Hello forum;

I may not be in the right forum for what I have to say, and if that is the case I apologize to all and trust I will receive some proper guideance.

Assuming I am in the correct forum, I have a comment following my reading of the opening article found in "Dental Issues", which discusses the need for a heightened awareness for regular cancer screening within the dental community.

I spent almost 25 years as a financial and business consultant specializing in the health professions, and well over 90% of my clients were dental practitioners seeking financial advice.

In recent conversation with my own dentist who has treated me for over 20 years, I understand that routine cancer screening is still not an approved billable procedure on the current fee guide in our neck of the woods.

My dentist has been doing routine cancer screening for the last 15 years, and does so as a value added service for his new and existing patients. Unfortunately, not all dentists are prepared or are financially able to provide such additional service on a pro bono basis, and for those and others, it simply will not happen until they are able to legitimately bill a patient or an insursance company for the procedure.

Consequently, the number of people who are denied the benefit of early detection is astronomical. Part of the solution is political in nature, and public pressure should be brought to bear on the regulatory and governing authorities to expedite whatever changes are necessary to the fee guide so that cancer screening is a billable procedure without further delay.

My dentist also demonstrated a new-to-the-market piece of diagnostic equipment he acquired for his practice that reportedly can identify cancerous tissue within the oral cavity. A very impressive device, about the size and shape of a standard hair dryer, that shouldn't elevate anyone's anxiety in visiting the dentist's office.

However, its "SSDD"; Same Situation, Different Device. Put another way, I found out that the use of this new tool is not a billable procedure as yet, which explains why its use is not more widespread. The approximate $8,000 capital cost was money out of my dentists pocket that he is unable to recover through the current fee guide.

That represents a substantial financial disincentive to any business person, including your dentist !

If many dentists cannot afford to spend 30 seconds or so examining the oral cavity for evidence of cancer using his or her eyes only, then it is arguably less likely that dentists would voluntarily spend the sum of $8,000 to search for evidence of cancer using a fancy new piece of equipment either.

Once again, it needs to be a billable procedure if the public is to derive the ultimate benefit of its use.

The dental profession as a whole has undergone extensive change over the course of the last 20 years particularly in the promotion of "preventive dentistry." In many ways they have worked themselves out of a job. Dentists have also had to improve their business awareness and management skills as the costs of staying in practice have increased at a faster pace than the fee guide in most regions of the country.

In order to survive in a very competitive environment, dentists have had to change their way of thinking from being a "healer" to being a "business-person", as distasteful a thought as that may be. This means the vast majority of dental practitioners today are in the right mindset to accept these new procedures and implement them once they are financially compensated for the time and effort as well as reimbursed through the fee guide for any capital expenditure for new technology.

The public has not been conditioned to associate doctors and dentists with financial motivation, but it is time for anyone at risk of getting oral cancer (any member of the general public, for instance) to become aware of this reality and demand the swiftest action. The sooner cancer screening is made a billable procedure, the sooner cancer screening will be made a routine procedure.

Increasing cancer awareness through dental screening is no more difficult a task than that. Period.

Given that approximately 60% of the population visits a dentist at least once per year, but only an estimated 15% of dentists perform any type of cancer screening on their patients, one doesn't need to be a mathematician to calculate how quickly and where a substantial improvement in early detection could be realized.

How many cancer patients would benefit from early detection than otherwise would be the case ? There is little doubt that the number would almost immediately justify any positive action initiated in that direction.

Just something to think about when contemplating further advances in cancer diagnosis, and in particular, the roles we all can play in its early detection - dentist and member of the public alike. Get the word out and let your feelings be known !

Thanks for listening, and good fortune with any personal battle with the beast called cancer.

Sincerely,
JT2

Hello JT2

Your post is fine here. "Activisim" may have been more appropriate but it does fall into "Symptoms & Diagnosis".

This topic will generate many responses from many senior members and activists.

My dentist always did an oral cancer check at every visit. Whether is was a complete one (3 minutes I heard) I do not know, but he would pull the tongue out and LOOK under it and around the mouth. Maybe 30 seconds. I think the 3 minute check involve feeling the lymph nodes.

I would say this was a value added service he just included. I know you will hear from Dr. Jerry Wilk DDS. He just purchased some new equipment that has been discussed extensively here.

Anyway, Welcome to the OCF. Best Wishes in Your TX. Petey

I have to weigh in here, though I am sure that Jerry will also, and he is, of course, more informed than I.

