▶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
1 minute and then spit out.
COLGATE DURAPHAT ® 5000PPM FLUORIDE
TOOTHPASTE Brush teeth for 3 minutes before spitting
out.
COLGATE DURAPHAT ® 2800PPM FLUORIDE
TOOTHPASTE Brush teeth for 1 minute before spitting out.
Ear, nose and oropharynx
PDF page 1300
There can be variation in the licensing of
different medicines containing the same drug.
Tablet
▶Endekay (Manx Healthcare Ltd)
Sodium fluoride 1.1 mg Endekay Fluotabs 3-6 Years 1.1mg tablets |
200 tablet p £2.38 DT = £2.38
Sodium fluoride 2.2 mg Endekay Fluotabs 6+ Years 2.2mg tablets |
200 tablet p £2.38 DT = £2.38
Paste
▶Sodium fluoride (Non-proprietary)
Fluoride (as Sodium fluoride) 2.8 mg per 1 gram Sodium fluoride
0.619% dental paste sugar free sugar-free | 75 ml P £4.17 DT =
£3.81
Fluoride (as Sodium fluoride) 5 mg per 1 gram Sodium fluoride
1.1% dental paste sugar free sugar-free | 51 gram P £7.88 DT =
£6.88
▶Colgate Duraphat (Colgate-Palmolive (UK) Ltd)
Fluoride (as Sodium fluoride) 2.8 mg per 1 gram Colgate Duraphat
2800ppm fluoride toothpaste sugar-free | 75 ml P £3.26 DT =
£3.81
Fluoride (as Sodium fluoride) 5 mg per 1 gram Colgate Duraphat
5000ppm fluoride toothpaste sugar-free | 51 gram P £6.50 DT =
£6.88
Chewable tablet
▶Fluor-a-day (DHP Healthcare Ltd)
Sodium fluoride 1.1 mg Fluor-a-day 1.1mg chewable tablets sugar-
free | 200 tablet p £3.38 DT = £3.38
Sodium fluoride 2.2 mg Fluor-a-day 2.2mg chewable tablets sugar-
free | 200 tablet p £3.38 DT = £3.38
Mouthwash
▶Sodium fluoride (Non-proprietary)
Sodium fluoride 500 microgram per 1 ml Sodium fluoride 0.05%
mouthwash sugar free sugar-free | 250 ml G s DT = £1.51
▶Colgate FluoriGard (Colgate-Palmolive (UK) Ltd)
Sodium fluoride 500 microgram per 1 ml Colgate FluoriGard 0.05%
daily dental rinse alcohol free sugar-free | 400 ml £2.99
Colgate FluoriGard 0.05% daily dental rinse sugar-free | 400 ml G
£2.99
▶Endekay (Manx Healthcare Ltd)
Sodium fluoride 500 microgram per 1 ml Endekay 0.05% daily
fluoride mouthrinse sugar-free | 250 ml G £1.51 DT = £1.51
sugar-free | 500 ml G £2.45
Oral ulceration and
inflammation
Oral ulceration and inflammation
Ulceration and inflammation
Ulceration of the oral mucosa may be caused by trauma
(physical or chemical), recurrent aphthae, infections,
carcinoma, dermatological disorders, nutritional
deficiencies, gastro-intestinal disease, haematopoietic
disorders, and drug therapy (see also Chemotherapy induced
mucositis and myelosuppression under Cytotoxic drugs
p. 938). It is important to establish the diagnosis in each case
as the majority of these lesions require specific management
in addition to local treatment. Local treatment aims to
protect the ulcerated area, to relieve pain, to reduce
inflammation, or to control secondary infection. Patients
with an unexplained mouth ulcer of more than 3 weeks’
duration require urgent referral to hospital to exclude oral
cancer.
Simple mouthwashes
A saline mouthwash may relieve the pain of traumatic
ulceration. The mouthwash is made up with warm water and
used at frequent intervals until the discomfort and swelling
subsides.
Antiseptic mouthwashes
Secondary bacterial infection may be a feature of any
mucosal ulceration; it can increase discomfort and delay
healing. Use of a chlorhexidine mouthwash p. 1275 is often
beneficial and may accelerate healing of recurrent aphthae.
Corticosteroids
Topical corticosteroid therapy may be used for some forms of
oral ulceration. In the case of aphthous ulcers it is most
effective if applied in the ‘prodromal’ phase.
Thrush or other types of candidiasis are recognised
complications of corticosteroid treatment.
Hydrocortisone oromucosal tablets p. 1281 are allowed to
dissolve next to an ulcer and are useful in recurrent aphthae
and erosive lichenoid lesions.
Beclometasone dipropionate inhaler p. 1280 sprayed on
the oral mucosa is used to manage oral ulceration
[unlicensed indication]. Alternatively, betamethasone
soluble tablets p. 1281 dissolved in water can be used as a
mouthwash to treat oral ulceration [unlicensed indication].
Systemic corticosteroid therapy (see under
Corticosteroids, inflammatory disorders p. 1216), is reserved
for severe conditions such as pemphigus vulgaris.
Local analgesics
Local analgesics have a limited role in the management of
oral ulceration. When applied topically their action is of a
relatively short duration so that analgesia cannot be
maintained continuously throughout the day. The main
indication for a topical local analgesic is to relieve the pain of
otherwise intractable oral ulceration particularly when it is
due to major aphthae. For this purpose lidocaine
hydrochloride 5% ointment below or lozenges containing a
local anaesthetic are applied to the ulcer. Lidocaine
hydrochloride 10% solution as spray can be applied thinly to
the ulcer [unlicensed indication] using a cotton bud. When
local anaesthetics are used in the mouth care must be taken
not to produce anaesthesia of the pharynx before meals as
this might lead to choking.
Preparations on sale to the public: many mouth ulcer
preparations, throat lozenges, and throat sprays on sale to
the public contain a local anaesthetic. To identify the active
ingredients in such preparations, consult the product
literature of the manufacturer— the correct proprietary
name should be ascertained as many products have very
similar names but different active ingredients.
Benzydamine hydrochloride p. 1280 and flurbiprofen
p. 1280 are non-steroidal anti-inflammatory drugs (NSAIDs).
Benzydamine hydrochloride mouthwash or spray may be
useful in reducing the discomfort associated with a variety of
ulcerative conditions. It has also been found to be effective
in reducing the discomfort of tonsillectomy and post-
irradiation mucositis. Some patients find the full-strength
mouthwash causes some stinging and, for them, it should be
diluted with an equal volume of water. Flurbiprofen lozenges
are licensed for the relief of sore throat.
Choline salicylate p. 1281 is a derivative of salicylic acid
and has some analgesic action. The dental gel may provide
relief for recurrent aphthae, but excessive application or
confinement under a denture irritates the mucosa and can
itself cause ulceration.
Other preparations
Doxycycline p. 1282 rinsed in the mouth may be of value for
recurrent aphthous ulceration.
Periodontitis
Low-dose doxycycline (Periostat ®) is licensed as an adjunct
to scaling and root planing for the treatment of
periodontitis; a low dose of doxycycline reduces collagenase
activity without inhibiting bacteria associated with
periodontitis.
For anti-infectives used in the treatment of destructive
(refractory) forms of periodontal disease, see under
Oropharyngeal infections, antibacterial therapy p. 1282. See
also Mouthwashes and other preparations for oropharyngeal
use p. 1275 for mouthwashes used for oral hygiene and
plaque inhibition.
ANAESTHETICS, LOCAL
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