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Medical Forum / General / Dentistry / October 2007vizilite question
Went for the semi-annual cleaning and the dentist handed me a brochure on vizilite. From what I've read, the effectiveness of this procedure is questionable and it does not appear to have the ADA's approval. At the time, the dentist mentioned that if the insurance did not cover it, I would have to pay $65 for the procedure. I'm leery about shelling out money in addition to what I pay in insurance for a product that does not appear to be a) considered a required procedure by the insurance and b) apparently questionable in the eyes of the ADA. Does anyone have additional information and/or experience with the product? It seems that it would be a bit odd to decline the procedure when I have my next cleaning. If the product is not considered to be effective, this also raises a concern with why it is being recommended in the first place. Insurance companies do NOT decide if a product is appropriate or not. They merely decide if they wish to pay for it at the level of premium collected. Vizilite is a good product, you simply need to decide your risk factor and make an appropriate decision. In a few years, tests like this may well become part of the standard of care. Right now the test is too new to be that widely accepted. I polled my patients to see if they would be willing to pay for the test, and then decided not to offer it based the responses I received. It is a good test and I do believe in it, I just did not have enough patients (even those at high risk) who were willing to accept it. I think denial comes into play here.  Signature/ Amatus / > Went for the semi-annual cleaning and the dentist handed me a brochure > on vizilite. From what I've read, the effectiveness of this procedure [quoted text clipped - 14 lines] > effective, this also raises a concern with why it is being recommended > in the first place. > Insurance companies do NOT decide if a product is appropriate or not. They > merely decide if they wish to pay for it at the level of premium collected. Ok. Point taken. > Vizilite is a good product, you simply need to decide your risk factor and > make an appropriate decision. In a few years, tests like this may well > become part of the standard of care. Right now the test is too new to be > that widely accepted. Would this be a reason that the ADA would not certify it? > I polled my patients to see if they would be willing to pay for the test, > and then decided not to offer it based the responses I received. It is a > good test and I do believe in it, I just did not have enough patients (even > those at high risk) who were willing to accept it. I think denial comes > into play here. This makes me curious about what the response will be at my dentist's office. >> Vizilite is a good product, you simply need to decide your risk factor >> and [quoted text clipped - 3 lines] > > Would this be a reason that the ADA would not certify it? That and certain costs involved. Not all manufacturers choose to pay for ADA certification. > It is a > good test and I do believe in it, I just did not have enough patients (even > those at high risk) who were willing to accept it. I think denial comes > into play here. I don't have the brochure in front of me, but I seem to recall that they labeled everyone over 18 at moderate risk and as you approach 40, you're put into the high risk category (or "highest" with alc. abuse, tobacco, etc.). Those are statistical risks. Obviously skewed in favor of the result they want. I would personally downgrade the risks they list by about 30% Signature/ Amatus / >> It is a >> good test and I do believe in it, I just did not have enough patients [quoted text clipped - 6 lines] > you're put into the high risk category (or "highest" with alc. abuse, > tobacco, etc.). >> It is a >> good test and I do believe in it, I just did not have enough patients (even [quoted text clipped - 5 lines] > you're put into the high risk category (or "highest" with alc. abuse, > tobacco, etc.). Age alone does not put someone in a high-risk category. In 31 years I have never seen a PRIMARY intraoral cancer in a patient who did not smoke AND drink heavily. Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 I was considering the Vizilite just for my patients who smoke and those over 70 years of age, but not very many were willing to pay $45 out of pocket is their insurance did not cover the test. I figured it would cost about $40 to administer the test and $5 to pay someone to look in the mouth. I am sure the disposable portions of the Vizilite are even more expensive now. Signature/ Amatus / >>> It is a >>> good test and I do believe in it, I just did not have enough patients [quoted text clipped - 12 lines] > > Steve > I was considering the Vizilite just for my patients who smoke and those over > 70 years of age, but not very many were willing to pay $45 out of pocket is > their insurance did not cover the test. I figured it would cost about $40 > to administer the test and $5 to pay someone to look in the mouth. I am > sure the disposable portions of the Vizilite are even more expensive now. I'm not sure how easy it is to search the archives at the bulletin board of oral pathology. It is a mailing list I belong to, out of SUNY Buffalo. You might enjoy some of the discussions--there are some smart people there, incl. a few I've had the pleasure to meet. Primarily oral pathologists, OMFSurgeons, and the odd GP ;-) Interesting discussions also about brush biopsy. It was my first source of information about bisphosphonate-related ONJ. http://www.sdm.buffalo.edu/bbop/ Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 On Oct 16, 3:06 pm, Mark & Steven Bornfeld <bornfeldm...@dentaltwins.com> wrote: > I'm not sure how easy it is to search the archives at the bulletin > board of oral pathology. It is a mailing list I belong to, out of SUNY [quoted text clipped - 5 lines] > > http://www.sdm.buffalo.edu/bbop/ Interesting...I am literally less than 5 miles from the UB campus. I appreciate your and Amatus' input. Thank you. > Went for the semi-annual cleaning and the dentist handed me a brochure > on vizilite. From what I've read, the effectiveness of this procedure [quoted text clipped - 14 lines] > effective, this also raises a concern with why it is being recommended > in the first place. Excellent question. The effectiveness of this device has been questioned--I've seen discussions on the bulletin board of oral pathology. Generally speaking, I believe that if a lesion is questionable in appearance, it should be biopsied or the patient referred to an oral surgeon for further evaluation. It is a screening device, and as such does not give you a diagnosis--this really requires a tissue biopsy. Since the mouth is accessible to visualization, it should be possible to do a good visual exam and refer as necessary. Every dentist should know what cancerous and precancerous lesions look like. Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 On Oct 16, 12:28 pm, Mark & Steven Bornfeld <bornfeldm...@dentaltwins.com> wrote: > Excellent question. The effectiveness of this device has been > questioned--I've seen discussions on the bulletin board of oral pathology. [quoted text clipped - 6 lines] > Every dentist should know what cancerous and precancerous lesions look > like. My understanding is that this procedure makes the lesions more visible (correct?). My dentist performs a visible inspection, but it appears that there is nothing more to the current process. Some pathologies will fluoresce to certain wave-lengths of light before they are easily found with the naked eye. Mucosal cancers are very sensitive to this wave-length of light. It does not guarantee that every pathology would be found, it just makes it hugely easier to find them. Signature/ Amatus / > On Oct 16, 12:28 pm, Mark & Steven Bornfeld > <bornfeldm...@dentaltwins.com> wrote: [quoted text clipped - 14 lines] > (correct?). My dentist performs a visible inspection, but it appears > that there is nothing more to the current process. > On Oct 16, 12:28 pm, Mark & Steven Bornfeld > <bornfeldm...@dentaltwins.com> wrote: [quoted text clipped - 12 lines] > (correct?). My dentist performs a visible inspection, but it appears > that there is nothing more to the current process. The light may make the stained tissues easier to see. But there is generally no mystery in a visual exam, and you basically must examine all the tissues that can be visualized. The danger is that the test is abused--either to send patients for unnecessary biopsies, or just as a way to pad the bill. IMO it should NOT be a routine part of every exam. There is enough disagreement in the oral pathology and oral surgical fields that I don't think making this a ROUTINE part of the oral exam is supportable. I have no problem with SELECTIVE use if it makes the doctor feel more comfortable, but it has the capability of both false positives and negatives. It is NOT a biopsy, and anything looking suspicious should be referred to a specialist for biopsy, IMO. Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 |
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