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23Sep/0726

ViziLite

During a recent visit to the dentist, I was offered an oral cancer screening using a product called ViziLite Plus (Zila Pharmaceuticals). Given a $65 price tag that is not covered by insurance, I accepted the marketing literature but politely declined the screening until I had a chance to do my own research. Apparently, everyone above the age of 18 is at an "increased risk" for oral cancer. I was then asked to sign a waiver (part of the Zila exam materials), which in my opinion, reeks of scare tactics.

As far as the details go, it seems you rinse with a dilute acetic acid solution, after which the dentist sticks a special light in your mouth to better see lesions that may be an indicator of oral cancer. According to the web site, unit price on the exam kit runs from $20-30. There are some interesting references to be found online:

Vizilite denied ADA seal of Approval [2005/11/10]

Kinda long, but very interesting:


listserv discussion of ViziLite [Bulletin Board of Oral Pathology, Nov 2005]

Short and to the point:

Efficacy of the ViziLite System in the Identification of Oral Lesions [abstract from Journal of Oral and Maxillofacial Surgery, March 2007]

[Edit 2009/04/24: This entry was posted originally a year and a half ago and continues to receive feedback, which thrills me to no end. I am adding a link to a fairly recent article that discusses the subject more thoroughly. Please note that I have no affiliation with the web site, and the author of the article is not a dentist but a retired psychiatrist and consumer advocate.]

ViziLite Screening: Does It Make Sense? [Quackwatch, September 2008]

[Update 2011/02/16: Adding related link, info from Zila web site. I'm not sure what information is presented in patient brochures currently (it's been a long time since I wrote my original post), but this is good information to have as a patient as opposed to telling everyone over 18 that they are at an increased risk for oral cancer without putting the statement into proper context.]

From the Zila Vizilite FAQ:

Because more than 25% of oral cancer victims have no lifestyle risk factors, many practices are now offering annual ViziLite exams to all adult patients (age 18 and older tobacco users of any age). Patients age 18 to 39 are at increased risk for oral cancer; Adults age 40 and older, and tobacco users of any age, are at high risk for oral cancer. Patients age 40 and older with lifestyle risk factors such as tobacco use, chronic alcohol use, diabetes, HIV an HPV 16/18 are at highest risk for oral cancer.

Regarding the profit issue, check out the Zila product training materials, specifically the "Revenue Production" section under "3. Incorporating Vizilite." The video clip touts the benefit of increasing office revenue and notes a $20-32 cost for the test assuming patient charges ranging from $35-100.

Study questions effectiveness of oral cancer detection devices [DrBicuspid.com 2008/09/30]

[Update 2011/03/22: updated BBOP link (Nov 2005) as archives were moved]

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  1. I just had a similar experience at my new (second visit) dentist. Not only did they
    require me to sign the waiver form you mention (scare tactics indeed) but I had the joy
    of doing so while seated in front of a poster telling me that “One American every
    hour dies of oral cancer”. I won’t be going back to this dentist! Thanks for this post.

  2. I was offered the same test, I love my dentist for checking oral cancer on me.
    Why would you say no to something as important as this. Your mouth is the most important part of your body, shouldn’t you check it???

  3. Yes, checking for signs of oral cancer is undoubtedly an important part of the regular dental visit, but the effectiveness of the ViziLite product is still in question in my opinion. Is using ViziLite significantly more effective than conducting a regular visual exam? Ask yourself why there isn’t a similar approach (opt-out with a waiver form) with regard to X-rays and fluoride treatments. Does your insurer cover any part of the ViziLite exam cost? Why does Zila offer payment to dentists for submitting cases where ViziLite works? Given the manner in which the product is offered to patients, I cannot help being a bit skeptical.

  4. I am a dental assistant of 15 years. I have seen alot of products come and go in that time. Some are scams, some are great assets to the dental profession and to the patient. That being said, our office started using Vizilite approx. 1 yr ago. I agree that there is not enough evidence that it is anymore effective than the visual oral cancer screen that you SHOULD be getting by both your hygienist and your doctor at every 6mth cleaning and exam. I agree that it is only a money maker. Ask yourself why the doctor is paying around $25 per unit and charging around $65 per exam. Knowing that ins. does not cover, couldnt they reduce the fee to their cost if early detection were the only concern? Medical and Dental offices are also businesses that have to make money. Not to say that making money and caring for your patients welfare cant be done, we do it every day. The waiver is not so much a “scare tactic” but a CYA (cover your ass) so that down the road if you are found to have ADVANCED oral cancer, the doctor can say that we offered an early detection screening and the patient refused. Long story short, in 1 yr I have not seen a great enough increase in detection to endorse spending the money.

