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Professional News Articles : : ON PRACTICE MANAGEMENT by Janyce Hamilton : Advantages vs. disadvantages of chemiluminescence for oral cancer detection

Advantages vs. disadvantages of chemiluminescence for oral cancer detection

March 07, 2007

Doctors of dental medicine and dental surgery must balance testing, acquiring and using the latest clinical disease prevention and treatment technologies with restoration, cosmetic and other advances.

In dental school, they teach visual inspection techniques and biopsy techniques for those not specializing in pathology.

Whenever I hear about a “new and improved” handpiece, periodontal probe or other innovation, I am skeptical. At each Midwinter Meeting, there are so many booths with the next greatest thing, how can you tell what's important?

When I heard about an inexpensive and fast oral cancer detector to use during exams, I remembered that it's not about making money, it's about protecting the patient from disease. Can using new technology to identify cancerous lesions make your patient feel you are over and above the average practitioner, and engender a sense of loyalty? Or is it just plain scary?

I interviewed Mark Bride, DDS, about an FDA-approved chemiluminescence device, ViziLite Plus, to learn the ins and outs of why someone should use it. Dr. Bride is the Director of Medical Affairs at Zila Pharmaceuticals, maker of the device.

Interview

Janyce Hamilton (JH): What is ViziLite and how long has it been in use and FDA approved?

Dr. Mark Bride (MB): The generic description for the technology that ViziLite Plus uses is “chemiluminescence” combined with Toluidine Blue.  It has been FDA-cleared for use in the oral cavity since November 2001.

JH: How was it invented?

MB: ViziLite was first designed in 1995 for examination of the female cervix, for identification of lesions during gynecological exams. It was initially called “Speculite.” Because the epithelium in the female cervix are nearly identical to those in the oral cavity, it was thought that the same technology could be used in that area, as well. 

Studies showed that this was correct: after abnormalities are swabbed with acetic acid and examined under chemiluminescent light, they present almost identically in both sites.

JH: What are clinicians' options without ViziLite, for either all patients or those in risk categories (smokers, tobacco chewers, chronic alcohol abusers, those with previous precancerous lesions, etc)?

MB: The conventional visual exam and palpation of the head and neck has been and continues to be the standard. Aside from examining with the naked eye, we also feel for deviations from normal in the oral cavity.

ViziLite is not meant to replace the visual exam, but rather to enhance it.

JH: How long does it take to add the ViziLite regimen to the oral exam for the dentist, and is it used only by those with DDS/DMD degrees or by hygienists as well?

MB: It only takes two to five minutes to administer a ViziLite Plus exam, and it can be done by a hygienist.  However, this is subject to state regulation, so dentists should check with their respective state boards for rules governing supervision.

JH: What's the cost of a ViziLite exam and why is this a good value?

MB: The cost to the practitioner when a 40-pack (the most common size) is purchased works out to around $19.95 for each ViziLite Plus kit.  The typical charge to the patient ranges from $50 to $120 with a mean of about $65.  The insurance companies that provide reimbursement are generally doing so in the $40 to $65 range.

JH: So it doesn't represent a significant financial outlay?

MB: No. One of the strengths of ViziLite Plus is that there is no capital cost for equipment to begin using it.

JH: What were the pros and cons that lookers said to you at your booth at CDS Midwinter Meeting this year?

MB: Some pros of ViziLite Plus that come up again and again, whether at the CDS Midwinter Meeting or elsewhere, include: it enhances the practice's standard of care, provides a more comprehensive oral cancer exam, enables the practitioner to capitalize on the revenue opportunity, and ensures that the best technology has been employed in the event of a legal/malpractice challenge. On the con side, reimbursement from insurance companies is not as uniform as we would like at the present time

JH: What is the current trend with oral cancer incidence rates as compared with other cancers?

MB: The most recent American Cancer Society study projects an estimated 11,150 new cases of cervical cancer for 2007 in the U.S., using a new and reportedly very accurate method of prediction recently introduced by the National Cancer Institute. It also estimates the incidence of oral cancer to be 34,360 cases. That's three times as many cases of oral cancer resulting in twice as many deaths as cervical cancer.

JH: Most dentists just do a visual “eyeball” check of the soft tissues--why isn't this sufficient anymore?

MB: The visual exam is clearly insufficient because there have been no true improvements in death rates associated with oral cancer.  There are different diseases that use adjunctive screening techniques that have improved the effectiveness of the examination. For example, the majority of American women over 18 gets an annual PAP smear, which has helped produce an 80 percent decrease in death rates.

It is very evident from looking at this and other examples that oral cancer screening needs a similar model.

As I mentioned, the visual examination has been the standard of care.  There is no way to replace it, but ViziLite Plus can help to improve the overall screening process. 

Additionally, since failure to diagnose oral cancer can exceed policy limits, it would be a prudent idea for a dental office to consider this type of technology.

JH: Do you think using this device would scare any patients who are already fearful of dentistry?

MB: We find that patients generally are grateful to have this type of exam available.

JH: What do you envision for your chemiluminescence product in the next five years?

MB: Since awareness of oral cancer among patients and consumers, generally, has been low, we need to simply continue to raise public awareness, which will, in turn, create demand.

Conclusion

The American Cancer Society recommends that all dental patients have a complete examination of their oral soft tissues annually. Dentists who are comfortable without using additional technology--for example, the ViziLite Plus rinse and light wand scan--can continue to rely only on a visual check. But the oral cavities of certain patients--especially those over 40--who use tobacco products, drink alcohol weekly, or who have a familial history of oral cancer, may require closer scrutiny. Getting a ViziLite tester kit and using it on a few of these patients is the way to decide if it works for you in a beneficial way, or if it doesn't.

Contact Zila Pharmaceuticals at www.zila.com or (866)945-2776 to learn more.

Janyce Hamilton is a Chicagoland freelance dental writer and editor. Send suggestions for topics to be covered, or any comments on this column, to review@cds.org.

Copyright 2007, Chicago Dental Society