A life-saving practice-builder

April 1, 2009
Throughout my many years in dentistry, I have consistently strived to provide a truly comprehensive treatment approach to my patients.

by Arlen D. Lackey, DDS

For more on this topic, go to www.dentaleconomics.com and search using the following key words: staff training, dental technologies, OralCDx®BrushTest®, Zila ViziLite® Plus, Trimira Identafi™ 3000, LED Dental VELscope®, patient fees, Arlen D. Lackey.

Throughout my many years in dentistry, I have consistently strived to provide a truly comprehensive treatment approach to my patients. I have always felt a responsibility to my patients to explore emerging dental technologies that might allow me to provide them with better oral health care while minimizing and, ideally, eliminating any discomfort or inconvenience.

Part of that comprehensive treatment has always included an examination of the oral tissues and the tongue through the traditional visual and tactile oral cancer exam. Over the years, products have come along that have allowed us to improve our ability to detect and diagnose both dysplasias and cancerous lesions.

The only way the dental community can lower the number of people who die due to oral cancer is to detect the early precursors. A number of new systems are in the marketplace today. Some have years of research behind them, and some have promising research that is still in progress.

Our office has been using a number of these products. The purpose of this article is to help dentists and their staff members learn how to implement the new, comprehensive oral tissue exam into your practice. It is critical that the entire dental office team embrace the concept of preventing oral cancer and stopping this disease. The team must be as committed to this exam as they are to finding decay, cracked teeth, and bleeding gums. Team members must believe they can make a difference.

Today there are four systems in use as adjuncts to our comprehensive oral tissue exam. They are the OralCDx®Brush Test®, the Zila ViziLite® Plus, the LED Dental VELscope®, and the recently introduced Identafi™ 3000 from Trimira.

Most companies will supply training DVDs for using their particular product in conjunction with the oral mucosa exam that can be administered by both dentists and trained dental hygienists. My hygienist and I reviewed the training DVDs and found that they covered not only the oral mucosa exam, but also the conventional intra- and extraoral head and neck exam using palpation and visual inspection under white light. In office training sessions, my hygienist and I practiced using the products on staff members and friends to gain expertise.

We considered several ideas before arriving at our protocol. We decided the screening examination would be performed on each new patient as well as patients of record at each recare visit. We also decided to offer this exam at no charge for the first six months. When it came time to charge a fee, we decided to charge an annual fee rather than a per exam fee. Our reasoning was that dental insurance companies will likely reimburse an annual fee much like they do with cavity detection X-rays.

This accomplished two important things. First, it enabled us to introduce all of our patients to a state-of-the-art technology that is potentially life-saving. Secondly, patient education and acceptance of the procedure require minimal time when it is a no-charge “gift.” As a result, patient acceptance reached almost 100%.

Our practice policy of having new patients see the dentist and the dental hygienist in their first two office visits corresponds to the procedure followed by many other dental offices across the United States. Therefore, we decided that every member of our team should be totally familiar with the systems, but the hygienist would be using them the most since all recare patients — as well as new patients — would be seen in the hygiene department.

Patient fees

At the end of six months, we begin to charge the annual fee, which means that, depending on their recare schedule, all of our patients receive either one or two free exams. Our acceptance rate is over 95% once we begin to charge for the exam.

For those few who do not agree to pay the fee, the reason is almost always financial. Our response to these patients is that the exam is not optional, but a part of our comprehensive hygiene examination. We will agree to waive the additional fee one more time. In most cases, they are willing to agree to the additional fee by the time of their next recare appointment.

Patient marketing

Before their initial exam with any of the new systems, we first remind our patients that we have always conducted an oral soft tissue exam by feeling for bumps and looking inside their mouths for any lesions that might be visible to the naked eye.

We then explain that we have recently invested in new technology that enables us to look for abnormal tissue and in some cases, detect precancerous conditions that might not be visible to the naked eye.

We explain that this new technology helps look for possible problems beneath the surface of their oral tissue in the same way that our annual X-rays help detect possible problems beneath the surface of their teeth. We tell patients that the exam complements the conventional exam by helping assess the overall health of the soft tissue in the oral cavity.

We also point out that the exam can help detect many different kinds of oral lesions, not just precancerous or cancerous ones. We assure them that it is highly unlikely that they have oral cancer, but we also make it very clear that we are taking no chances with their health and that we believe this exam is essential to their ongoing oral health care. At this point, we inform them that there will be no charge for the exam for the first six months, after which we will assess a reasonable annual fee that might be covered by their insurance.

After their first exam with the new system, we give the patient a simple information sheet that communicates important facts about oral cancer incidence and explains why the dental practice is the first line of defense against oral cancer. In addition, we devoted a full page to oral cancer in one of our patient newsletters


While the financial impact of the system on our practice is rewarding, its most important impact has been in enhancing our ability to provide for the oral and systemic health of our patients. During the past 12 months, over 1,500 exams have been conducted on our patients.

We have discovered precancerous conditions in approximately 15 patients. In two of our new patients, we discovered what was subsequently diagnosed to be squamous cell carcinoma. It is possible that our discoveries literally saved these patients' lives.

Often, we see something that arouses only mild concern. In many cases, a brief discussion with the patient will reveal that the abnormality we have detected was probably caused by a hot beverage, cheek-biting, or some other minor trauma.

To be certain, we ask the patient to return in two to three weeks for a follow-up exam at no charge, and in most cases, these conditions are resolved by that time. This means that the vast majority of the time, we are able to give our patients the reassuring news that we found nothing of concern. These facts are comforting to patients, as well as to the clinical team in this dental office.

It is important to remember that this is not an oral cancer exam. It is a comprehensive oral tissue examination. The exam is easy to incorporate into the office, it takes only two or three minutes, it is a pleasant and affordable experience for the patient, and it is economically beneficial for the dental practice. Most importantly, it can help save lives!

Arlen D. Lackey, DDS, FACD, FAGD, has presented in the United States and internationally more than 400 seminars and workshops for dental societies on technology practice administration, cosmetic dentistry, and integrating CAD/CAM systems. He is a member of the Academy of CAD/CAM Dentistry and the Academy of Laser Dentistry. You may reach him by e-mail at [email protected].

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