  5. If offices were out to make money on the exam they would charge a lot more. It is actually the least profitable product that is offered in dental offices. We do require patients to sign refusals for x-rays b/c it is a part of the exam and a full exam can’t be done without them. As for the fluoride, refusing that is not going to kill you it will just cost you more money in the long run with restoration fees. Why does one insurance say we can charge $600 for a crown and another will say $800? The bottom line is the fees that are charged are to offset cost of running the office. Believe me We do not make money off of vizilite. I have been known to do it for free because that is how strongly I feel. I have had fellow hygienist’s that have lost patients to oral cancer. One being only 23 and having no risk factors. It is a small price to pay to save your life. Unfortunately oral cancer in stage 1 and 2 can not be detected by the naked eye. If you want to wait until stage 3 or 4 then you can talk with my oral cancer patients who now have no teeth and are missing half of their mouth. They will tell you it is stupid to not pay $65 because when you are $650,000 in debt with medical bills $65 sounds much more appealing

  6. money maker? take a look at the stats. The visual exam that they should get has been proven not to be an effective means of early detection of premalignant lesions and early stage cancer. ViziLite Plus with Tblue is a highly sensitive cancer screening technology (100%) with the Tblue staining technology (no false negatives, reduces false positives). At $65, it is far less expensive than other cancer screening technologies, and more insurance companies are reimbursing. But, insurance companies shouldn’t dictate treatment. Bottom line, patients are provided a dental professional’s recommendation. The patient can choose to decline. Most patients, when offered, don’t decline, however, because they understand the need for early detection

    zila offered payment for case reports to publicize the benefits of early stage detection.

  7. Melissa- if you are 23 you are at an increased risk according to the vizilite. It also does not have the ada seal of approval and there is no evidence that it is beneficial. I will not ask my patients, because it will not catch cancer in early stages 1 and 2 there is no proof of that. It will also show linea alba, cheek biting, and trauma as positive results

  8. I went to a dentist as a new client. While they were in the middle of the Vizilite procedure, they told me that it may or may not be paid by the insurance company. I am a non-smoker with no family history of cancer. I feel duped out of $65. This smacks of incremental profit margins. I can just picture 50 Dentist on a weekend cruise ship seminar on Vizilite with instructions on how to “ding” the patients and make that new Lexus payment. A little research on-line shows that this is a VERY profitable product for Zila Pharmaceuticals. I am not saying that this is useless, but given my circumstances, it is about the $$$$.

  9. When was the last time your dentist examined the underside of your tongue? Thats where my oral cancer was detected and I am 34 yo with 3 small kids and now half a tongue, no nerves in the lower left side of my jaw, 5 teeth dying and am about to have further surgery to try and correct my drooling. I smoked occasionally for 5 years from the age of 16 to 21 and have no other risk factors. If this product makes a dentist actually examine your mouth in full then for gods sake pay $65.

  10. I have never used any tobacco products, have no family history of oral cancer and no complaints. I got strong-armed into getting a ViziLite screening today by a dentist who found nothing. I paid $70 out-of-pocket for something to swish in my mouth and a tech who shone a flashlight in my teeth. I found that odd, so I began researching this product as soon as I got home. I got ripped off! They tried selling me tooth whiteners and all sorts of products and procedures and I walked out without the cleaning I was there for. I paid the $70 and walked out. I am now looking for another dentist.

  11. Dear patients,
    Please understand that the first duty of a health care provider is to “do no harm”. Every good dentist performs an oral cancer screening using the naked eye. However, there are abnormalities that can be missed, which is where the Vizilite steps in. When you go to your medical doctor for a pap smear, you don’t tell the doctor,”Just take a look! As long as everything appears normal, it probably is!” In fact, you would immediately choose another doctor if they told you visual examination of your cervical cells was all that was needed. You would be livid if the doctor told you that you could not have a pap smear because your insurance did not cover it, even though it was only $65. More than likely, you would pay the nominal fee to insure that you were completely, to best of the doctor’s ability and available technology, evaluated. Vizilite, although valuable, is optional. I do not believe for one moment that any one is being harangued into doing the exam. The reason that you decline the vizilite exam on the form is so that in the future, because of the inherently litigious nature of the uneducated (dental knowledge only) patient, you do not sue your doctor if you are diagnosed with oral cancer. To those individuals who sincerely believe that after walking through the waiting area, past the receptionist and office manager, to sit in a chair with a number of disposables on the tray where your dental assistant or hygienist drapes you, that the doctor is paying off his or her Lexus with your piddly $65 is insane! If only you understood, what is required to run a dental office, you would be arguing with your insurance company instead of the front desk about the poor reimbursement. Unfortunately, you are not paying for cruises and luxury homes, you are paying inadequately for a service that is rendered with an significant amount of expertise.

