Treatment for Dry Mouth, Stomatitis, and Mucositis

Loss of saliva (xerostomia) is one of the most common complaints among patients who have received radiation therapy of the head and neck. Xerostomia contributes to radiation-induced periodontal infection, dental caries, osteoradionecrosis, and poor digestion of carbohydrates. Ask us about sialogogues (saliva stimulants) in customized dosage forms.

Aust Dent J 2002 Sep;47(3):249-53

An investigation into the use of pilocarpine as a sialagogue in patients with radiation induced xerostomia.

Frydrych AM, Davies GR, Slack-Smith LM, Heywood J.
School of Dentistry, The University of Western Australia, Crawley.

In order to access the PubMed abstract of this article, visit this website link.

When a person is receiving chemotherapy or radiation, mouth tenderness and infections can interfere with the ability to eat. Malnutrition may result, yet it is often preventable. Our pharmacy can compound medications which may enable patients to enjoy eating again. We can compound numerous medications into a preparation such as an oral rinse that contains the needed concentrations of each drug.

A three-drug mouthwash (lidocaine, diphenhydramine and sodium bicarbonate in normal saline) can provide effective symptomatic relief in patients with chemotherapy-induced mucositis.

Support Care Cancer. 2000 Jan;8(1):55-8

Efficacy of treatment to relieve mucositis-induced discomfort.

Turhal NS, Erdal S, Karacay S.
Department of Medicine, Marmara University Hospital, Istanbul, Turkey.

In order to access the PubMed abstract of this article, visit this website link.

Compounding dental mouthwashes or rinses may offer numerous advantages over commercially available dosage forms. Elixirs, syrups, and suspensions often contain preservatives such as alcohol which can cause reactions or gastrointestinal irritation, or sugar which makes the preparation undesirable for prolonged use in the mouth or for diabetic patients. A customized preparation without unnecessary excipients - i.e., a sugar-free, dye-free, lactose-free, and preservative-free dosage form - can eliminate concerns of palatability, alcohol content, and dyes which may stain exposed mucosa.

Various preparations are also available to treat burning mouth syndrome and anesthetic/analgesic and antibiotic/anti-infective mouthwashes are commonly requested.

Tranexamic acid solution (4.8%) used as a mouthwash has been used successfully to prevent postsurgical bleeding after oral surgery without dose modification of oral anticoagulants.

J Oral Maxillofac Surg 1993 Nov;51(11):1211-6

Prevention of postsurgical bleeding in oral surgery using tranexamic acid without dose modification of oral anticoagulants.

Ramstrom G, Sindet-Pedersen S, Hall G, Blomback M, Alander U
Department of Oral and Jaw Diseases, Karolinska Hospital, Stockholm, Sweden.

Compounding allows countless active ingredients to be incorporated into customized mouthwashes, gels, troches, etc. For example, to treat periodontal disease, antibiotics can be formulated as a mouthwash, or added to an oral adhesive paste or a plasticized gel that will maintain the contact between the tissue and medication for a prolonged period of time.
Metronidazole 25% in a lipogel-type base provides an efficient treatment of anaerobic infection when applied topically in the periodontal pockets.

Click on the following citations for abstracts/more information:
J Int Acad Periodontol. 2000 Jul;2(3):64-70
Vojnosanit Pregl. 2005 Jul-Aug;62(7-8):565-8
Minerva Stomatol. 2000 Jan-Feb;49(1-2):59-67
J Clin Periodontol. 1992 Oct;19(9 Pt 2):693-7

The gag reflex can cause a patient considerable discomfort as well as interfere with dental procedures. An electrolyte tablet administered and retained intraorally a few minutes before the start of a procedure can suppress the gag reflex, allowing a mandibular block to be given with much greater ease, which further reduces the gagging reflex.

Tablets can be prescribed for home use for patients who can not properly perform oral hygiene procedures due to the gagging problem. Severe gaggers may need to repeat a dose in 15 to 20 minutes. (Dent Today. 1991 Dec;10(9):68-71)

Some patients and dentists prefer to use electrolyte lollipops.

We believe that Transdermal application of NSAIDs such as ketoprofen results in significantly higher tissue levels beneath the site of application than are achieved with oral administration. Additionally, side effects such as gastrointestinal irritation are avoided.

The below mentioned article describes how topical non-steroidal anti-inflammatory drugs are effective in relieving pain in acute and chronic conditions.

BMJ. 1998 Jan 31;316(7128):333-8

Quantitative systematic review of topically applied non-steroidal anti-inflammatory drugs.

Moore RA, Tramer MR, Carroll D, Wiffen PJ, McQuay HJ.
University of Oxford, Oxford Radcliffe Hospital, Headington.

In order to access the PubMed abstract of this article, visit this website link.

Free full text article available at bmj.com: http://bmj.bmjjournals.com/cgi/content/full/316/7128/333

 The following article reports "The systemic concentrations of ketoprofen have also been found to be 100 fold lower compared to tissue concentrations below the application... Topically applied ketoprofen thus provides high local concentration below the site of application but lower systemic exposure."

Pharm Res. 1996 Jan;13(1):168-72

The below mentioned article investigates the Percutaneous absorption of ketoprofen from different anatomical sites in man.

Shah AK, Wei G, Lanman RC, Bhargava VO, Weir SJ.
Pfizer Inc., Central Research Division, Groton, Connecticut 06340, USA

In order to access the PubMed abstract of this article, visit this website link.

Iontophoretic delivery of dexamethasone and lidocaine may be effective in improving mandibular function in patients with temporo-mandibular disorders who have concurrent temporo-mandibular joint capsulitis and disc displacement without reduction.

J Orofac Pain 1996 Spring;10(2):157-65

Temporomandibular joint iontophoresis: a double-blind randomized clinical trial.

Schiffman EL, Braun BL, Lindgren BR.
TMJ and Craniofacial Pain Clinic, School of Dentistry University of Minnesota, Minneapolis 55455

In order to access the PubMed abstract of this article, visit this website link.

Topical application of anti-emetics in a gel formulation provides a rapid onset and offers an effective alternative to oral administration. Oral surgeons have found this formulation to be particularly useful.

Promethazine is commonly compounded for topical or transdermal application to treat nausea, vomiting, and vertigo, but this preparation may be used as an antiemetic for cases ranging from chemotherapy to motion sickness. The dose is typically 25mg for adults, and the dose is decreased for children. The gel is applied to an area of soft skin, such as the inside of the wrist or arm, the side of the torso, or the inside of the thigh. For children, the gel is often applied to the inside of one wrist, and then the wrists are rubbed together.
US Pharmacist, August 1999; 74-5

Other dosage forms include suppositories and lollipops.