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COMPOUNDING SHOP PHARMACY Established 1982 www.compoundingshopinc..com 11851A Wilcrest Drive Houston, TX 77031 Phone: 281-495-2230 Fax: 281-495-2232 DENTISTRY ANY OF THESE MEDICATIONS CAN BE MODIFIED TO YOUR PREFERENCE MEDICATION ( ) Dyclonine 1% FORMS Solution (Tutti-Frutti or Tropical Punch) ACTIONS/USES QUANTITY Gargle for anesthesia, pre-injection, 60ml ea block gag-reflex ( ) Lidocaine/Prilocaine/Tetracaine Gel Anesthetize crown and gum 30ml or 60ml ( ) Polyphenol Sulfonic Acid Solution Aphthous ulcer/canker sore 4ml Suspension Mouth wash for irritation/infection 480ml (formerly Negatan, Negatrol) ( ) Magic Mouth Wash (tetracycline, nystatin, Benadryl, Maalox, lidocaine, hydrocortisone, etc.) ( ) Tetracycline 3% Ointment Dental implants 30gm ( ) Metronidazole 25% Gel Dental gel 20gm Syrup Pre-op, pre-surgery anesthesia 240ml +/- Minocycline 0.8% ( ) Meperidine 25 mg/5ml + promethazine 12.5 mg/5ml (Regular or blue-berry) (good for children; need triplicate) ( ) Whitening 15% 20% Gel Teeth whitening 60ml ( ) Sargenti’s Powder Root canal paste 60ml (with or without paraformaldehyde or lead) ( ) Eugenol Oil To be used with Sargenti’s 60ml ( ) Tetracaine 1% Lollipop Local anesthesia 1ea ( ) Ketoprofen 20%/Lidocaine 10%/ Transdermal TMJ pain 30gm or 60gm Gabapentin 6%/Cyclobenzaprine 1% Direction for use or OFFICE USE:___________________________________________________________ ____________________________________________________________________ Refills:_________ Comments:_______________________________________________________________________________ ________________________________________________________________________________________ Doctor’s Name ___________________________ Doctor’s Signature _________________________ Doctor’s Address ________________________________ Doctor’s Phone # _______________________________ Patient’s Name ________________________ Patient’s Phone #_______________________