Discuss the arguments for and against the use of toluidine blue Essay

Discuss the arguments for and against the use of toluidine blue staining as a screening method for oral cancer in dental practic - Essay Example This paper elucidates on the arguments for and against the use of toluidine in screening for oral cancer. The use of toluidine blue in uterine and oral cancer screening was pioneered by Richart in 1962. A 1% aqueous solution of toluidine blue is painted over the target area for ten seconds followed by a rinse of 1% solution of acetic acid. The toluidine blue binds to the DNA on surface cells, causing the surface to take on a bluish hue. The amount of DNA material present may be used as an indication of suspected dysplasia or neoplasia (Richart 1962). 2.0. Arguments for toluidine screening Jones and Rankin (2008) consider toluidine blue staining as a diagnostic aid for the dental professional in the evaluation of the possible malignancy of oral lesions. The potency of staining with toluidine blue has been likened to that of brush biopsy in terms of early detection, speeding up of biopsy and subsequent diagnosis of oral cancer. Application of aqueous toluidine blue to a lesion followed by a rinsing of 1% acetic acid results in selective binding with dysplastic and malignant cells accurately. The blue stain also marks a good site to extract for biopsy. Extreme care should, however, be practiced to ensure that the dye is neither mutagenic nor carcinogenic for best results. Patton, Epstein and Kerr (2008) performed a systematic review of literature related to several adjunctive techniques used in the early detection of oral premalignant and malignant lesions or OPML, such as toluidine blue. A total of 23 articles were reviewed wherein the majority focused on the use of toluidine blue. Results of the review revealed the effectiveness of toluidine blue in diagnosing oral premalignant and malignant lesions in high-risk populations and suspected mucosal lesions. However, clinicians are advised not rely much on diagnostic adjuncts alone. A complete oral mucosal examination is recommended together with specialty referrals or tissue biopsy to correctly diagnose OPML. Epste in, Silverman, Epstein, Lonky and Bride (2008) evaluated the effects of ViziLite, a chemiluminiscent light source in conjunction with toluidine blue in the process of verifying lesions identified by oral soft tissue examinations. Lesion assessment by chemiluminiscense combined with toluidine blue staining was compared with conventional visual examination. Subsequently, the suspected lesions were subjected to biopsy and diagnosed through conventional histopathological methods. Moreover, toluidine staining was performed on lesions related to severe dysplasia, carcinoma in situ, and squamous cell carcinoma. Results of the assessment show an improvement in the brightness and sharpness of margin in 60 out of 97 identified lesions that underwent the chemiluminiscent exam. Meanwhile, toluidine staining exhibited a false positive rate of 55.26% while maintaining a 100% negative predictive value (Epstein, Silverman, Epstein, Lonky and Bride 2008). Fedele (2009) described toluidine blue as an indispensable tool in identifying the area damaged by a malignant lesion due to its ability to stain nucleic acids. This effect makes it easier to remove malignant lesions since toluidin blue clearly marks the boundaries of the lesion, thus allowing precise excision. Recent studies on the use of toluidine blue were rather limited due to the dearth of research efforts in relation to randomized controlled trials, histological diagnosis