CE Dojo

08/21/2026

If you hold a sedation or anesthesia permit in North Carolina, there's a new rule with your name on it.

The Dental Board adopted 21 NCAC 16Q .0105. It requires a Board-approved update course of at least 6 hours, first completed by December 31, 2030 and repeated every 3 years. It applies to general anesthesia, moderate conscious sedation, and moderate pediatric conscious sedation permit holders, and to auxiliaries dedicated to patient monitoring.

The course covers 6 areas: patient assessment and selection, medications and dosing, sedation levels and reversal, monitoring, airway management, and medical emergencies.

And it has to include a demonstration of sedating a patient or an in-person simulation of deep sedation induction, recognition, and reversal. So at least part of this happens in a room, with people.

The deadline moved in your favor. The proposed version wanted a 2-year cycle starting in 2027. The adopted version gives you until the end of 2030, then every 3 years.

Worth a calendar entry today.

08/09/2026

North Carolina dentists: your controlled-substance CE is annual, and December 31 does not move.

CE Dojo is running a free live Zoom on Thursday, September 10 at 7:00 PM ET.

David Lambert, DDS, oral and maxillofacial surgeon and pharmacist, covers opioid pharmacology, safe prescribing, the new non-opioid analgesics, and why anesthesia is getting harder. Suzetrigine reached the market in 2025 on trials in abdominoplasty and bunionectomy patients. What that means for a dental extraction is an open question, and it is one worth asking out loud.

Sean Kurdys, former lead investigator for the NC Board of Dental Examiners, covers regulatory updates and what the board is looking at right now in anesthesia, record keeping, and case reviews.

Bring your own prescribing questions. The discussion is the point.

100 seats, first come. No charge to attend.

Mark your calendar. Details and registration: https://ce-dojo.com/sop-september/

08/07/2026

The office cannabis policy just got 5 new findings. One exam takes a penlight. One takes a question.

Convergence, rebound dilation, nystagmus, finger to nose, and the teach-back.

Here is why more findings is the whole point. Only 4 of the 5 appear in the numbers below, because nystagmus and the teach-back have no sensitivity figure in the literature.

In the roadside drug recognition data, rebound dilation on its own runs 70.9% sensitivity. Convergence on its own, 78.8%. Finger to nose on its own, 87.1% or better on every measure. Either eye test positive, 92.7%.

The combination outperformed every single test. So a chairside decision gets better as independent findings accumulate, and the policy now carries more of them.

THE EYE EXAM. 25 seconds, a penlight.

Convergence. Pen tip slowly toward the bridge of the nose. Normal is both eyes tracking inward and crossing, holding to about 2 inches. Abnormal is one or both breaking outward before that. 78.8% of cannabis cases, 10.9% of controls.

Rebound dilation. Penlight in the eye, watch 15 seconds. Normal is the pupil constricting and staying constricted. Abnormal is a brief constriction followed by a steady re-opening that never comes back. 70.9% of cases, 1.0% of controls.

Nystagmus, which runs the other way. Cannabis doesn't cause it. Vertical gaze nystagmus was found in 0 of 302 cannabis cases. So if it's there, something else is on board, and that matters in the minute before a patient gets nitrous.

THE COGNITIVE ASSESSMENT.

Finger to nose. Eyes closed, head back, arms out. 6 trials, record the misses. 3 or more out of 6 ran 87.1% or better on every measure.

The teach-back. "Tell me back in your own words what we're doing today, and name one thing that could go wrong." Every other finding tells you a drug is probably on board. The teach-back tells you whether the patient can understand, appreciate, reason, and choose, which is the accepted standard for capacity and the actual decision in front of you.

WHAT NONE OF IT DOES.

A positive eye finding suggests a drug is on board. It does not establish impairment and it does not establish inability to consent. More elements make the pattern defensible. They don't make any single one decisive.

And the source data has a flaw worth naming. Those 302 controls were police officers and academy cadets. In a placebo-controlled trial in JAMA Psychiatry, certified drug recognition instructors classified 49.2% of the sober placebo group as impaired.

