Good morning ya pharmacists,

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Here’s today’s legal advice

• 🧑‍⚖️A Cautionary Tale of Clindamycin. How one oral surgeon got sued and the literature on the controversial antibiotic.

• ☕Coffee Break. Random strangers helping your productivity and some endo on a tiger.

• 🍺Trivia Night. Thursday morning trivia to make you 37% better at diagnosing cracked teeth.

While sometimes we make up stories about Michael Jordan loving oral pathology…sometimes we tell real stories to help you in your practice

And this is one of them.

So, this is Karen (*cough* fake name *cough)

And this is the story of how she sued an oral surgeon because of this once very-popular antibiotic.

So she just had #20 extracted and we know two things:

1) The procedure was indicated (non-vital)

2) Dr. Whatley (pictured below) did a very good job.

But the patient had a WEIRD request after an uneventful extraction

The oral surgeon told the patient

• A clindamycin prescription was not indicated, and

• There are dangers with clindamycin use

Unfortunately, the doc gave in to Karen’s pleads and gave her the drug. Spoiler alert: DON’T let patients dictate treatment.

Fast forward 4 days.

Karen finds herself in the hospital with a problem

…which they deemed antibiotic associated colitis secondary to C. Diff…all because of that Clindamycin prescription.

This resulted in a 5 day hospital stay to treat the colitis, along with lost wages, and weight loss.

So 2 months later,

Dr. Whatley gets a call from Karen…

And this is where Karen really starts to get sneaky. What Dr. Whatley did not know was that she was recording that phone conversation…

Whatever Dr. Whatley said on the phone, it doomed him…

and to make a frustrating story short, Karen hired her family member as an attorney which led to this…

Yup, Dr. Whatley got sued and his insurance company paid for her out-of-pocket expenses, a portion of her lost earnings, and a small amount for her “pain and suffering”.

So here’s a question before we get to the literature:

Rewind the clock 5 to 10 years…and clindamycin was still prescribed A LOT

But jump to 2019 and things changed:

And it’s because of this little bugger

Or C. Diff for short…and he is:

• Anaerobic gram-positive

• Spore-forming

• Toxin producing

Blah. Blah. Blah. Not important…

But what IS important is that usually Karen’s own microbiota can stop these guys…

But when Clindamycin is prescribed…*ahem* let’s say after tooth extraction.

Those annoying Clindamycin whack Karen’s microbiota security team like a scene out of the Sopranos.

…Thus allowing C. Diff to dump a bunch of toxin into her stomach- producing diarrhea and colitis

You’re right!

But it turns out that the risk of C. Diff with Clindamycin is significantly higher…

Like 8x higher!!

Which can turn into life threatening pseudomembranous colitis and why the FDA put a black-box warning on the drug.

And therefore caused many organizations (including the AAE) to kick clindamycin out of their office.

Yet, Clindamycin is a great drug! It’s broad spectrum and it is said to whack 75% of endodontic bacteria.

And it IS sometimes indicated as a back-up, back-up plan.

So if you really going to prescribe it…here are two things to keep in mind:

Symptoms of C. Diff to watch out for include:

• 🥵Fever

• 🤮Abdominal cramping

• 💩Bloody stool

Research has shown that probiotics with antibiotic use significantly decreases C. Diff associated diarrhea.

And when we say “significant” we mean a:

For our German/Wisconsin clinicians out there…that could mean prescribing this:

Because who knew sauerkraut had probiotics in it. (We sure didn’t)

But for those that don’t love a good brat, there are more realistic options.

In any case, review your prescribing guidelines

Because one thing that stuck out to us during this research: it’s estimated that 85% (!!) of antibiotics are incorrectly prescribed:

BIG yikes.

Coffee Break

Some randomness to entertain until your next hygiene check.

• 📚Good for studying? Get paired with a random stranger as a virtual study buddy (or any other task) and apparently be 232% more productive.

• 🐅What was the working length?! Some pictures of a Washington vet treating a tiger with a root canal…but we don’t see no damn rubber dam!

• 😴After he sold his company (Venmo)...this guy is trying to live to 120. Crazy. Interesting, but crazy.

• 🎥For the movie buffs...a website with a whole bunch of short films for your viewing pleasure

• 💻Interesting. A necessary introduction into the game-changing dental software you need to know about.

Trivia Night

Belly-up to the bar and answer some trivia from a previous edition of tipsy dentistry that will make you 37% better at diagnosing cracked teeth

We’ll even give you a hint

Looking Forward to Next Week

We’re talking about the literature of a new super-soldier saving pulps everywhere

Talk to you soon,

luv u 😘😘😘😘

tipsy dentistry