Mouth and throat products

I. Introduction

Mouth and throat products are a diverse group of topical and systemic agents used to treat, soothe, or prevent conditions affecting the oral cavity and pharynx. These include antiseptics, anesthetics, antifungals, anti-inflammatories, corticosteroids, lubricants, lozenges, sprays, and mouthwashes, among others. They play an essential role in the management of oral infections, inflammation, pain, ulcers, dry mouth (xerostomia), and throat irritation due to conditions like pharyngitis, tonsillitis, stomatitis, gingivitis, and oral candidiasis.

The choice of product depends on the underlying condition, severity of symptoms, patient-specific factors (age, allergies, comorbidities), and formulation preference (lozenge, spray, solution, gel, tablet, etc.).

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II. Classification of Mouth and Throat Products

Mouth and throat products can be categorized based on their therapeutic function:

1. Topical Antiseptics and Antibacterials

Used for controlling microbial growth in the oral cavity.

• Chlorhexidine gluconate (e.g., Corsodyl, Peridex)

• Benzydamine hydrochloride (e.g., Difflam)

• Cetylpyridinium chloride

• Hexetidine (e.g., Oraldene)

• Hydrogen peroxide (oral rinse)

• Povidone-iodine (Betadine mouthwash)

• Phenol (in lozenges/sprays)

• Sodium bicarbonate mouthwashes

2. Topical Anesthetics and Analgesics

Used for symptomatic relief of pain or burning.

• Benzocaine

• Lidocaine (e.g., Xylocaine 2% viscous)

• Ambroxol hydrochloride

• Phenol (low concentration in sprays/lozenges)

• Polidocanol

3. Antifungal Agents (Oral Candidiasis Treatment)

Target Candida albicans and related species.

• Nystatin oral suspension or pastilles

• Miconazole oral gel (e.g., Daktarin Oral Gel)

• Clotrimazole lozenges (U.S.)

• Amphotericin B lozenges

4. Anti-inflammatory Agents

Reduce local inflammation in gingivitis, stomatitis, pharyngitis.

• Benzydamine (NSAID class)

• Flurbiprofen lozenges

• Aspirin gargles (off-label use)

• Corticosteroids (triamcinolone oral paste for aphthous ulcers)

5. Corticosteroids (Topical for Oral Lesions)

Primarily used for inflammatory or autoimmune oral lesions.

• Triamcinolone acetonide dental paste (Kenalog in Orabase)

• Clobetasol propionate oral paste

• Fluocinonide oral gel

• Hydrocortisone lozenges (for ulcers)

6. Mucosal Protectants and Healing Agents

For aphthous ulcers, mucositis, or radiation-induced lesions.

• Sucralfate suspension (off-label)

• Hyaluronic acid gels/mouthwashes

• Zinc-based preparations

• Vitamin B12 or folic acid lozenges for ulcer healing

7. Dry Mouth (Xerostomia) Management

Saliva substitutes and stimulants.

• Pilocarpine (systemic; for severe xerostomia, Rx only)

• Artificial saliva (e.g., Biotène, XyliMelts)

• Carboxymethylcellulose-based sprays/gels

• Sugar-free chewing gum with xylitol

8. Throat Lozenges, Sprays, and Tablets

Multi-ingredient products that combine analgesics, antiseptics, demulcents.

• Strepsils (amylmetacresol + dichlorobenzyl alcohol)

• Difflam lozenges/spray (benzydamine)

• Throatsil (benzydamine + cetylpyridinium chloride)

• Halls, Vicks (menthol-based for symptomatic relief)

9. Mouth Ulcer Gels / Oral Adhesives

Target aphthous ulcers and mouth trauma.

• Bonjela (choline salicylate)

• Orabase protective paste

• Gengigel (hyaluronic acid)

• Oralmedic (sulphonic acid solution; cauterizing)

10. Immune Modulators (Severe Recurrent Aphthous Ulcers)

Prescription use only.