  12. Dr Latifah

    Obviously your protecting your establishment. Our piddly $65 and I was attempted to charge $75 and that adds up rather quickly, because I assume you see more than one patient a day. I moved to a new city and found a new dentist and made appointments for myself, college age daughter and son. Daughter was first to be seen, After xrays the Hygenist tried to strong arm her into signing on for the vizilite exam and would not clean her teeth until she signed. But she is a smart girl and called Mom back, she knew I was paying the bill. So I began to ask questions why she needed this, with no smoking history, no family history of cancer etc…. Insurance won’t pay. I still couldn’t believe they wouldn’t visually check and clean her teeth like we’ve done year after year. Anyways after 10 minutes of no real answers, and the Dentist didn’t even show her face in the room, My children and I all left the building. So this dentist Lost 3 new patients for trying to strong arm me into cancer screening with this visilite with no good explanation.

  13. Careful oral cancer screenings are extremely important. Comparing the Vizilite to a Pap smear, a procedure in which a specimen is looked at under a microscope by a pathologist to discover cellular abnomalities, is just crazy. If you want to make a more accurate comparison, on Oprah, Dr Oz talked about some kind of a brush test that dental professionals can do a in their office, and it goes to a lab. At least it sounds feasible.

    In other words, there are options. We, as patients, shouldn’t have to go along with, and pay for the poor choices of our dentists or hygienists. Where else in medicine is a glow-stick used to help detect something? They actually dim the lights to help them see…? If it worked, wouldn’t dermatologists use it?

  14. Interesting discussion. Looking at several articles on this product and how it is marketed, it certainly raises many questions of it’s effectiveness. I question whether some people that have posted have the expertise that they suggest. I have a very good dentist, who unfortunately joined a very organized dental group to simplify his practice. To me it is clear, that my dental hygeinist is being strongly influenced into pushing this product by the office. That is not normal for her, but, she probably wants to keep her job. It is interesting to learn that a dentist should be doing a visual exam and comparison tests have shown that Vizilite is not any more effective than a visual screening. It is interesting to learn that EVERYONE over 18 is considered high risk. None of this is disclosed in the literature or when the dental office pushes the test. That in itself tells me that Vizilite is not truly ethical. I am not in the dental profession, but do work in medical device manufacturing. The claims and the consent form to decline from Vizilite are very much scare tactics in my book and are pushing the limits of marketing as seen by the FDA. I’ve been with older family members in the hospital where several options were presented and I don’t recall don’t recall having to sign a form to decline a procedure. Lastly, can you pay off a Lexus with it?. Well if you are already being paid to do an oral exam and cleaning, and make an extra $30 during that 30-4 5 minutes, I’d say it sure does help! Sure it takes a lot to run an office with many expenses, but these types of things seem to distract the professionals from patient care and attention to the individual. I do believe the hygienist spent more time reviewing the literature, pushing it and going through signing the form, than the dentist needed to perform an oral exam.

  15. I would rather pay $65 any day then to not do the exam at all and find out later I had oral cancer. That stuff is not something you want to mess with. Even if you don’t have any risk factors, you can still get it. I did the exam, and it was the easiest thing I ever did at the dentist. It was worth it to me and I would do it again.

  16. I am actually having a Vizilite test done tomorrow(10/27/2009) with my cleaning

    I have had a very small painless bump on my lower lip since June, it has not grown.

    When I had my yearly exam in Sept. my dentist gave me a visual cancer exam, he felt all over my lip for any lumps. He said that the lower lip has hundreds of minor slaivary glands and it looks to him that it just became raised and is harmless and my mouth looked good.

    I asked him if there was another type of test and he mentioned the vizilite, but again stated He saw no signs of oral cancer and said it was up to me if I wanted the test. I actually felt he was trying to talk me out of it. But I had used smokeless tobacco for 20 years, so to make myself feel better I scheduled the exam.

  17. There still doesn’t seem to be any agreement as to whether Vizilite or allied systems work; but there does seem to be evidence that the toluidine-blue dye test is effective. I don’t know if the studies are large enough to be significant.

    WRT the cost – that $45 profit is multiplied by the number of people they can sell this thing to; that adds up fast. The test is a high-profit item, too: It’s usually administered by a hygienist, whose time is cheaper than a dentist’s; the dentist gets involved if the hygienist spots anything, and in my (limited) experience also does a visual.

    IMO, an oral-cavity screening should ONLY be done by a dentist or other physician.

