Source: Sciencedirect
Author: Esther S. Oh DDS and Daniel M. Laskin DDS, MS
Purpose
Early detection of oral cancer is crucial in improving survival rate. To improve early detection, the use of a dilute acetic acid rinse and observation under a chemiluminescent light (ViziLite; Zila Pharmaceuticals, Phoenix, AZ) has been recommended. However, to date, the contributions of the individual components of the system have not been studied. The present study was done to investigate the efficacy of the individual components of the ViziLite system in providing improved visualization of early oral mucosal lesions.
Patients and Methods
A total of 100 patients, 39 males and 61 females, age 18 to 93 years (mean age, 44 years), who presented to the Virginia Commonwealth University School of Dentistry for dental screening were examined. There were 58 Caucasians, 29 African-Americans, 5 Hispanics, 6 Asians, and 2 of mixed ethnicity. Thirty-five patients smoked, 53 used alcohol, and 25 both smoked and drank. After written consent, the oral cavity was examined under incandescent light for soft tissue abnormalities. After 1-minute rinse with 1% acetic acid, the mouth was re-examined for additional mucosal abnormalities. Then, the mouth was examined once again using the ViziLite system’s chemiluminescent light. Any lesions detected by these 3 examinations that were clinically undiagnosable were brush biopsied (Oral CDx) for determination of cellular representation.
Results
In the original examination of the 100 patients, 57 clinically diagnosable benign lesions (eg, linea alba, leukoedema) and 29 clinically undiagnosable lesions were detected. After the rinse, 6 additional diagnosable lesions (linea alba) and 3 undiagnosable lesions were found. No additional lesions were detected with the chemiluminescent light. Of the 32 undiagnosable lesions that were brush biopsied, 2 were positive for atypical cellular characterization and warranted further investigation with a scalpel biopsy. Neither of these lesions was found to be premalignant or malignant.
Conclusion
Although the acid rinse accentuated some lesions, the overall detection rate was not significantly improved. The chemiluminescent light produced reflections that made visualization more difficult and thus was not beneficial.
It comes a little surprise that this “test” which played hard on the term “chemiluminesence”, a chemical reaction which has nothing to do with tissue, cancer, or more than the combination of two chemicals to produce light, has fallen into disfavor in the US dental marketplace. I am always surprised when scientific papers use this marketing department generated term, to talk about Vizilite, as it is purely a “marketing phraseology” to create the illusion of real science, in those that are unfamiliar with it. Omniglo which makes the light sticks, sells them to novelty shops where they are found at kids rave parties, to campers for lighting in tents, and to the US military as a non electrical light source for our troops in larger and more powerful forms. There is nothing unique in wave length with this light compared to the blue colored light sticks they sell to others in non medical industries. (They sell many colors). Claims to the contrary are marketing rhetoric.
Since the publication of this article, the product’s manufacturer has gone bankrupt, and it assets, including this product line, picked up by another company for pennies on the dollar. While it will likely survive in the marketplace for some period of time in the future at some limited level, there is little question that as an early detection device, it always had limited value, and has been vastly superseded by newer ideas that are firmly grounded in real science (paid for by tens of millions of dollars of NIH funding), which will in the long run spell its demise as a product. After all, it is only a chemical light which could be replaced by any other light source – as there is no cancer related reason to use this chemiluminesent source, (such products exist in the market) and what is essentially Heinz white vinegar with a few drops of raspberry flavoring in it. (2% acetic acid). There are other sellers of similar products in the US marketplace in a very small way that use the same idea with a battery powered white light source with similar results.
The product was the triumph of marketing rhetoric over science, and successful because it was the first product out there that actually created a small profit center in dental practices. For that reason I feel that the marketing dollars to sell it did some good for the oral cancer cause, as it gave dentists a reason to be engaged in screenings for a change. (Though I wish that more chose to do the screenings for reasons other than profit motive. The New York Times did a extensive article on this that questioned in a very articulate way if the test did any good for patients at all, or was it just good for the dental communities income.) So in an obtuse way, it did serve the cause of early detection. But its scientific value is certainly questionable as this article points out.