Early Detection of Oral Potentially Malignant Disorders: A Review on Prospective Screening Methods with Regard to Global Challenges

Abstract

Oral cancer is a cancer type that is widely prevalent in low-and middle-income countries with a high mortality rate, and poor quality of life for patients after treatment. Early treatment of cancer increases patient survival, improves quality of life and results in less morbidity and a better prognosis. To reach this goal, early detection of malignancies using technologies that can be used in remote and low resource areas is desirable. Such technologies should be affordable, accurate, and easy to use and interpret. This review surveys different technologies that have the potentials of implementation in primary health and general dental practice, considering global perspectives and with a focus on the population in India, where oral cancer is highly prevalent. The technologies reviewed include both sample-based methods, such as saliva and blood analysis and brush biopsy, and more direct screening of the oral cavity including fluorescence, Raman techniques, and optical coherence tomography. Digitalisation, followed by automated artificial intelligence based analysis, are key elements in facilitating wide access to these technologies, to non-specialist personnel and in rural areas, increasing quality and objectivity of the analysis while simultaneously reducing the labour and need for highly trained specialists.

Dental hygienists and dentists as providers of brush biopsies for oral mucosa screening

“…As dental hygienists (DHs) and dentists (Ds) regularly see their patients, they should be able to identify patients at increased risk. After being referred to a specialist these patients could be enrolled in a follow‐up program at the primary point of care 33 . In difference to a previous study, 34 focusing on evaluating the level of comfort in clinicians for using different adjunctive screening devices, including brush biopsies, this study was the first to investigate in depth the role for DHs in screening for premalignant oral lesions in the primary care settings.…”

“…It is concluded that a pipeline for nuclei classification and localization using deep learning can contribute to minimize the subjectivity of the human analysis and also support the detection of cancer at early stages 39 . Through integration of explainable AI techniques, enabling cytologists to interpret and support the AI system, it is possible to develop an interactive tool with which medical and dental expertise can offer the best possible diagnostics at minimal cost 38,40–41 …”

“…After being referred to a specialist these patients could be enrolled in a follow-up program at the primary point of care. 33 In difference to a previous study, 34 focusing on evaluating the level of comfort in clinicians for using different adjunctive screening devices, including brush biopsies, this study was the first to investigate in depth the role for DHs in screening for premalignant oral lesions in the primary care settings. For the primary point of care to be responsible for the continuous surveillance of OPMDs, they require an easy, fast, and affordable, non-invasive method which brush biopsies fulfil.…”

“…39 Through integration of explainable AI techniques, enabling cytologists to interpret and support the AI system, it is possible to develop an interactive tool with which medical and dental expertise can offer the best possible diagnostics at minimal cost. 38,[40][41]…”

A paradigm shift in the prevention and diagnosis of oral squamous cell carcinoma

“…Current methods used to assess at‐risk patients are either invasive and too costly for larger initiatives or insufficiently sensitive and specific. To address this problem, intensive research is being conducted to find non‐invasive methods that can identify the risk of developing OSCC without requiring expensive equipment or expertise, allowing them to be handled at the point of care 6 …”