Palliative Care Guidelines - NHS Lanarkshire

Palliative Care Guidelines: Mouth CareManagementCandidiasis• Chlorhexidine gluconate 0.2%, 10ml twice daily.• Nystatin suspension 1ml, as a mouthwash then swallowed, 4 times daily for 7-14 days. Givenystatin with any dentures out and at least 30 minutes after chlorhexidine or it becomesinactive.• Fluconazole (capsules or suspension) 50mg daily for 7-14 days. Check BNF for druginteractions.• Angular cheilitis can be treated with nystatin suspension. Miconazole gel (topically 4 timesdaily) can be used to treat cheilitis and oral candidiasis.• Dentures should be cleaned thoroughly.Ulcerated mouth• Identify the cause if possible; exclude infection, dental problems.• If ulcers are painful, try benzydamine hydrochloride 0.15% (Difflam) 15ml, 2-3 hourly; or atopical steroid (eg. hydrocortisone lozenge or triamcinolone in orabase).• Use chlorhexidine gluconate 0.2% mouthwash twice daily to prevent and treat infection.• If persistent mucositis, consider sending swab for culture.• Treat herpetic ulcers on the lips with topical aciclovir; use oral aciclovir for herpes infection inthe mouth.• Treat anaerobic (foul smelling) lesions or gingivitis with oral metronidazole.Practice point• Refer to a dentist if pain or ulceration is related to teeth or dentures.Patient / carer advice points• Regular toothbrushing and dental hygiene are essential. Visit a dentist regularly.• Avoid sugary drinks. Try sugar free chewing gum.ResourcesPatientPatient leaflet on website: Managing a dry or sore mouth.Key references1. Davies A, Finlay I. Oral Care in Advanced Disease: OUP 2005, Oxford2. De Conno. Mouth care. In Oxford Textbook of Palliative Medicine. 3 rd Edition 2004, p673-6873. Gillam JL, Gillam DG. The assessment and implementation of mouth care in palliative care: a review.The Journal Royal Society Promotion of Health 2006; 126(1): 33-37Further reading: http://www.palliativecareguidelines.scot.nhs.uk2 Issue date: January 2009 Review date: March 2012 © NHS Lothian