Where are the updated Prophylaxis Recommendations?


2TheApex:  AAE Guide RIGHT HERE!  ADA Guides here!

Key points to note:

Antibiotic inadvertently NOT administered pre-operatively can be given up to two hours following treatment.

If the patient is already taking an antibiotic, a different class antibiotic should be given for prophylaxis.  (Example: Patient already taking Penicillin for days is not good enough and should be given another class of antibiotic acceptable for prophylaxis, i.e. Clindamycin 600mg)

In general, NOT recommended for prosthetic joint implants unless specifically prescribed by the patient’s orthopedic surgeon.  Their surgeon should recommend the specific regimen and ideally write the RX for the patient when possible.

(image: Staph. Aureus)



What is your “MacGuffin?”

2TheApex:  Huh??


This is a post I found interesting from Summit Practice Solutions.  Enjoy and have a Safe and Happy New Year!!  -Derek

The Great MacGuffin

After all the great movies that are out now, I thought I would use a film term to illustrate a huge barrier to growth. “MacGuffin” was coined in 1939 by famed filmmaker Alfred Hitchcock. McGuffin is defined as: A plot device that motivates the characters and advances the story. This plot device is often in the form of some goal, desired object, or other motivator that the protagonist pursues, often with little or no narrative explanation. The most common MacGuffin is an object, place, or person. Other more abstract types include money, victory, glory, survival, power, love, or some unexplained driving force. I know that you’re asking yourself: “How is this pertinent to Dentistry or my practice?” It has everything to do with it. In the movies, the MacGuffin is made up. In real life, this motivator is what will define our successes and failures. We are all driven to succeed, and you can define success any way you want. For me, it has always been centered on a balance of faith, family, and serving my patients at work. It is that balance that I struggle with, but it is the MacGuffin that drives me to keep striving.

So what are you chasing in your story? What motivates you or could motivate you to take your practice to another level of excellence?

  • Money: The default, low level, knee-jerk goal that catches all of us. It starts with a huge school debt, accelerates when we buy our first practice (we call it investing in our future at that point), and is perpetuated by an entitlement mentality that creates a life built on debt and the hope that someday your ship will arrive. In the book, The Fulfillment Curve, there is a justified amount of money that we need to set as a benchmark. It allows us to service our debts, provide food and shelter while educating and supplying the needs of our growing families. It is what comes after this base amount that creates a life of diminished rewards and a lifestyle that jeopardizes our future. Money is not the root of all evil; it is the love of money. Leadership and success demands that each of us get a handle on how we save, spend, give, and invest the money and time that we have here.
  • Peer pressure: Sometimes in just keeping up with the community we live in, or the dentist down the street, we allow other peoples opinions to define our self-worth. Not a very good goal in life because you are setting yourself up for failure. You can’t control what others do or how they live, you can only decide and execute your life plan.
  • Clinical excellence: Great standard to move towards. The mistake is thinking that you will ever arrive. If you’re like me, the more I learn the more I find out that I have more to learn. A lifetime of learning is a great ambition, just make sure that you understand that every doctor should strive for more competence every year. But clinical excellence will not grow a practice or compensate for a lack of systems, people skills, great patient relationships, and an incredible staff.
  • To get out: Maybe the most desperate reason to push yourself. With over 50% of dentists wishing they had not entered the field, we can assume that the profession (or the path to it) is fraught with numerous potholes that many of us find ourselves in. I run into at least one doctor each month with a sad story of being trapped in a profession that they feel they are ill equipped for and facing the realization that they were never really suited for.

For me, the driving force behind my career always seemed to morph and evolve as the years progressed. Now four decades later, as I look back, I still find that my deepest MacGuffin was my desire to serve in an excellent way: clinically, relationship wise, and business success wise from production and profitability. I guess I could leave it at that, but just under the surface in a place I don’t like to go, I was also driven by the desire to “not die broke”. I have no idea where this came from, but even today I tend to worry about the clients that just can’t seem to grasp a path toward financial independence.

