ViziLite Oral Cancer Screening Consent

In continuing efforts to provide the most advanced technology and highest quality care available to our patients, this practice is proud to announce the inclusion of the ViziLite Plus exam as an integral part of our annual comprehensive oral cancer screening program.

One person dies every hour from oral cancer in the United States-and the mortality has remained unchanged for more than 40 years. Alarmingly, more than 25% of oral cancer victims have no lifestyle risk factors. Clinical studies have determined that using ViziLite after the standard oral cancer examination improves the clinicianÕs ability to identify, evaluate and monitor suspicious areas at their earliest stages. Early detection of pre-cancerous tissue can minimize or eliminate the potentially disfiguring effects of oral cancer and possibly save your life. Proven screening techniques such as mammogram, Pap smears, PSA and colonoscopy offer the same types of early detection of cancer. ViziLite Plus is an easy and painless examination that gives this practice the best chance to find any oral abnormalities you may have at the earliest possible stage. This technology is the only medical device cleared by the FDA for the identification and monitoring of oral abnormalities that could lead to cancer.

Oral cancer risk by patient profile:
Highest risk: Patients age 40 and older and lifestyle risk factors (tobacco use); patients with a history of oral cancer
High risk: Patients age 40 and older; tobacco users of any age
Increased risk: Patients age 18-39

Dental insurance might not cover this advanced oral cancer screening as an addition to the standard visual examination. This practice prescribes the ViziLite Plus exam for all patients at increased risk but especially
those at high risk and highest risk for oral cancer. With your consent, we will be performing the ViziLite Plus exam following the standard oral cancer examination of the oral cavity for a fee of $65.00.