title: Adjunctive screening devices for oral lesions: their use by Canadian Dental Hygienists and the need for knowledge translation.
abstract: Screening for oral cancer and other mucosal conditions is a knowledge-to-action objective that should be easy: there is supportive evidence, it is fast and non-invasive, and the oral cavity is easy to visualize. However, over 60% of oral cancers are diagnosed late, when treatment is complex and prognosis poor. Adjunctive screening devices (ASDs), e.g. toluidine blue (TB), fluorescence visualization (FV), chemiluminescence (CL) and brush biopsies, were designed to assess risk of oral lesions or aid in identification and localization of oral premalignant and malignant lesions. Little is known on how clinicians feel about using ASDs.
  
  
  OBJECTIVE
  To evaluate use and level of comfort in using ASDs for oral cancer screening among dental hygienists.
  
  
  METHODS
  Online email survey of a stratified random sample of nearly 3000 dental hygienists from four Canadian provinces.
  
  
  RESULTS
  A total of 369 hygienists responded about ASDs. Ninety-three (25%) had used an ASD. Use was associated with six or more continuing education (CE) courses per year (P = 0.030), having a CE course in oral pathology within the last 3 years (P = 0.003) and having a screening protocol (P = 0.008). The most commonly used ASD is FV, which was the tool hygienists felt most comfortable using. Few used brush biopsies. Older graduates were more comfortable using TB (P = 0.014) and CL (0.033).
  
  
  CONCLUSIONS
  Current evidence and education through CE appears to bolster knowledge translation efforts for hygienists to become more comfortable in the use of ASDs. ASDs with minimal supporting evidence and not specifically targeted to hygienists, such as the brush biopsies, are not well utilized.
authors.affiliation: Department of Oral Biological and Medical Sciences, University of British Columbia, Vancouver, BC, Canada.|Cancer Control Research, BC Cancer Agency, Vancouver, BC, Canada.
authors.forename: D M
authors.initials: DM
authors.lastname: Laronde
authors.affiliation: School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada.
authors.forename: K K
authors.initials: KK
authors.lastname: Corbett
mesh_terms: D000328:Adult; D001706:Biopsy; D002170:Canada; D002983:Clinical Competence; D004396:Coloring Agents; D003756:Dental Hygienists / Q000523:psychology*; D055088:Early Detection of Cancer / Q000379:methods*; D004498:Education, Dental, Continuing; D005260:Female; D006801:Humans; D008163:Luminescent Measurements; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008856:Microscopy, Fluorescence; D009062:Mouth Neoplasms / Q000175:diagnosis*; D019239:Practice Patterns, Dentists'; D014048:Tolonium Chloride; D057170:Translational Research, Biomedical
chemical_list: D004396:Coloring Agents; D014048:Tolonium Chloride
keywords: brush biopsy; decision-making; fluorescence visualization; knowledge translation; oral cancer screening; oral premalignant lesions; toluidine blue