Symptomatic treatment of dry mouth
▶ Adult: Apply 2–3 sprays as required, spray onto oral
l PROFESSION SPECIFIC INFORMATION
Dental practitioners’ formulary
AS Saliva Orthana ® Oral Spray may be prescribed.
Lactoperoxidase, lactoferrin, lysozyme, whey colostrum,
xylitol and other ingredients.
Dry mouth as a result of having (or having undergone)
radiotherapy | Dry mouth as a result of sicca syndrome
▶ Adult: Apply as required, apply to oral mucosa
l PROFESSION SPECIFIC INFORMATION
Dental practitioners’ formulary
BioXtra ® Gel may be prescribed.
BioXtra Dry Mouth oral gel (R.I.S. Products Ltd)
40 ml . NHS indicative price = £3.94 . Drug Tariff (Part IXa)
Lactoperoxidase, lactoferrin, lysozyme, glucose oxidase,
Symptomatic treatment of dry mouth
▶ Adult: Apply as required, apply to gums and tongue
l PATIENT AND CARER ADVICE Avoid use with toothpastes
containing detergents (including foaming agents).
l PROFESSION SPECIFIC INFORMATION
Dental practitioners’ formulary
Biotene Oralbalance ® Saliva Replacement Gel may be
prescribed as Artificial Saliva Gel.
Biotene Oralbalance dry mouth saliva replacement gel
(GlaxoSmithKline Consumer Healthcare) Glucose oxidase 12000 unit,
Lactoferrin 12 mg, Lactoperoxidase 12000 unit, Muramidase
12 mg 50 gram . NHS indicative price = £4.46 . Drug Tariff (Part IXa)
Carmellose sodium 500 mg, sorbitol 1.5 g, potassium
chloride 60 mg, sodium chloride 42.2 mg, magnesium
chloride 2.6 mg, calcium chloride 7.3 mg, and dipotassium
hydrogen phosphate 17.1 mg/50 g, pH 5.75.
Dry mouth as a result of having (or having undergone)
radiotherapy (ACBS) | Dry mouth as a result of sicca
▶ Adult: Apply as required, spray onto oral and
l PROFESSION SPECIFIC INFORMATION
Dental practitioners’ formulary
Glandosane ® Aerosol Spray may be prescribed.
Glandosane synthetic saliva spray lemon (Fresenius Kabi Ltd)
50 ml . NHS indicative price = £5.68 . Drug Tariff (Part IXa)
Glandosane synthetic saliva spray natural (Fresenius Kabi Ltd)
50 ml . NHS indicative price = £5.68 . Drug Tariff (Part IXa)
Glandosane synthetic saliva spray peppermint (Fresenius Kabi
50 ml . NHS indicative price = £5.68 . Drug Tariff (Part IXa)
ORALIEVE MOISTURISING MOUTH SPRAY
aqua, glycerin, xylitol, poloxamer 407, sodium benzoate,
monosodium phosphate, xanthan gum, aroma, disodium
phosphate, benzoic acid, whey protein, lactoferrin,
lactoperoxidase, potassium thiocyanate, glucose oxidase,
SLS free, alcohol free, pH 5.8
▶ Adult: 1 spray as required, on the inside of each cheek,
Oralieve moisturising mouth spray (Oralieve UK)
50 ml . NHS indicative price = £4.95 . Drug Tariff (Part IXa)
Symptomatic treatment of dry mouth
▶ Adult: Apply as required, particularly at night, to oral
l PRESCRIBING AND DISPENSING INFORMATION Contains
traces of milk protein and egg white protein.
Sugar-free, citric acid, malic acid and other ingredients in
Symptomatic treatment of dry mouth in patients with
impaired salivary gland function and patent salivary
▶ Adult: 1 tablet as required, allow tablet to dissolve
l PROFESSION SPECIFIC INFORMATION
Dental practitioners’ formulary
May be prescribed as Saliva Stimulating Tablets.
Carmellose sodium (sodium carboxymethylcellulose),
calcium chloride, magnesium chloride, potassium
chloride, sodium chloride, and dibasic sodium phosphate,
Dry mouth as a result of having (or having undergone)
radiotherapy (ACBS) | Dry mouth as a result of sicca
▶ Adult: Apply 1 spray as required, spray onto oral
l PROFESSION SPECIFIC INFORMATION
Dental practitioners’ formulary
Saliveze ® Oral Spray may be prescribed.
