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12.3.1 Drugs for oral ulceration and inflammation

Oral ulceration may be treated with corticosteroids.
New advice on oral salicylate gels in under 16s from the MHRA  
The main products affected are Bonjela®  and Bonjela®  Cool Mint Gel. 
The new advice recommends that these products should not be used in  those under 16 years of age. This is due to salicylate salts
having the same effect on the body as aspirin which is already  contraindicated in children and young people under 16 years of  
GREEN      Bonjela® oral gel      
GREEN      Hydrocortisone pellets 2.5mg      
AMBER     Gelclair® - only for acute chemotherapy/radiation induced mucositis 
AMBER     Betamethasone 500 microgram soluble tablets   
                    This product is used in oral surgery practice only: dissolved in water and used as a mouthwash
Treatment of inflammatory conditions
GREEN      Benzydamine oral rinse 0.15%, spray 0.15% [Consider OTC/Self care]     

12.3.2 Oropharyngeal anti-infective drugs

The most common cause of a sore throat is a viral infection which will not benefit from anti-infective treatment.
Chlorhexidine mouthwash renders nystatin ineffective, therefore wait 15-30 minutes before applying nystatin.
Fungal infections   
First line: 
GREEN      Fluconazole* 50mg (capsules) orally once daily   
                  Course duration 7 days 
                   *Fluconazole has clinically significant interactions with other medicines - check these before prescribing* 
Second line or for infants under 4 months or patients taking warfarin:    
GREEN     Nystatin   
                  suspension 100,000 units/mlL   
                  pastilles 100,000 units     
                  [adult dose: 4mL every 6 hours for 7 days]

12.3.3 Lozenges and sprays

There is no convincing evidence that antiseptic lozenges have a beneficial action and they sometimes irritate and cause
sore tongue and sore lips. Some of these preparations also contain local anaesthetics which relieve pain but may cause
sensitisation. The following products are stocked within the hospitals for symptom relief only but are not generally 
recommended for prescribing.
RED        Dequadin® lozenges       

12.3.4 Mouth-washes, gargles, and dentifrices

For use if a patient has, or is at risk of, an oral infection. Chlorhexidine inhibits the formation of plaque and may be 
useful when tooth-brushing is not possible. (see ELHT Mouth Care Policy May 2003)
GREEN      Chlorhexidine mouth wash 0.2%       
GREEN      Chlorhexidine oral gel 1%     

12.3.5 Treatment of dry mouth           

Endorse prescription with ‘ACBS’ – patients suffering from dry mouth as a result of having (or having undergone) radiotherapy, or sicca syndrome, apply to gums and tongue as required.

GREEN      Glandosane® synthetic saliva spray     
                   (acidic pH – try to avoid for patients with their own teeth in situ)
GREEN      Biotene Oralbalance® - saliva replacement gel   
                   (pH neutral when used in vivo)
GREEN      Saliveze®  synthetic saliva spray     
                   (pH neutral)
AMBER      Pilocarpine 4% eye drops - Unlicensed use *
AMBER      BioXtra® saliva replacement gel
                   {for use as additional saliva replacement gel  in patients who have had radiotherapy to oral cavity)
AMBER      Oralieve®  Moisturising Mouth Spray [palliative care use only]

refer to Lancashire ad South Cumbria Specialist Palliative Care Prescribing 



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  pharmacist, nurse or contact NHS111 Service 
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