So the screen tells you how carefully to proceed and whether consent holds. It never tells you a patient is high. Chart the findings, not the conclusion.

The policy template and the one-page chairside algorithm are rebuilt and free: https://ce-dojo.com/cannabis-office-policy-five-new-findings/

08/04/2026

Don't pose with a THC seltzer at the society golf outing.

The same people who process impairment referrals are at the table.

I've seen the pictures. Dentists after a sponsored round, Bud in hand, smiling for the camera. Up on social media that night. Thursday there's a meet and greet at a brew pub. More pictures. Society principals are in the room. They can see.

And the silent auction table has a 5th of aged whiskey on it, raising money for the association.

Now swap the beer for a bottle of Willie's. Legal in a lot of grocery stores, including in states with no legal cannabis, because of a h**p loophole. Same setting. Same smiling photo.

Except THC is lipid soluble. It sits in your system for weeks.

And it takes 1 call. A spouse in a rocky marriage. An assistant you had to write up.

Once the practitioner health program has the referral, the program has the incentive to admit you. The referral is the revenue. Passes happen. They're the exception.

That's one side of it.

Here's the other. Patients medicate before stressful appointments. They do it constantly, and most offices have no plan for it beyond hoping the schedule holds.

So we wrote a policy. Screen, assess, document, then proceed or defer. 1 page, 1 algorithm, and it works in a real operatory.

It went to a state board's executive director, its director of investigations, a society committee on dental practice policy, and an academy executive committee.

Crickets.

The position organized dentistry has taken on cannabis is to hand the problem to the practicing dentist. No guidance on the intoxicated patient. Full exposure on the impaired practitioner.

You make the judgment call with no framework, and you carry all of the risk when it goes wrong.

The policy is finished and it's free. Anyone who wants it can have it.

What we'd like to know is why the people who would discipline a dentist over a test result won't put a single sentence in writing about the patient in the chair.

08/01/2026

The THC seltzer at your grocery checkout is a pharmaceutical drug-delivery system wearing a beverage label.

I mean that literally, as a formulation.

Cannabinoids don't dissolve in water. They're oily and lipophilic, so THC stirred into a can would barely absorb. The absorption of a poorly soluble drug is capped by how fast it can dissolve, and dissolution scales with surface area. That's basic pharmaceutics.

So formulators reached for the same trick the drug industry uses to rescue insoluble compounds: shrink the particle. Cut an oil droplet down to nanometers and you multiply its surface area enormously. At nanoscale the absorption goes from sluggish to turbocharged.

That's a nanoemulsion. Onset drops from an hour-plus to roughly 15 minutes, bioavailability climbs several-fold, and more of the parent THC reaches your brain before the liver ever touches it. It's genuinely elegant engineering. I'll say that plainly.

Here's what stops me.

This technology was built for licensed cannabis markets: lab-tested, dose-controlled dispensary products in states that legalized. The formulation then got ported to exploit the federal h**p loophole, putting the same engineered dose on an open grocery shelf in states that never legalized anything.

Same nanoemulsion. Two different regulatory universes. One side has testing rules, dose caps, and an ID check. The other side is a can next to the sparkling water.

A drug delivery system this deliberate would, in almost any other context, sit behind a pharmacist. This one is an impulse buy at the register.

And when the federal definition changes this November, the emulsion tech doesn't disappear. It migrates to whatever's legal next.

We regulate drug-delivery systems for a reason. What do we call it when one is sold as a soft drink?

**p

08/01/2026

You can buy a THC seltzer at a North Carolina grocery store right now. Legal. On the shelf next to the sparkling water.

If you hold a professional license, that can could end your career. And "it was legal" won't save you.

A drug test can't tell where the THC came from. H**p-derived delta-9 breaks down into the same metabolite as ma*****na. Same molecule, same positive. No test distinguishes the legal seltzer from an illegal joint, because chemically there's nothing to distinguish.

So a nurse, pharmacist, physician, pilot, or trucker who tests positive and says "I drank a legal h**p product" is asking the board to accept a story the chemistry can't confirm.

