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BNSSG Adult Joint Formulary

12.3 Oropharynx

Last edited: 15-04-2024

12.3.1 Treatment of dry mouth

First line drugs Second line drugs Specialist drugs Secondary care drugs


See BNF for conditions that allow saliva substitutes to be prescribed

See UKMI – Saliva substitutes: Choosing and prescribing the right product


Artificial saliva products 

Artificial saliva spray (Oralieve®) (TLS Green)

Alternative: (TLS Blue)

Artificial saliva spray (Glandosane®, AS Saliva Orthana®)

Specific indication: (TLS Blue)

Saliva replacement gel (Biotene Oralbalance®)

  • Sicca syndrome & palliative care
  • Biotene OralBalance® is also available for use on advice of Speech & Language Therapy

Salivix® pastilles



Specific indication: (TLS Blue)

Pilocarpine tablets (TLS Amber Specialist Recommended)



Glycopyrronium bromide (TLS Amber 3 months)

  • For hypersalivation in line with SCP for the treatment of hypersalivation in people with swallowing problems and with neurological conditions, motor neurone disease or Parkinson's Disease in line with the hypersalivation pathway document

Botulinum toxin type A (TLS Red) 

  • For drooling in patients with motor neurone disease and Parkinson's Disease where oral pharmacological treatments have failed
  • NICE TA605 Xeomin® - For treating chronic sialorrhoea

See Botulinum Toxin Pathways page for more information


12.3.2 Oral hygiene

Chlorhexidine 0.2% mouthwash (TLS Green)

Chlorhexidine 1% dental gel (TLS Green)

Hydrogen peroxide mouthwash 6% (TLS Green)

N.B. Hydrogen peroxide mouthwash solution needs to be diluted prior to use

Mouthwash solution tablet (TLS Green)

Caphosol® mouthwash (TLS Red)

  • For patients undergoing bone marrow transplant treatment and haematology patients on multiple drug regimens that include high dose methotrexate

Sucralfate liquid (oral) (TLS Red) 

  • For treatment of oral mucositis for oncology and haematology patients


12.3.3 Oral hygiene, dental caries

High Strength Toothpaste (Duraphat 5000ppm)

The BNSSG Joint Formulary Group consider that the most appropriate clinician to prescribe high strength fluoride toothpaste such as Duraphat is the patient's dentist.

Patients with head and neck cancer/following radiotherapy

Where High Strength Toothpaste (Duraphat 5000ppm) is required for patients with head and neck cancer or who have undertaken a course of radiotherapy, this should be prescribed by the general dental practitioner, if the patient has an NHS dentist. 

If patients are not registered with an NHS dentist or can’t access their NHS dentist to start treatment in a timely way as advised by their oncology team, the GP practice may prescribe High Strength Toothpaste (Duraphat 5000ppm) to support patient care and timely access to treatment in this small cohort of patients.

This pathway has been agreed by NHS England South West.

Where NHS dentistry is available, the NHS dentist remains the preferred route for supply of High Strength Toothpaste (Duraphat 5000ppm).


12.3.4 Oral ulceration and inflammation


Hydrocortisone 2.5mg muco-adhesive buccal tablets (TLS Green)

Betamethasone soluble tablets (TLS Green)

Betamethasone soluble tablets (TLS Amber Specialist Recommended)

Dexamethasone soluble tablets (oral rinse) (TLS Amber Specialist Recommended)

Fluocinolone Acetonide 0.025% gel (Synalar®) (oral) (TLS Amber Specialist Recommended)

  • For topical management of oral ulceration / oral erosions and inflammation

See Guide for Primary Care on the use of off-label topical steroids for inflammatory oral conditions within the Oral Medicine Department


Non-steroidal anti-inflammatory drugs

Benzydamine 0.15% oral rinse/spray (Difflam®) (TLS Green)



Choline salicylate gel (Bonjela®) (TLS Green)

Specific indication: (TLS Blue)

Gelclair® gel

  • Haematology, Oncology and Palliative care use only for pain associated with mucositis


Dapsone (oral) (TLS Amber 3 months) (SCP)


12.3.5 Oropharyngeal bacterial infections

Link to BNF Oropharyngeal bacterial infections

See local antibiotic guidelines

BNSSG Primary Care Antimicrobial Guidelines

  • NBT antibiotic guidelines click here (N.B. Only available via Trust intranet )

  • UHB antibiotic guidelines click here (N.B. Only available via Trust intranet)

  • WAHT see local guidance


12.3.6 Oropharyngeal fungal infections

Link to BNF Oropharyngeal fungal infections

Nystatin oral suspension (TLS Green)

  • Nystatin suspension should be continued for 48 hours after lesions have resolved
  • Consider systemic treatment with oral fluconazole

Miconazole oral gel (TLS Green)


12.3.7 Devices

See funding policy for information about temporomandibular jaw motion rehabilitation devices e.g. therabite


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