I had the great pleasure today of partnering with a patient to complete crown preps and core buildups on her eight posterior teeth on the lower arch. We have been working together and discussing this care and treatment plan for over a year, and in the last few weeks she decided it was time to move forward. Our plan was to level her lower occlusal plane and open her vertical to create restorative clearance. To do this I used composite in the anterior and completed preps and provisionals in the posterior. We also took all of the impressions and records for her final crowns. With this explained you can imagine today was a very long appointment.
There are several different challenges patients face with dental appointments. One in this case is the length of the appointment and the ability to lie still and stay relaxed for the entire time. Anxiety about the appointment, the injection and the process is always present, and varies in intensity from patient to patient. Other patients have challenges staying open, with their gag reflex and many more. One of the things I have found very helpful for patients who are interested in longer appointments, generally have a only mild anxiety and simply need help relaxing and staying comfortable for an appointment is to have them pre-med with Fiorinal #3.
Fiorinal #3 contains 30 mg codeine, 50 mg Butalbital, 40 mg caffeine, and 325 mg aspirin. This combination does vary from country to country, and there are different formulations of Fiorinal; this one specifically has the number 3 after the name. My patients are advised to have someone drive them to and from their appointment. The combination of medications creates a mild to moderate drowsiness, along with being anxiolytic, it also is a potent pain reliever with the combination of the codeine, aspirin and caffeine, so makes keeping the patient comfortable much easier. Patients take one pill an hour before the appointment, and are instructed to bring the bottle as we will have them take one in 4 or 6 hours for very long appointments. It is a miraculous addition without many of the challenges and side effects of many other types of sedation. My patient today was very appreciative of the medication and felt much more comfortable then her previous appointments.