Saliveze mouth spray (Wyvern Medical Ltd)
50 ml . NHS indicative price = £3.50 . Drug Tariff (Part IXa)
Sugar-free, reddish-amber, acacia, malic acid and other
Symptomatic treatment of dry mouth
▶ Adult: 1 unit as required, suck pastille
l PROFESSION SPECIFIC INFORMATION
Dental practitioners’ formulary
Salivix ® Pastilles may be prescribed as Artificial Saliva
50 pastille . NHS indicative price = £3.55 . Drug Tariff (Part IXa)
Sugar-free, water, sorbitol, carmellose
(carboxymethylcellulose), potassium chloride, sodium
chloride, potassium phosphate, magnesium chloride,
calcium chloride and other ingredients, pH neutral.
Symptomatic treatment of dry mouth
l PROFESSION SPECIFIC INFORMATION
Dental practitioners’ formulary
Xerotin ® Oral Spray may be prescribed as Artificial Saliva
Xerotin spray (SpePharm UK Ltd)
100 ml . NHS indicative price = £6.86 . Drug Tariff (Part IXa)
Xerostomia following irradiation for head and neck cancer
▶ Adult: 5 mg 3 times a day for 4 weeks, then increased if
tolerated to up to 30 mg daily in divided doses if
required, dose to be taken with or immediately after
meals (last dose always with evening meal), maximum
therapeutic effect normally within 4–8 weeks;
discontinue if no improvement after 2–3 months
Dry mouth and dry eyes in Sjögren’s syndrome
▶ Adult: 5 mg 4 times a day; increased if tolerated to up
to 30 mg daily in divided doses if required, dose to be
taken with meals and at bedtime, discontinue if no
l CONTRA-INDICATIONS Acute iritis . chronic obstructive
pulmonary disease (increased bronchial secretions and
increased airways resistance). uncontrolled asthma
(increased bronchial secretions and increased airways
resistance). uncontrolled cardiorenal disease
l CAUTIONS Asthma (avoid if uncontrolled). biliary-tract
(avoid if uncontrolled). cognitive disturbances . maintain
adequate fluid intake to avoid dehydration associated with
excessive sweating . peptic ulceration . psychiatric
disturbances .risk of increased renal colic .risk of
increased urethral smooth muscle tone . susceptibility to
l INTERACTIONS → Appendix 1: pilocarpine
▶ Uncommon Gastrointestinal disorders
hallucination . hypotension . memory loss . psychiatric
disorder.respiratory distress . shock .tremor
l PREGNANCY Avoid—smooth muscle stimulant; toxicity in
l BREAST FEEDING Manufacturer advises avoid—present in
l HEPATIC IMPAIRMENT Manufacturer advises caution in
Dose adjustments Manufacturer advises initial dose
reduction in moderate to severe cirrhosis.
l RENAL IMPAIRMENT Manufacturer advises caution with
Driving and skilled tasks Blurred vision may affect
performance of skilled tasks (e.g. driving) particularly at
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug. Forms available
from special-order manufacturers include: oral solution
CAUTIONARY AND ADVISORY LABELS 21, 27
▶ Salagen (Merus Labs Luxco S.a R.L.)
Pilocarpine hydrochloride 5 mg Salagen 5mg
tablets84 tablet P £41.14 DT = £41.14
preparations for oropharyngeal use
There is no convincing evidence that antiseptic lozenges and
sprays 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.
Mouthwashes, gargles, and dentifrices
Superficial infections of the mouth are often helped by warm
mouthwashes which have a mechanical cleansing effect and
cause some local hyperaemia. However, to be effective, they
must be used frequently and vigorously. A warm saline
mouthwash is ideal and can be prepared either by dissolving
half a teaspoonful of salt in a glassful of warm water or by
diluting compound sodium chloride mouthwash p. 1212 with
an equal volume of warm water.
Mouthwashes containing an oxidising agent, such as
hydrogen peroxide p. 1212, may be useful in the treatment of
acute ulcerative gingivitis (Vincent’s infection) since the
organisms involved are anaerobes. It also has a mechanical
cleansing effect arising from frothing when in contact with
Chlorhexidine p. 1211 is an effective antiseptic which has
the advantage of inhibiting plaque formation on the teeth. It
does not, however, completely control plaque deposition and
is not a substitute for effective toothbrushing. Moreover,
chlorhexidine preparations do not penetrate significantly
into stagnation areas and are therefore of little value in the
control of dental caries or of periodontal disease once
Chlorhexidine mouthwash is used in the treatment of
denture stomatitis. It is also used in the prevention of oral
candidiasis in immunocompromised patients. Chlorhexidine
mouthwash reduces the incidence of alveolar osteitis
following tooth extraction. Chlorhexidine mouthwash
should not be used for the prevention of endocarditis in
patients undergoing dental procedures.