• Thalidomide (severe cases, HIV/AIDS-related)

• Dapsone (in autoimmune oral lesions)

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III. Therapeutic Indications

Condition	Product Types Used
Sore throat / Pharyngitis	Antiseptic lozenges, benzydamine, lidocaine sprays
Oral candidiasis	Nystatin, miconazole oral gel, amphotericin B lozenges
Gingivitis / Periodontitis	Chlorhexidine mouthwash, hydrogen peroxide rinses
Aphthous ulcers	Triamcinolone paste, benzydamine, mucosal protectants
Xerostomia	Artificial saliva, pilocarpine, xylitol-containing products
Post-dental procedures	Chlorhexidine, antiseptic mouthwashes, lidocaine viscous
Viral sore throat	Analgesic lozenges, sprays with menthol or lidocaine
Oral mucositis (chemo/radiation)	Sucralfate, cryotherapy, lidocaine rinses, magic mouthwash
Halitosis (bad breath)	Chlorhexidine, zinc chloride rinses, tongue scrapers

IV. Routes and Formulations

• Lozenges / Troches: Slowly dissolve in mouth for extended contact (e.g., Strepsils, nystatin)

• Sprays: Local anesthesia or antiseptic effect (e.g., Difflam spray)

• Mouthwashes / Rinses: Antiseptic or antifungal (e.g., chlorhexidine)

• Gels / Pastes: Adhesive protection for ulcers (e.g., Kenalog in Orabase)

• Oral suspensions: For infants and children (e.g., nystatin suspension)

• Viscous solutions: For swish and spit/swallow (e.g., lidocaine 2% viscous)

• Sublingual tablets / lozenges: Vitamin B12, corticosteroids (hydrocortisone)

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V. Key Ingredients by Function

Function	Common Ingredients
Antiseptic	Chlorhexidine, povidone-iodine, CPC, hexetidine
Antifungal	Miconazole, nystatin, amphotericin B
Anesthetic	Lidocaine, benzocaine, ambroxol, polidocanol
Anti-inflammatory	Benzydamine, flurbiprofen
Corticosteroids	Triamcinolone, hydrocortisone, clobetasol
Moisturizers	Glycerin, CMC, xylitol
Demulcents	Honey, glycerol, slippery elm
Astringents	Zinc sulfate, tannic acid

VI. Adverse Effects and Precautions

Agent / Class	Possible Adverse Effects
Chlorhexidine	Tooth staining, altered taste, mucosal irritation
Benzydamine	Burning, stinging, hypersensitivity, rare anaphylaxis
Lidocaine	Numbness, choking risk, systemic toxicity if swallowed
Corticosteroids	Oral candidiasis with prolonged use, mucosal thinning
Antifungals (topical)	GI upset if swallowed, rare allergy
Artificial saliva	Usually safe; occasional nausea or taste alteration
Lozenges with menthol	Throat irritation, hypersensitivity, laryngeal spasm in children
Alcohol-containing rinses	Dryness, burning, especially in mucositis

VII. Drug Interactions

• Miconazole + Warfarin: Risk of bleeding; monitor INR

• Chlorhexidine + Toothpaste: Sodium lauryl sulfate in toothpaste inactivates chlorhexidine – use >30 mins apart

• Lidocaine + Class I Antiarrhythmics: Risk of additive cardiac depression

• Corticosteroids + Immunosuppressants: Increased infection risk

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VIII. Special Populations

Pediatrics

• Avoid lozenges with choking risk in children <6 years

• Nystatin oral suspension preferred for candidiasis

• Lidocaine use should be cautious due to systemic absorption

Pregnancy and Lactation

• Most topical agents (chlorhexidine, nystatin, saline) are safe

• Avoid corticosteroids unless prescribed

• Alcohol-based rinses are generally avoided

Geriatrics

• Xerostomia more common; artificial saliva and lubricants helpful

• Monitor for oral fungal infections with denture use

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IX. OTC vs. Prescription Products

Over-the-Counter (OTC)	Prescription-Only (Rx)
Strepsils, Halls, Vicks lozenges	Kenalog (triamcinolone), clobetasol oral paste
Biotène (saliva substitute)	Pilocarpine tablets for xerostomia
Hydrogen peroxide rinse	Lidocaine viscous 2%, benzydamine spray
Bonjela (choline salicylate)	Amphotericin B lozenges, clotrimazole troches
Oraldene (hexetidine rinse)	Miconazole oral gel

X. Clinical Guidelines and Recommendations

• NICE Guidelines (UK):

  • Recommend topical corticosteroids for severe recurrent aphthous ulcers

  • Chlorhexidine for post-surgical care and gingivitis management

• IDSA Guidelines:

  • Nystatin or miconazole for oropharyngeal candidiasis

• MASCC/ISOO Guidelines:

  • Cryotherapy or benzydamine for mucositis prevention in chemotherapy

• ADA Guidelines:

• Advise non-alcoholic mouthwashes for dry mouth, oral mucositis