Cliff's Notes

The Business of Dentistry

Oral Cancer, Your Silent Killer & What’s A Spirapost?

Cliff’s Notes for August 22, 2010

Cliff Marsh, Henry Schein ……Cell: 201-321-7494……Fax: 201-262-2210…..E-mail:

“Try not to become a man of success but rather try to become a man of value.”Albert Einstein

In This Week’s Issue
• Oral Cancer, Your Silent Killer! It Feels Great When You Save a Tooth, What About When You Save A Life?
• Spirapost PFS, Absolutely The Best!

Oral Cancer, Your Silent Killer!……….
“It feels great when you save a tooth, what about when you save a life?”
Mr. Sam Jones and his family have been coming to your dental office for 10 years. You talk to him and his wife about their 3 kids, the expenses of education, the price of milk and all other life experiences as part of your “marketing program.” His wife, Mary, had some soft tissue issues several years ago and went through your perio management program. Some deep root scaling and Arestin solved her problems and now everyone is healthy and on a 6 month re-care program.

Today, Sam came into the office for his routine check-up. Last time he was in (6 months ago) there was a small white spot on his tongue and you noted it in your chart as a “watch”. Today, the spot was still there so you plan on referring him to the OS for a “look see” and probably a biopsy. Unfortunately you know what the diagnosis may be. What’s worst, is that you could have identified it years earlier when the survival rate is 90% or better. Now you have to explain to his wife why you didn’t diagnose it sooner when the technology has been available for years. It could have identified it as early as 3 years ago. I guess the $45k BMW was more important than the $2k worth of equipment that would have earned you $50.00/patient and peace of mind.

You are a healthcare professional. You are a physician that specializes in the oral cavity. You don’t just fix teeth, you are responsible for your patients overall health and now you are facing a legal liability as well as a moral one. When you get home tonight, spend some time thinking about your family because I don’t think you will be sleeping well. I could write all day recalling stories about dentists saving lives, but the most important issue is why isn’t it happening every day.

So, where do we go from here. Technology can detect situations before they develop, that fact cannot be disputed. Dentistry (you) is the forefront of preventive medicine, the tip of the sword. I’ll debate that point with anyone at any time.

Please watch the video before reading the rest of the blog. It was taken off of YouTube when searching for oral cancer. This is what the public sees.

I’m not trying to sell you on the equipment, I’m trying to sell you on the service you need to provide to your patients. What ever method you choose as your standard of care will be in your professional, etc.. However, I wouldn’t rely on just visual observation.

There are 2 methods available to a dentist for locating non-visible abnormal tissue in the oral cavity. They both utilize light spectrum biotechnology.

The first is the Visilite “glow stick”. The patient rinses with a terrible tasting solution and the glow stick is activated to illuminate the oral cavity. The fluorescent light from the glow stick reacts with the solution that saturates the soft tissue. This method is somewhat effective, however, it is not easy to digitally document. You need to remember that the NHII (National Health Information Infrastructure –See February 14, 2010 /Digital 2015) is coming in January 1, 2015 and the digital record will be required. Visilight has about a 70-80% accuracy (according to my clients) and costs about $9.00/use.

Then there is the 2nd generation VelScope. In my world, this is the product of choice, hands down and not because you looked at the video.

The VelScope is now small and wireless (about the size of a small hair dryer). It produces a high intensity blue light that penetrates the soft tissue and illuminates the entire oral cavity. The fluorescent light reacts with abnormal tissue (without solutions) and identifies abnormalities deep into the stroma. That may be up to 4 years prior to any malignancy being visible. The digital format allows for documentation in most practice management programs and the ability to transfer images electronically to the OS for review. It also can attach to a digital camera for photographic documentation.

The VelScope 2nd Generation, used twice a day will pay for its self in about one month. After that, the cost of use is about $1.50 for the barrier protection.
LED’s Technical Platform – The company’s technology was jointly developed by scientists at the British Columbia Cancer Agency (BCCA) and company principal Peter Whitehead. It integrates four concepts: light, sophisticated filtering, natural tissue fluorophores and the power of the human optical and neural physiology.
Its technology platform is based on the direct visualization of tissue fluorescence and the changes in fluorescence that can result when abnormal tissue is present. This technology will help the clinician visualize abnormal tissue beneath the surface that may not be apparent under white light.
LED expects that expanding its proprietary visualization technology beyond dental applications will provide gynecologists, gastroenterologists, ENT specialists, dermatologists and family practitioners with cost-effective tools to aid in cancer and abnormal tissue screening.
VelScope is comprised of a light source, light guide, and viewing handpiece. The VelScope Handpiece emits a safe, visible, blue light into the oral cavity, which excites mucosal tissue and causes it to fluoresce. The clinician can examine the oral cavity in real time and quickly identify suspicious tissue that may require further investigation. Typically, healthy tissue shows up as a brighter green color while suspicious tissue can cause a loss of fluorescence, which thus appears dark. When used in combination with traditional oral mucosal examination procedures, VelScope facilitates the discovery and enhances the visualization of mucosal abnormalities. The company received 510(k) clearance for these claims in April 2006.
LED Dental is committed to reducing oral cancer. The services of LED Dental and its partners are directed toward developing a professional outreach program with key university–based oral pathology, oral surgery, and oral medicine leaders worldwide to assist all healthcare providers as the need arises. LED Dental is positioned to facilitate the dissemination of new findings that address early detection based on fluorescence and other technologies.
Note: The image below is the original VelScope. The 2nd Generation is smaller, wireless and more users friendly

Representative examples of direct visualization under both white light and VELscope examination – photos courtesy of the British Columbia Oral Cancer Prevention Program.

No apparent lesion – Normal fluorescence pattern

Visible leukoplakia – Irregular, dark area visible under fluorescence visualization. Biopsy-confirmed severe dysplasia

No apparent lesion – Irregular, dark area visible under fluorescence visualization. Biopsy-confirmed Carcinoma in Situ (CIS

What’s A Spirapost……………………………………………………..

Spirapost PFS™ unique esthetic post from Zenith Dental – You have never seen a concept like this; it is truly a revolutionary design for an endodontic post. The Spirapost has the strength of a cast post and the esthetics of a fiber post without the drawbacks of either one. It looks like a test tube brush. It is made of surgical stainless steel wires twisted around biocompatible, natural-color polyfiber strands. This innovative design causes the Spirapost to adapt to the irregularities of the root canal by integrating the flexible polyfiber strands with the anatomy of the endodontically prepared canal. The flexibility of the twisted wires and the polyfiber strands allow the post to travel down the canal and conform to its unique shape as it goes. The strands act as a rebar for the post cement, much like steel bars that reinforce concrete in a building foundation. A solid foundation is created in the canal that remains flexible to accommodate external stresses. The cement integrates with the coronal portion of the post to unify the entire restoration. Best of all, the Spirapost does not have a long learning curve. It offers ease of use without concern for additional reduction of tooth structure. Selection is simple; only one size in two designs (tapered and parallel) is needed, thanks to its adaptability to any endodontically prepared canal.

Sunday August 22nd……….
Well, the summer of 2010 is almost over. Those of you who have kids know that the 2 best days of the year are the last day of school and the first. Enjoy the day, be positive and please be safe.

Cliff Marsh
Henry Schein Dental
P.O. Box 663, 45 Rt. 46 East, Suite 605
Pine Brook, NJ 07058
tel. 201-321-7494

August 22, 2010 - Posted by | Uncategorized

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