Chlorhexidine can be used as a mouthwash, spray or gel for
secondary infection in mucosal ulceration and for
controlling gingivitis, as an adjunct to other oral hygiene
measures. These preparations may also be used instead of
toothbrushing where there is a painful periodontal condition
(e.g. primary herpetic stomatitis) or if the patient has a
haemorrhagic disorder, or is disabled.
Chlorhexidine preparations are of little value in the
control of acute necrotising ulcerative gingivitis. With
prolonged use, chlorhexidine causes reversible brown
staining of teeth and tongue. Chlorhexidine may be
incompatible with some ingredients in toothpaste, causing
an unpleasant taste in the mouth; rinse the mouth
thoroughly with water between using toothpaste and
chlorhexidine-containing products.
There is no convincing evidence that gargles are effective
Oral hygiene and plaque inhibition | Oral candidiasis |
Gingivitis | Management of aphthous ulcers
▶ Child: Rinse or gargle 10 mL twice daily (rinse or gargle
▶ Adult: Rinse or gargle 10 mL twice daily (rinse or gargle
▶ Adult: Cleanse and soak dentures in mouthwash
solution for 15 minutes twice daily
Oral hygiene and plaque inhibition and gingivitis
▶ Child: Apply 1–2 times a day, to be brushed on the
▶ Adult: Apply 1–2 times a day, to be brushed on the
Oral candidiasis | Management of aphthous ulcers
▶ Child: Apply 1–2 times a day, to affected areas
▶ Adult: Apply 1–2 times a day, to affected areas
Oral hygiene and plaque inhibition | Oral candidiasis |
Gingivitis | Management of aphthous ulcers
▶ BY MOUTH USING OROMUCOSAL SPRAY
▶ Child: Apply up to 12 sprays twice daily as required, to
be applied tooth, gingival, or ulcer surfaces
▶ Adult: Apply up to 12 sprays twice daily as required, to
be applied tooth, gingival, or ulcer surfaces
Bladder irrigation and catheter patency solutions
▶ BY INTRAVESICAL INSTILLATION
▶ Adult: (consult product literature)
l UNLICENSED USE Corsodyl ® not licensed for use in
children under 12 years (unless on the advice of a
▶ With oromucosal use Dry mouth . hypersensitivity . oral
disorders .taste altered .tongue discolouration .tooth
SIDE-EFFECTS, FURTHER INFORMATION If desquamation
occurs with mucosal irritation, discontinue treatment.
▶ With oral (topical) use Chlorhexidine gluconate may be
incompatible with some ingredients in toothpaste; rinse
the mouth thoroughly with water between using
toothpaste and chlorhexidine-containing product.
l PROFESSION SPECIFIC INFORMATION
Dental practitioners’ formulary
Corsodyl ® dental gel may be prescribed as Chlorhexidine
Gluconate Gel; Corsodyl ® mouthwash may be prescribed as
Chlorhexidine Mouthwash; Corsodyl ® oral spray may be
prescribed as Chlorhexidine Oral Spray.
