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Oral exfoliative cytology is another commonly used adjunct to oral visual inspection. The major limitations of this technique are high false-negative rates and smaller number of exfoliated cells identified in the smear. The use of a cytobrush as a sampling device has improved the technique, providing adequate good-quality specimens for interpretation. By brushing, it is possible to reach the deeper layers of the oral mucosa where squamous intraepithelial neoplasia begins. The biological characteristics of the oral epithelial cells obtained can be evaluated using the following additional methods: computer-assisted image analysis, DNA cytometry, immununo histochemistry, monolayer cytology and molecular biological analysis. All of these methods may increase sensitivity and specificity of oral brush biopsy  Hullmann M, Reichert TE, Dahse R, Von EF, Pistner H, Kosmehl H and Driemel O (2007). Oral cytology: historical development, current status, and perspectives, Mund Kiefer Gesichtschir., vol. 11, no. 1, pp. 1-9.. However, the lesion still must be visually identified before taking the biopsy.

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