Rinse mouth thoroughly with water in between using toothpaste and a chlorhexidine-containing product

Also thegel must not be applied to the nipple of a breast-feeding woman for administration to an infant - risk of choking. Medicines that should be initiated by a specialist and prescribed by primary care prescribers only under a shared care protocol, once the patient has been stabilised. Rinse diluted solution around the mouth for at least 1 minute or as long as possible to coat tongue, palate, throat, inside of cheeks and all oral tissue thoroughly Athough there is no evidence base to support the use of the following for treatment of chemotherapy or radiotherapy induced mucositis in children they may be of benefit to some patients: Mometasone nasal spray may be used in children aged 3-6 years of age as it is the only licensed product for this age group.

Mouthwash solution tablets may help relieve traumatic ulceration. One tablet dissolved in a tumblerful of warm water produces a solution that can be used to rinse the mouth at frequent intervals. Drug Safety Update: Oral salicylate gels: not for use in those younger than age 16 years (Dec 2014) Advice should be given to brush at least twice a day with a fluoride toothpaste (containing 1,000 ppm fluoride +/- 10%) No known disease interactions. This does not necessarily mean no interactions exist. Always consult your healthcare provider.

If using part of a MST sachet mix well with water and use immediately. MST sachets should not be used for doses <5mg as sachets do not disperse equally therefore dosing may be inaccurate Oral hygiene advice should be given to children and parents prior to commencing cancer treatment and this should be provided both verbally and in writing. Half Life The half-life of a drug is the time taken for the plasma concentration of a drug to reduce to half its original value. To be used in line with Primary Care Antimicrobial Policy & Guidance. Only to be used ifan immediate antibiotic is not given, and there is no eardrum perforation or otorrhoea. See also NICE NG91: Otitis media (acute): antimicrobial prescribing. For babies without teeth or for children where it is not possible to brush teeth, parents /carers should be instructed on how to clean the mouth with oral sponges. Sponges should be moistened with water

Available from

Aciclovir is only recommended as a preventative strategy for herpes simplex in patients undergoing high dose chemotherapy with stem cell transplant If not available, then by usual dental provider with clear communication and guidance from the cancer centre If no water is available, Gelclair® is safe to use undiluted - applied directly with a sponge or swab Grey / Non-Formulary (no formal assessment): APC has not formally reviewed this medicine or indication because it had never been requested for formulary inclusion. Often used for drugs new to market. pH neutral and a mucin-derived saliva substitute (porcine derivative) - may not be suitable for vegetarians or some religious groups

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.

What is Gelclair?

The purpose of this document is to provide guidance for the management of mucositis in children and young people with cancer receiving chemotherapy/radiotherapy. For SMC recommended medicines/indications where local clinical experts do not wish to add to the formulary at this time Appropriate pain control is recommended together with the continuation of good oral hygiene, as tolerated Prescribing should only be undertaken by primary care after dose and efficacy have been established. Miconazole gel is not licensed in children less than 4 months, or5-6 months of age for infants who are pre-term, or infants exhibiting slow neuromuscular development. There have been issues of choking in infants and young children using miconazole, use nystatin in very young children.

Parents and patients should be informed for the importance of keeping the mouth clean and encouraged to practice good, basic oral hygiene glycopyrronium bromide 400micrograms/mL(Sialanar® 320micrograms/mL oral solution) see SmPC or PIL for dosing informationDrug Safety Update: Hydrocortisone muco-adhesive buccal tablets: should not be used off-label for adrenal insufficiency in children due to serious risks (Dec 2018)