NHS England (NHSE) has published new prescribing guidance for various common conditions for which over the counter (OTC) items should not be routinely prescribed in primary care (quick reference guide). These conditions include acute sore throats, mouth ulcers, and prevention of dental caries.

Many of these products are cheap to buy and are readily available OTC along with advice from pharmacies. Some self-care medicines are available from shops and supermarkets. Please click here for further information, exceptions, and a patient leaflet.

Sodium chloride

Notes

1. A simple sodium chloride mouthwash may be made by dissolving a teaspoon of salt in a glass of warm water. It must be used frequently and vigorously.

Chlorhexidine gluconate

• Mouthwash 0.2% (£2.24 = 300ml)
• Dental gel 1% (£3.24 = 50g)
  

Indications

• Oral hygiene and plaque inhibition, oral candidiasis, gingivitis, and management of aphthous ulcers

Notes

1. MHRA Drug Safety Alert (January 2012): Healthcare professionals are reminded that chlorhexidine is known to induce hypersensitivity, including generalised allergic reactions and anaphylactic shock.
2. Chlorhexidine may be used as an antiseptic to prevent secondary infection in mouth ulcers or following oral surgery. It can also prevent the formation of plaque. It is not a substitute for effective toothbrushing.
3. All above products are available over the counter at a cost currently less than the prescription charge.

Hydrogen peroxide

• Mouthwash 6% (20 vol.) (£0.85 = 200ml)

Indications

• Oral hygiene

Dose

• Rinse the mouth for 2–3 minutes with 15ml diluted in half a tumblerful of warm water 2–3 times daily

Notes

1. Hydrogen peroxide has a mechanical cleansing action particularly useful to release oral debris post trauma or surgery.