    To put this in some economic perspective: A friend who is a dentist told me, about 10 years ago, that he needed to gross $2500 per day in order to break even, That’s over $600,000 a year, and this was a small practise: one dentist, one receptionist, one assistant, and one p/t hygienist, in rented space in a suburb of NY.

    Clearly, that’s a big nut. So if a dentist can boost his/her margins a few hundred dollars a day by adding a simple test, and just incidentally protect against future litigation, the motivation’s pretty strong.

  18. Just like many dental devices, the Vizilite is of dubious patient benefit. It is part of the dog and pony show with lasers to help fill, the wand to help numb teeth. If you ever run into a dentist using all three they are stupid to have bought the laser, clumsy to need the wand and unethical to routinely use the Vizilite. Head for the hills with your wallet.

  19. I had the Vizilite test done and it showed a pale inconclusive area in my check. It’s probably because I have an extremely misaligned bite and frequently bite my cheek when eating. Without the product nothing shows. If I’m going to have a biopsy, I want to go to an oral surgeon who accepts medicare so the biopsy and any other surgery is covered by my regular insurance. Guess what? I can’t find someone who does the Vizilite, is an oral surgeon and accepts medicare.

    The biospy and lab could run me $500 thats I don’t have!

  20. Yep, it does seem to be a scam. Wish I’d check this website out first before I had the Vizilite test done. I like the dentist — have gone to him for over 20 years — so I guess mostly what’s been accomplished is helping him support his Beemer and other expensive toys including a luxurious cabin in the woods. Still like him I guess but like and trust him a little less than before.

  21. some of you people on here are so cynical its sad. Why can’t anyone take oral cancer seriously? what’s wrong with early detection? and yes, Doctors mark up the test but they spend extra time and expertise performing the exam or paying their hygienst (whos making 40-50per hour) to do the exam.

  22. I take cancer seriously, and I see nothing wrong with early detection.

    My question is whether this test is a proven method, and reasonably priced.

    My impression is that it has not been proven (yet), and the price is high.

    There are lots and lots of tests, procedures, diets, etc available for all kinds of things including cancer, but even though I support early detection, I do not request or accept them. There needs to be some proof that it provides a benefit other than profit before I am comfortable spending money for prevention or early detection.

    ymmv

  23. My son was duped into taking this test and it returned a False Positive for which he ended up having to have a biopsy. I am an RN and I told him to never take these kinds of tests without calling me first. The whole ordeal ended up costing him hundreds of dollars the insurance woul not cover, to say nothing of the panic and fear it cost him and his wife.

  24. Zila now has a strategy to rip patients off with regard to cleaning teeth. The “know the stages of periodontal disease” scam comes complete with marking material such as posters, tri-folds and software. My dentist didn’t want to talk about anything other than getting me on a “treatment plan”, I thought I was talking to a used car salesman. He wanted me to get worked on every 6 months, and it might even be better to break up the treatment to two visits every 6 months. I’m in the Army and we are at a remote base so we have to get our medical on the economy. I went back and spoke with my fellow team members and we all were at “high risk” and required “extensive cleaning”. Bottom line, Zila is a rip off and from here on out if I see any of their marketing materials in a dentists office I’m walking out!!!

  25. Sounds like the negative people on this forum have it all figured out. All dental professionals are scam artists and all we care about is making money. This is so unfortunate. I am a dental hygienist and have been saving teeth and treating patients for over 17 years. You come to us with these diseases; we do not give them to you. Periodontal disease is treatment planned (Brian!) How else can we reverse and maintain your chronic disease. Hey! here is a thought; google periodontal disease. Maybe you will learn something. We are trained and schooled extensively to stay abreast of current treatment algorythms. This schooling is not free by the way. We have to pay for it. Charging for exams, paying for groceries is what makes the world go round. If you want free bad dental services then find state programs.
    As for ViziLite exams; anything we do above and beyond the standard exam is worth every penny. I pay out of my pocket for additional breast exams that my insurance does not pay for. PEOPLE!! LISTEN UP!!!!!!! INSURANCE COMPANIES ARE BUSINESSES. THEY DO NOT CARE ABOUT YOU OR YOUR HEALTH!! THEY ONLY WANT TO PAY OUT THE MINIMUMS!!!!
    Dentist’s who offer the adjunctive oral cancer screening are not getting rich off your oral cancer exam. They have incorporated these exams because they care about you as their patient.
    As for nurses on the forum; you of all people should be adovcating adjunctive screenings. The fda cleared vizilite as an adjuntive screening; so there must have been so evidence to prove this screening actual does enhance abnormalities.

  26. If it was for free or if the insurance paid for it NO ONE would be complaining! Everyone wants everything unless they have to pay. What a shame..What do you people do for a living


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