First, the device to which JT2 refers is surely the Velscope, which Jerry has purchased for his own practice. Yes, it would be wonderful if every dentist had one!!

Secondly, and more important, from my own point of view, is that just DOING a "cancer screening" will do little good if the dentist in question is not fully educated about what he is seeing. As one whose oral cancer was overlooked and mis-diagnosed for over 8 months, I can attest that some dentists (mine, at least) do not suspect cancer quickly enough.

What could have been done differently for me? 1. If I had been more aware myself, I would have insisted on a return visit the first time we noticed a tender spot, and a biopsy if it didn't get better in that time. It would have meant that my surgery would have been MUCH less destructive.

2. If my dentist had in place a policy to have patients who have had an area treated return for a quick look to be sure that it did, indeed, improve, then we would have biopsied the area at that time, not allowing my lesion to spread in my mouth.

3.....or the second time....

4. ....or the third time (well, the third time, after he had cauterized my malignant lesion for the second time...eek!) he showed that he did not know what oral cancer in this location looked like, because it was classic, and obviously spreading, and very clear to the naked eye....and he still called it ANUG (formerly called "trench mouth.")

My point: The public MUST be made aware of the possibilities of oral cancer, and the dental profession MUST be certain that their practioners are competent in this area. I do not know how to be sure that your own dentist is competent. Mine was not, as I unfortunately discovered, yet how could I have known? I don't know. Perhaps some certificate that verifies that they are a certified cancer screening office, but they should already have one of those. It is called a DDS degree on the wall!!

Maybe we should work toward a separate course in cancer screening that would give refresher information to the dentists....and their hygienists, since much of the actual hands-on work is done by them.....and then they would have some concrete evidence of specialized, up-to-date training in the field of oral cancer screening.

Hi JT2,

Received an email from Petey after he read your post and I see that not only he, but my dear friend, Colleen as well, knew I would be posting.

First of all congratulations on being cancer free since May/06. Your post is certainly a timely one, very well written and thought provoking.

Like Colleen, I assume that the device that your dentist purchased is a VELscope. I have posted some information about it in the Activism Forum and I am in contact with either their sales rep or advertising department quite often. By the way, the VELscope was developed by a company in BC, Canada called LED Dental, Inc.

If it is the VELscope, I assume that cost of $8,000 you mentioned is Canadian money. We pay $5,000 in the states.

In our office we have never looked at oral cancer screenings as a money making service and have always included it as a part of our examinations. Whether the doctor does one at an new patient exam or a hygienist does one at a recall exam, we don't charge for it. That is not to say that charging for it is wrong, this is just our office policy.

As far as the VELscope is concerned or the system we used to use, called ViziLite, we have decided to charge only enough to cover our costs. We charge $25 for the VELscope exam and I can say that only 3 people have declined the exam since I started doing them.

The value of these services in regard to the posssiblilty of saving someone's life, is immeasureable and we want to do whatever we can to encourage patients to have the exams performed. The financial aspect is not and never will be, a consideration for us. However, I do know that we are the exception to the rule.

In the USA, the use of the VELscope can be reported to an insurance company by the dental procedure code 0431, however, mostly all insurance companies do not pay for it. So it's billable, but not covered!!! I would think that it could be billed with the same code in Canada.

As with other newer procedures that have come about in dentistry over the years, it takes quite a long time for insurance companies to increase the premiums in order to cover the cost of adding benefits. There is no doubt in my mind that this will happen, but I have no idea when. Insurance companies are in the business of making money and that's why their corporate offices are in such magnicent buildings.

I'm sorry if this post is disjointed as I have been typing it between patient visits.

Thanks for bringing this topic up and I hope to see more posts from you in the future.

Jerry

I see no reason for an insurance company to be additionally reimbursed for oral cancer exam which takes a few minutes and does not include the Velscope and is being done as part of a periodontal, normal cleaning or other procedure, however my insurance does. My prosthodontist charges $35 for it, my periodontist doesn't charge anything.

AND as Colleen points out, many of these guys don't recognize cancer when it is staring them in the face and now we want to pay them extra for misdiagnosis(sorry Jerry, not you). However, if the dentist is putting out $5000 for the device, I do think the exam should be covered by insurance and the dentist should charge for it. I think my dental insurance is overly generous covering an extra oral exam charge. Too bad they aren't on anything else. Wonder what they pay for Velscope exams?

Take care,
Eileen