They mostly don't. The DOT flatly rejects h**p or CBD as an excuse. Licensing boards treat any cannabinoid positive as a regulatory event and put the burden on you to prove it was legal. Guilty until proven otherwise.

The numbers: across four state nursing boards, 17 of 19 positives blamed on legal CBD still ended in mandated monitoring. A year or two of random testing, thousands of dollars. The defense failed 9 times out of 10.

And this isn't a false positive. The test is right. You drank THC, your body made the metabolite, the assay found it.

The kicker: the THC in that can was cooked from CBD in an acid reaction. Not a GMO plant. Semi-synthetic, poured into a can, sold with no warning it's identical to the thing that can pull your license.

The whole loophole sunsets November 12, 2026, when a new federal definition wipes the category out. Until then, the can is on the shelf and the landmine is live.

Did you know a legal grocery-store drink could cost a clinician their license?

**p

07/19/2026

I've made several posts about our new course "Cannabis & Dentistry". As the result of producing it, I personally have had a renaissance in my own thinking and future approach. This is important for dentistry - especially with anesthesia. Patients are becoming more difficult to sedate and there's a reason why. Cannabis is one of those reasons. But trying to "push through" is NOT the answer. Find out more at ce-dojo.com

https://vimeo.com/1211165249?share=copy&fl=sv&fe=ci

This is "Trailer 60s (Overview)" by CE Dojo on Vimeo, the home for high quality videos and the people who love them.

07/18/2026

A new mental health and substance abuse course for NC dentists, hygienists and everybody else:

Do you have a cannabis practice policy? You should. A patient is probably va**ng in your parking lot right now, steadying their nerves before the appointment. The pre-op Va**um has a new form.

Today's cannabis flower runs about 15x the THC of the 1970s, and concentrates push toward 90%. The patient who "used back in the day" is on a different drug now.

It changes your sedation, your airway, and your drug interactions, and it shows up in the mouth before anyone admits to using.

My new 1-hour CE course, Cannabis & Dentistry, covers what the plant actually is now and 6 real chairside scenarios you can use Monday morning. AGD PACE approved. 1 CE. $49. Link in the comments.

07/09/2026

A claim is making the rounds in dental groups: clindamycin has no role in dentistry anymore, it's been pulled from the formulary. It sounds authoritative. It's wrong, and the mix-up is simple.

In 2021 the AHA and ADA took clindamycin out of the prophylaxis regimen, the single dose some patients get before a procedure to protect an at-risk heart. Fair call. For prevention in a healthy patient, the C. diff risk outweighs the benefit.

Treating an active infection is a different situation. The ADA's 2019 treatment guideline still lists clindamycin for the genuinely penicillin-allergic patient, 300 mg 4 times a day, with an honest warning about C. diff.

The black box is real. So is C. diff. And nearly every antibiotic can cause colitis, so how we prescribe matters more than which drug gets blamed.

Give me a correct diagnosis, a documented penicillin allergy, and a real reason to treat, a spreading swelling or an abscess, and clindamycin is a fair choice. The patient has the disease. The guideline doesn't.

This is what we teach at CE Dojo: sourced, independent CE from clinicians who actually do the work.

https://ce-dojo.com/webstore/

Part 2: what careful antibiotic use actually looks like.

07/08/2026

Revenue is a fairy tale. Cash flow is reality.

That's the idea behind our newest CE Dojo course, taught by Dr. David Darab, a board-certified oral and maxillofacial surgeon who spent over 30 years building and then transitioning a 3-location surgical practice in North Carolina.

Now known as "The Cash Flow Surgeon" and founder of Darab Business Advisors, Dr. Darab teaches the 4 moves that close the gap between what your practice produces and what actually reaches your bank account: charging to value, cutting supply waste, tracking the right indicators, and scheduling for profit.

He also covers the real cost of waiting, and how cash flow drives what your practice is worth when you eventually sell it.

0.5 AGD PACE-approved CE hours. Same chair time. Better cash.

Check it out: https://ce-dojo.com/webstore/revenue-is-a-fairy-tale-cash-flow-is-reality/