Require long term on-going monitoring and dose adjustment to ensure efficacy and minimise toxicity by a specialist

The patient’s mouth should be regularly examined by a nurse/doctor/dentist using the otoscope/torch as part of routine assessment to observe any changes ie inflammation, ulcerated areas and candida plaques using the scoring chart below ( see Appendix 1). External changes ie sore or vesicles on the lips should also be noted and bacterial/viral swabs taken where necessary. Other chlorhexidine brands include: Acclean, Bactoshield, Betasept, Biopatch, Calgon Vesta, ChloraPrep One-Step, Chlorostat, Chlorostat 4, Denti-Rinse, Dyna-Hex, Exidine, Hibiclens, Hibistat, Hibistat Towelette, Paroex, PerioChip, Periogard, Scrub Care, Scrub Care Exidine, Sky Oral Rinse, Spectrum-4, Tegaderm CHG Dressing View more

More about Gelclair (sodium hyaluronate topical)

If no water is available, Gelclair® is safe to use undiluted - applied directly with a sponge or swab First line saliva replacement product. To be considered only after full oral assessment and examination, including patient education, and if simple measures eg frequent drinks/ mouthwashes, sugar free gum, sugar free boiled sweets have failed. Discontinue if patient perceives no benefit after 5 days. glycopyrronium bromide 400micrograms/mL(Sialanar® 320micrograms/mL oral solution) see SmPC or PIL for dosing information

Secondary care use only as a mouthwash for a variety of oral mucosal diseases.Also available for use by ENT surgery. Other sodium hyaluronate brands include: Bionect, Hylase Wound Gel, Hylinate, Hylira, IPM Wound, RadiaPlexRx, Xclair Treatment may be initiated in either Primary or Secondary Care, including Community Pharmacies for minor illnesses included in the NHS Pharmacy First Scotland Approved List.

Children under 12 years must see a doctor before starting each course of hydrocortisone buccal tablets. No known drug interactions. This does not necessarily mean no interactions exist. Always consult your healthcare provider.

Medicines which are suitable for initiation and ongoing prescribing within primary care. Primary care prescribers take full responsibility for prescribing and monitoring. pH neutral and a mucin-derived saliva substitute (porcine derivative) - may not be suitable for vegetarians or some religious groups Higher risk medicines requiring significant regular monitoring which would be initiated by or at the recommendation of a specialist service which may include mental health services, secondary care, tertiary care, community providers, private providers and GPs with a specialist interest. For patients who do experience nosebleeds use Vaseline to both sides of the nose twice a day ideally before using the spray. SFH guide to all mouthcare products-permitted for severe oral stomatitis by specialist palliative care requestSFH information: From 11th March 2019 will no longer be supplied from Pharmacy. Instead Oralieve moisturising gel is available from Supply Chain.

From the National Specialist Service for pulmonary arterial hypertension (Scottish Pulmonary Vascular Unit or similar specialists)

Looking to ditch the itch?

Basic oral care plus (Clinical decision required. If antifungal agent to be used choose one absorbed from GI tract eg fluconazole or itraconozole At SFH: Either one crushed 500mg tablet (or one ampoule 500mg/5ml) made up to 10ml with tap water. This gives 10ml of 5% solution. Usual dose is 10ml qds. Inhalation of steam is an inexpensive alternative that may be beneficial. Addition of an aromatic product e.g. compound benzoin tincture may make this a more attractive therapy to use. Clarification from the BNF (March 2017) has confirmed that the dose should be 100,000 units (1ml) FOUR times daily. Grey / Non-Formulary: Medicines, which the Nottinghamshire APC has actively reviewed and does not recommend for use at present due to limited clinical and/or cost effective data.