Have you seen the CSI-type shows where the crime scene detective puts on some funky goggles and shines an eerie blue light over the scene, looking for clues? They are using an alternative light source to reveal details that are difficult to detect under normal white light. The same kind of technology is behind today's oral cancer detection systems. These new dental practice management tools and technologies help us treat our patients better.
There are two major oral cancer detection systems currently available. ViziLite Plus from Zila Pharmaceuticals and VELscope from LED Dental. These systems appear similar in that they both use a blue light and filters; however, they employ quite different science.
ViziLite Plus is a disposable chemical light source packaged in a wand. When the chemicals are mixed the wand gives off a specific blue light that is used to illuminate the oral tissues. Certain changes in the mucosa are easier to detect with this alternative light source.
VELscope produces a specific blue light as well. However, the tissues are then viewed through the VELscope hand-piece, which filters out most of the ambient reflected light. What the user sees through the hand-piece is the natural fluorescence of the mucosal tissue.
Dysplasia (even early dysplasia) produces chemical changes at the cellular level in both the epithelium and the underlying connective tissue, which results in decreased fluorescence.
The ViziLite Plus system includes a tissue stain called TBlue, which, when applied to lesions discovered with the alternative light source, allows for visualization of the lesion with normal white light.
Just the first step
Neither system will actually diagnose oral cancer. The only true diagnostic protocol remains a biopsy. What these instruments do is enhance the routine visual and manual head and neck exam. They give the practitioner the ability to visualize tissue changes that often are not apparent with normal unfiltered white light.
"VELscope is not a magic cancer stick," said Dr. David Morgan, the Chief Science Officer of LED Dental. "It does not replace the traditional head, neck and oral soft-tissue exam."
Buying in to detection
In addition to different science, these companies employ different delivery and pricing methods.
ViziLite Plus is a disposable wand combined with single dose of a mouth rinse and swabs of TBlue. The average cost is $18.50 per use. The low unit cost makes it easy to get started with a small investment.
VELscope is sold as an instrument consisting of a base and attached hand-piece. The manufacturer's suggested retail price is $6,995.00. The relatively high start up cost can pose a barrier to entry. On the other hand, the ongoing expense of the disposable ViziLite kits adds up quickly. The math is easy: $6,995 / $18.50 = 378.
If you saw eight hygiene patients a day, four days a week and half of them needed an oral cancer exam, that would be 16 a week. You would exceed 378 exams in less than six months.
A revised protocol
There is a tendency to think, "The exam I have been doing up to now has been good enough. I will only need to use an enhanced protocol on high-risk patients or those over 40."
That approach is flawed. Anyone who receives a routine head and neck exam as a new patient or recall patient is a candidate for an enhanced examination. After all, it is the routine patient with no obvious risk factors who is most likely to be missed. The protocol most often recommended is for all patients 18 and older to receive a head and neck soft-tissue exam at least once a year.
This may help you catch other oral lesions not found in high-risk cancer patients alone, including Candida, HPV and even HIV.
Most patients are probably not aware they are receiving a head and neck cancer exam as part of a routine examination. Introducing this technology to patients is a great way to let them know you are providing the service, helping differentiate your office from everyone else.
Detecting the profits
There are about 4,000 dentists using VELscope and 12,000 ViziLite users. Together, that is less than 2% of practicing dentists. Joining that minority can be beneficial because patients who believe you are providing advanced care are more likely to stay and to refer others.
Sometimes the justification for adapting a new diagnostic technology is that it is the right thing to do. In this case, it is not only the right thing to do-early detection of oral cancer can literally save a life-it also can be profitable. When you use one of these systems you are providing a service that is different, so you can justify a different fee. Some users do not have a separate fee but most charge between $35 and $75 for the enhanced exam.
The math to justify a return on investment for either system is simple. If you have an average patient base of 2,500 people and you do an enhanced examination on half of them once a year at $60 that is an additional income of $75,000.
If you subtract the cost of the $6,995 VELscope, your gross profit is $68,005.
If you use ViziLite Plus, the exam kits will cost you $18.50 each, and 1,250 x $18.50 = $23,125. If you subtract the cost of the ViziLite from the extra $75,000, your gross profit is $51,875.
Beyond the basics
Dentists can combine examination findings with other technology to further enhance diagnosis. For example, it is possible to attach a camera to the VELscope hand-piece and take high-quality digital photos of the tissue. These images can become part of the electronic patient record and be used to observe changes over time.
As more data is collected and more experience developed with these protocols, dentists will be able to send the digital photos (both enhanced and normal) to a specialist for a preliminary evaluation that could save patients time and money.
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