Vital staining as a tobacco cessation aid and diagnostic adjunct: a cross-sectional study on high-risk Indian...

Oral squamous cell carcinoma (OSCC) ranks among the most prevalent cancers worldwide, typically arising from oral potentially malignant disorders (OPMDs). Early detection in high-risk individuals is critical for improving patient outcomes. This cross-sectional study assessed the diagnostic accuracy of sequential vital staining with 5% Methylene Blue (MB) and 3% Lugol's Iodine (LI) and explored its influence as a visual behavioural motivator to encourage tobacco cessation among Indian tobacco users.

Fifty adult tobacco users presenting with oral mucosal lesions underwent in vivo double vital staining. Each lesion was first stained with MB, followed by LI. Clinically retained MB and non-retained (negative) LI areas were recorded. Targeted biopsies were obtained from stained and unstained sites. Histopathological findings were correlated with staining patterns to determine sensitivity, specificity, and overall diagnostic accuracy.

MB staining alone demonstrated high diagnostic yield, with sensitivity of 94.7%, specificity of 87.1%, and overall accuracy of 90.0%. Combining MB and LI increased sensitivity to 100%, ensuring no dysplastic lesions were missed, but reduced specificity to 67.7%, leading to more false positives. Clinically, the vivid contrast provided by double staining enhanced lesion delineation, and many participants reported that seeing the stained lesions heightened their awareness and spurred discussions on tobacco cessation.

The MB-LI sequential staining technique offers exceptional sensitivity for identifying dysplasia in tobacco-related oral mucosal lesions. Its bright visual feedback not only supports early diagnosis but also appears to function as a powerful motivational tool, prompting self-reflection and encouraging cessation behaviour among tobacco users. These findings suggest that vital staining has dual utility: as an effective diagnostic adjunct and as a behavioural intervention aligned with tobacco-cessation strategies recommended by dental professionals.