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
▶ Corsodyl (GlaxoSmithKline Consumer Healthcare)
Chlorhexidine gluconate 10 mg per 1 gram Corsodyl 1% dental gel
sugar-free | 50 gram p £1.56 DT = £1.56
▶ Chlorhexidine (Non-proprietary)
Chlorhexidine acetate 200 microgram per 1 ml Chlorhexidine
acetate 0.02% catheter maintenance solution | 100 ml p s
▶ Uro-Tainer (chlorhexidine) (B.Braun Medical Ltd)
Chlorhexidine acetate 200 microgram per 1 ml Uro-Tainer
chlorhexidine 1:5000 catheter maintenance solution | 100 ml p
▶ Chlorhexidine (Non-proprietary)
Chlorhexidine gluconate 2 mg per 1 ml Chlorhexidine gluconate
0.2% mouthwash aniseed | 300 ml G £2.09 DT = £4.18
Chlorhexidine gluconate 0.2% mouthwash natural | 300 ml G £4.18 DT = £4.18
Chlorhexidine gluconate 0.2% mouthwash plain | 300 ml G £4.18
Chlorhexidine gluconate 0.2% mouthwash peppermint | 300 ml G £4.18 DT = £4.18
Chlorhexidine gluconate 0.2% mouthwash original | 300 ml G £4.18 DT = £4.18
Chlorhexidine gluconate 0.2% mouthwash alcohol free |
▶ Corsodyl (GlaxoSmithKline Consumer Healthcare)
Chlorhexidine gluconate 2 mg per 1 ml Corsodyl 0.2% mouthwash
aniseed | 300 ml G £2.44 DT = £4.18
Corsodyl Mint 0.2% mouthwash | 300 ml G £2.57 DT = £4.18 | 600 ml G £4.50
Corsodyl 0.2% mouthwash alcohol free | 300 ml G £3.06 DT =
▶ Chlorhexidine (Non-proprietary)
Chlorhexidine acetate 200 microgram per 1 ml Chlorhexidine
acetate 0.02% irrigation solution 1litre bottles | 1 bottle p s
Chlorhexidine acetate 500 microgram per 1 ml Chlorhexidine
acetate 0.05% irrigation solution 1litre bottles | 1 bottle p s
▶ Child 12–17 years: Rinse or gargle 15 mL 2–3 times a day,
▶ Adult: Rinse or gargle 15 mL 2–3 times a day, to be
▶ Rare or very rare Anaesthesia .taste altered
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
▶ Oraldene (McNeil Products Ltd)
Hexetidine 1 mg per 1 ml Oraldene 0.1% mouthwash peppermint
sugar-free | 200 ml G £2.92 DT = £2.92
l DRUG ACTION Hydrogen peroxide is an oxidising agent.
Oral hygiene (with hydrogen peroxide 6%)
▶ Child: Rinse or gargle 15 mL 2–3 times a day for
2–3 minutes, to be diluted in half a tumblerful of warm
▶ Adult: Rinse or gargle 15 mL 2–3 times a day for
2–3 minutes, to be diluted in half a tumblerful of warm
▶ Child 6–17 years: Rinse or gargle 10 mL 3 times a day for
about 1 minute, for maximum 7 days, to be used after
▶ Adult: Rinse or gargle 10 mL up to 4 times a day for
about 1 minute, to be used after meals and at bedtime
l PRESCRIBING AND DISPENSING INFORMATION When
prepared extemporaneously, the BP states Hydrogen
Peroxide Mouthwash, BP consists of hydrogen peroxide
6% solution (= approx. 20 volume) BP.
l HANDLING AND STORAGE Hydrogen peroxide bleaches
l PROFESSION SPECIFIC INFORMATION
Dental practitioners’ formulary
Hydrogen Peroxide Mouthwash may be prescribed.
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
▶ Peroxyl (Colgate-Palmolive (UK) Ltd)
Hydrogen peroxide 15 mg per 1 ml Peroxyl 1.5% mouthwash sugarfree | 300 ml G £2.94 DT = £2.94
Sodium bicarbonate with sodium
▶ Adult: (consult product literature)
l DIRECTIONS FOR ADMINISTRATION For mouthwash,
extemporaneous preparations should be prepared
according to the following formula: sodium chloride 1.5 g,
sodium bicarbonate 1 g, concentrated peppermint
emulsion 2.5 mL, double-strength chloroform water 50 mL,
water to 100 mL. To be diluted with an equal volume of
warm water prior to administration.
l PRESCRIBING AND DISPENSING INFORMATION Flavours of
mouthwash may include peppermint.
l PROFESSION SPECIFIC INFORMATION
Dental practitioners’ formulary
Compound sodium chloride mouthwash may be
l MEDICINAL FORMS Forms available from special-order
manufacturers include: mouthwash
▶ Child: Rinse or gargle as required
▶ Adult: Rinse or gargle as required
l DIRECTIONS FOR ADMINISTRATION Extemporaneous
mouthwash preparations should be prepared according to
the following formula: sodium chloride 1.5 g, sodium
bicarbonate 1 g, concentrated peppermint emulsion
2.5 mL, double-strength chloroform water 50 mL, water to
100 mL. To be diluted with an equal volume of warm water.
l PRESCRIBING AND DISPENSING INFORMATION No
mouthwash preparations available—when prepared
extemporaneously, the BP states Sodium Chloride
Mouthwash, Compound, BP consists of sodium
bicarbonate 1%, sodium chloride 1.5% in a suitable vehicle
▶ In children The RCPCH and NPPG recommend that, when a
liquid special of sodium chloride is required, the following
l PROFESSION SPECIFIC INFORMATION
Dental practitioners’ formulary
Compound Sodium Chloride Mouthwash may be
l MEDICINAL FORMS No licensed medicines listed.