This time each year I like to do my Ten Year Plan in which I set up goals for the next 10 years. It has gotten a little scarier each year as I approach my “use before date”. As a New Year’s goal this year, explore where you are and where you want to go by taking the Ten Year Plan challenge. Just click on this link to get your copy and call me if you have any questions.



Mike Abernathy, DDS

972-523-4660 cell


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Nasal Spray alternative to Needle?


2TheApex: Yes!

Last June the FDA approved an anesthetic nasal spray (Kovanaze) for use in restorative procedures on teeth #4 through #13.  It takes two squirts 5 minutes apart (a third squirt may be needed sometimes).  One big advantage, in addition to calming patients with a needle phobia, could be pulpal anesthesia without lip numbness for esthetic cases.  Use for root canal treatment or biopsy has not been studied yet.  Kovanaze is reported to be available sometime this fall.  Recent Study  Manufacturer Press Release

Explanation with diagrams from Spear Education

What percentage of crown-prepped teeth become necrotic?

Kelly, M Tooth #30 Pre Op 8-22-16

2TheApex:  Roughly 10%

One statistic you may want to share with patients is that 1 in 10 teeth with crowns end up requiring root canal therapy. Here is the Study.  Not a bad statistic for patients to know prior to a crown prep.  There is always a risk.  The more highly the tooth is restored increases the chances.


Kelly, M Tooth #30 Post Op 8-22-16


What are the most recent guidelines regarding bisphosphonates?

2TheApex:  Guidelines for patients taking antiresorptive medications can be found here.


The AAOMS recently released a position paper about medication-related osteonecrosis of the jaw (MRONJ).  Bisphosphonates are the most common class of medication associated with MRONJ.  The definition has been expanded, however, and now includes medications taken by more than 5.1 million people over the age of 55.  Dental procedures which expose and/or damage bone have the potential to cause osteonecrosis for these patients.  The highest risk category is IV cancer therapy, which is about 100 times higher than patients being treated for osteoporosis.  Patients taking oral bisphosphonates for greater than 4 years are at an increased risk and should consult with their physician regarding a 2 month drug holiday prior to invasive treatment such as extraction.  Patients should be treated aggressively prior to, and direct osseous injury should be avoided during, IV therapy.  This could mean root canal treatment in lieu of extraction, if they are high risk.  I highly encourage you to review the paper itself, as there much more information provided there.




What’s the best way to avoid post-operative muscle pain for your patients?


Mouth Prop

2TheApex:  Use a bite block

Whenever a patient can tolerate a bite block/mouth prop, aka “tooth pillow”, we use one.  Since using them routinely, I perceive a decrease in post-op myofascial pain complaints.  And it also makes the access easier and the treatment more smooth when the patient doesn’t need to be constantly reminded to open their mouth.  We explain to the patient that, “We plan to use a mouth pillow for your comfort.  This way you can relax your jaw and you don’t need to hold your mouth open for the entire procedure.  If you don’t like it just let us know and we can always take it out.”  We tie a piece of floss to it so it can be removed quickly if needed.


Good idea to mix Chlorhexidine and Sodium Hypochlorite in the canals??

2TheApex:  No.

Mixing chlorhexidine and sodium hypochlorite forms a precipitate called parachloroaniline (PCA).  It is orange-brown in color and, in theory, could compromise the treatment.  The compound has also been shown to be toxic and classified as a carcinogen.

Can you irrigate with both of these solutions in one tooth?  Sure, just don’t mix them directly.  You can irrigate with EDTA or alcohol after the sodium hypochlorite and prior to the chlorhexidine.

The point is to avoid chlorhexidine and hypochlorite from coming in direct contact.

More info here.

Thank you for Dr. McCormick in Mauston for posing the question.  We felt it was worth sharing.  If you have a particular topic or question don’t hesitate to ask. Thanks Mick!