Oral Screening Consent Form

Our practice continually looks for advances to ensure that we are providing the optimum level of oral health to our patients. We are concerned about oral cancer and do a visual oral cancer examination on every patient at every exam.

One American dies every hour from oral cancer. Late detection of oral cancer is the primary cause that incidence and mortality rates of oral cancer continue to increase. As with most cancers, age is the primary risk factor for oral cancer. Tobacco and alcohol use are the other major predisposing risk factors but more than 25% of oral cancer victims have no such lifestyle risks. Oral cancer risk by patient:

Increased risk: Patients ages 18-39

High risk: Patients ages 40 and older; tobacco users

Highest risk: Patients ages 40 and older with lifestyle risk factors and a previous history of oral cancer.

We have recently incorporated Trimera 3000 into our oral cancer screening standard of care. We find that using Trimera 3000 along with a standard visual oral cancer examination improves the ability to identify suspicious areas in their earliest stages. Trimera 3000 is a simple and painless examination that gives the best chance to find any oral abnormalities at their earliest possible stage. Early detection of pre-cancerous tissue can minimize or eliminate the potentially disfiguring effects of oral cancer and possibly save your life. The Trimera 3000 exam will be offered to you annually.

This enhanced examinationis recognized by the American Dental Association code revision committee as CDT-5 procedure code D0431. However, this exam might not be covered by your insurance. The fee for the enhanced examination is $30.

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