplasia and malignancy
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. Spectroscopy - Reflectance sp: cell morphology : mean nuclear diameter, size distribution, refractive index. - Fluorescence sp: cell metabolism, chromophores : NAD(P)H, flavins, porphyrins, collagen crosslinks. - Raman sp: tissue chemistry. - Elastic-scattering sp: sub-cellular architectural changes : nuclear grade, nuclear:cytoplasmic ratio, mitochondrial size and density. Spectroscopy is the use of the absorption, emission, or scattering of electromagnetic radiation by matter to study the matter. Different forms of spectroscopy probe a wide range of phenomena.
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Wilder+Smith+ - Emerging Laser-Based Approaches To Oral...

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