If the patient has had the problem for more than 14-21 days, and the dentist doesn't know what it is, I want that patient to have a referral to a dental medicine specialist (they are at most dental schools and are not just a regular dds), or I want that tissue looked at and biopsied by a periodontist, oral surgeon, or ent, who sends it out to a certified pathology lab. This is especially true if the patient comes into the practice and says day one that they have had it in their mouths for at least two weeks. This is not the time to mess around with lights and brushes if the DDS does not know difinatively what he is looking at. The problem with the biopsy brush is that it is designed (and the company states this) for early (under 14-21 days) determination if something is worth taking a more serious look at or not. That more serious look, is a biopsy done with a knife or a punch. While I'm in favor of the brushes use up to that time period, anything after three weeks that is still there needs something more than a brush biopsy. It also cannot be used on open sores, so there is another limitation to it that would not exist with a conventional biopsy. Even if the brush comes back positive (abnormal actually, since the brush provides no architecture because of its collection system it scrambles all the cells up and you do not know what level in the tissue they were at) they still have to go out for a regular biopsy (published cdx brush protocol). I'm with you, anything that will get people interested in doing a screening is OK with me. But just because the Visilite lights something up, that doesn't mean the dentist is going to do anything about it...in his mind the thing lights up things that are not malignant 95% of the time. I am afraid that this is going to put the dentist into a watch and wait mentality. And the brush is only good for those lesions that are not actually sores, but discolored tissue, so that is also limiting besides the early period when it's use is of optimum value. Remember it is used to prevent someone from going three weeks without a diagnosis and the dentist isn't sure. A punch or incisional biopsy takes 5 minutes. You get a finite definition of what's what from the pathology lab in less than 4 days. Done deal. These things are all helpful, but I want to know without ambiguity, and I want to know NOW. I do not think that it is in the realm of responsibility of a general DDS to diagnose cancer. I think they should be looking for suspect tissue and referring. Too many cases of watching and waiting have shown me that DDS are not even doing the most basic thing - referral. This is nothing less than treating the patient with watchful neglect in my book, and any one of them that does this should end up in court. In my lectures to dental students, I always tell them when you refer, you are covering your rear end, and you are potentially saving the patient's. Referral to someone more knowledgeable is also deferral of lawsuits, and it is in the patient's best interest.