BNF for Children 2011-2012

548 12.3.5 Treatment of dry mouth BNFC 2011–201212 Ear, nose, and oropharynxSODIUM CHLORIDEIndication and doseOral hygiene (see notes above); for dose, see underpreparationSodium Chloride Mouthwash, Compound, BPMouthwash, sodium bicarbonate 1%, sodium chloride1.5% in a suitable vehicle with a peppermintflavourDoseExtemporaneous preparations should be preparedaccording to the following formula: sodium chloride 1.5 g,sodium bicarbonate 1 g, concentrated peppermint emulsion2.5 mL, double-strength chloroform water 50 mL,water to 100 mLTo be diluted with an equal volume of warm waterDental prescribing on NHS Compound Sodium ChlorideMouthwash may be prescribedTHYMOLIndication and doseOral hygiene (see notes above); for dose, see underpreparationMouthwash Solution-tabletsConsist of tablets which may contain antimicrobial,colouring, and flavouring agents in a suitable solubleeffervescent basis to make a mouthwash suitable fordental purposes. Net price 100-tab pack = £15.09DoseDissolve 1 tablet in a tumblerful of warm waterNote Mouthwash Solution-tablets may contain ingredientssuch as thymolDental prescribing on NHS Mouthwash Solution-tabletsmay be prescribed12.3.5 Treatment of dry mouthDry mouth (xerostomia) may be caused by drugs withantimuscarinic (anticholinergic) side-effects (e.g. antispasmodicsand sedating antihistamines), by irradiationof the head and neck region or by damage to or diseaseof the salivary glands. Children with a persistently drymouth may develop a burning or scalded sensation andhave poor oral hygiene; they may develop dental caries,periodontal disease, and oral infections (particularlycandidiasis). Dry mouth may be relieved in manypatients by simple measures such as frequent sips ofcool drinks or sucking pieces of ice or sugar-free fruitpastilles. Sugar-free chewing gum stimulates salivationin patients with residual salivary function.Artificial saliva can provide useful relief of dry mouth.A properly balanced artificial saliva should be of aneutral pH and contain electrolytes (including fluoride)to correspond approximately to the composition ofsaliva. The acidic pH of some artificial saliva productsmay be inappropriate.Local treatmentArtificial saliva products with ACBS approval may beprescribed for children with dry mouth as a result ofhaving (or having undergone) radiotherapy, or siccasyndrome. SST tablets may also be prescribed on theNHS.AS Saliva Orthana c (AS Pharma)Oral spray, gastric mucin (porcine) 3.5%, xylitol 2%,sodium fluoride 4.2 mg/litre, with preservatives andflavouring agents, pH neutral, net price 50-mL bottle= £4.92; 500-mL refill = £34.27Dose(ACBS) spray 2–3 times onto oral and pharyngealmucosa, when requiredDental prescribing on NHS AS Saliva Orthana c Oral Spraymay be prescribedLozenges, mucin 65 mg, xylitol 59 mg, in a sorbitolbasis, pH neutral, net price 30-lozenge pack = £3.50Note AS Saliva Orthana c lozenges do not contain fluorideDental prescribing on NHS AS Saliva Orthana c Lozengesmay be prescribedBiotène Oralbalance c (GSK)Saliva replacement gel, lactoperoxidase, lactoferrin,lysozyme, glucose oxidase, xylitol in a gel basis, netprice 50-g tube = £4.10; 24 12.4 mL tube = £30.40(for hospital use)DoseSymptomatic treatment of dry mouthApply to gums and tongue as requiredNote Avoid use with toothpastes containing detergents(including foaming agents)Dental prescribing on NHS Biotène Oralbalance c SalivaReplacement Gel may be prescribedBioXtra c (RIS Products)Gel, lactoperoxidase, lactoferrin, lysozyme, wheycolostrum, xylitol and other ingredients, net price 40-mL tube = £3.94, 50-mL spray = £3.94Dose(ACBS) apply to oral mucosa as requiredDental prescribing on NHS BioXtra c Gel may beprescribedGlandosane c (Fresenius Kabi)Aerosol spray, carmellose sodium 500 mg, sorbitol1.5 g, potassium chloride 60 mg, sodium chloride42.2 mg, magnesium chloride 2.6 mg, calcium chloride7.3 mg, and dipotassium hydrogen phosphate17.1 mg/50 g, pH 5.75, net price 50-mL unit (neutral,lemon or peppermint flavoured) = £4.82Dose(ACBS) spray onto oral and pharyngeal mucosa asrequiredDental prescribing on NHS Glandosane c Aerosol Spraymay be prescribedSaliveze c (Wyvern)Oral spray, carmellose sodium (sodium carboxymethylcellulose),calcium chloride, magnesiumchloride, potassium chloride, sodium chloride, anddibasic sodium phosphate, pH neutral, net price 50-mL bottle (mint-flavoured) = £3.50Dose(ACBS) 1 spray onto oral mucosa as requiredDental prescribing on NHS Saliveze c Oral Spray may beprescribed