Availability of adequate fluoride confers significant
resistance to dental caries. It is now considered that the
topical action of fluoride on enamel and plaque is more
important than the systemic effect.
When the fluoride content of drinking water is less than
700 micrograms per litre (0.7 parts per million), daily
administration of fluoride tablets or drops provides suitable
supplementation. Systemic fluoride supplements should not
be prescribed without reference to the fluoride content of
the local water supply. Infants need not receive fluoride
supplements until the age of 6 months.
Dentifrices which incorporate sodium fluoride or
monofluorophosphate are also a convenient source of
Individuals who are either particularly caries prone or
medically compromised may be given additional protection
by use of fluoride rinses or by application of fluoride gels.
Rinses may be used daily or weekly; daily use of a less
concentrated rinse is more effective than weekly use of a
more concentrated one. High-strength gels must be applied
regularly under professional supervision; extreme caution is
necessary to prevent children from swallowing any excess.
Less concentrated gels are available for home use. Varnishes
are also available and are particularly valuable for young or
disabled children since they adhere to the teeth and set in
Prophylaxis of dental caries for water content less than
300micrograms/litre (0.3 parts per million) of fluoride
▶ Child 6 months–2 years: 250 micrograms daily, doses
▶ Child 3–5 years: 500 micrograms daily, doses expressed
▶ Child 6–17 years: 1 mg daily, doses expressed as fluoride
▶ Adult: 1 mg daily, doses expressed as fluoride ion (F-
Prophylaxis of dental caries for water content between
300 and 700micrograms/litre (0.3–0.7 parts per million)
▶ Child 3–5 years: 250 micrograms daily, doses expressed
▶ Child 6–17 years: 500 micrograms daily, doses expressed
▶ Adult: 500 micrograms daily, doses expressed as
Prophylaxis of dental caries for water content above
700micrograms/litre (0.7 parts per million) of fluoride
▶ Child 6 months–17 years: Supplements not advised
▶ Adult: Supplements not advised
Prophylaxis of dental caries for individuals who are caries
prone or medically compromised
▶ Adult: Rinse or gargle 10 mL daily
DOSE EQUIVALENCE AND CONVERSION
▶ Sodium fluoride 2.2 mg provides approx. 1 mg fluoride
▶ These doses reflect the recommendations of the British
Dental Association, the British Society of Paediatric
Dentistry and the British Association for the Study of
Community Dentistry (Br Dent J 1997; 182: 6–7).
COLGATE DURAPHAT ® 2800PPM FLUORIDE TOOTHPASTE
▶ Child 10–17 years: Apply 1 centimetre twice daily, to be
▶ Adult: Apply 1 centimetre twice daily, to be applied
COLGATE DURAPHAT ® 5000PPM FLUORIDE TOOTHPASTE
▶ Child 16–17 years: Apply 2 centimetres 3 times a day, to
be applied after meals using a toothbrush
▶ Adult: Apply 2 centimetres 3 times a day, to be applied
after meals using a toothbrush
Prophylaxis of dental carries for individuals who are
caries prone or medically compromised
▶ Adult: 5 drops daily, dilute 5 drops to 10 mL of water,
alternatively 20 drops once weekly, dilute 20 drops to
l CONTRA-INDICATIONS Not for areas where drinking water
l SIDE-EFFECTS Dental fluorosis
l DIRECTIONS FOR ADMINISTRATION
▶ With oral use Tablets should be sucked or dissolved in the
mouth and taken preferably in the evening.
▶ With oral (topical) use For mouthwash, rinse mouth for
COLGATE DURAPHAT ® 5000PPM FLUORIDE
TOOTHPASTE Brush teeth for 3 minutes before spitting
COLGATE DURAPHAT ® 2800PPM FLUORIDE
TOOTHPASTE Brush teeth for 1 minute before spitting out.
l PRESCRIBING AND DISPENSING INFORMATION Flavours of
oral tablet formulations may include orange.
Mouthwash Avoid eating, drinking, or rinsing mouth for
COLGATE DURAPHAT ® 5000PPM FLUORIDE
TOOTHPASTE Patients or carers should be given advice on
how to administer Sodium fluoride toothpaste.
COLGATE DURAPHAT ® 2800PPM FLUORIDE
TOOTHPASTE Patients or carers should be given advice on
how to administer sodium fluoride toothpaste.
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