A Guide to

Oral Products

Speech-Language Therapy Services Tauranga Hospital Ph 07 579 8785 Oral Hygiene Products

It is extremely important to maintain good oral hygiene, particularly if brushing teeth is difficult, you are at risk of aspiration (food/drink going down ‘the wrong way’ into your airway), or you have (dry mouth). Oral effects overall health and it is important to maintain a clean mouth and teeth (no matter how many or few teeth you have!)

Please discuss your oral hygiene routine, and which products are most suitable for you, with your speech- language therapist.

Ordering information:

Some of these products are available from pharmacies. Others need to be purchased from medical suppliers. The following information will assist you with ordering from these suppliers. Please note prices listed are approximate, based on 2011 prices, and will vary between different suppliers and pharmacies.

Capes Medical Supplies

A family-owned and operated local business based at Mt Maunganui. They mostly sell to clinics and hospitals, but are also happy to sell to individuals. There is no minimum order.

How to order: Visit their premises at 18 Tukorako Drive, Mt Maunganui. Place an order by phone: (07) 575 9777 (postage will be charged). Place an order by email: [email protected] (postage will be charged). USL Medical (Universal Specialties Ltd)

A New Zealand owned, Auckland-based company which generally sells to hospitals and clinics. They will also take orders from individuals, although there is a minimum order of $75. This may be made up of a range of different products, or you could order in bulk so you have ongoing supplies. There will also be a charge for postage.

How to order: Place an order by phone: (09) 829 0960. Place an order through the website: www.uslmedical.co.nz. Ask your local pharmacy to place an order for you for products from USL Medical – the price will be approximately the same as if you order directly from the company and the $75 minimum order will still apply. The company are very happy for you to contact them if you have problems with this system.

Websites: ‘Toothshop’ and ‘Great Smile’

www.toothshop.co.nz

www.greatsmile.co.nz

Some of the products can be ordered online through these websites. There will be a charge for postage.

How to order: Visit the website. Search for the product you wish to buy. Place an order and pay online by credit card. The products will be delivered to your home.

Mouthwashes

Use a in addition to brushing teeth twice daily (AM /PM) to maintain a healthy mouth free of harmful bacteria. Use mouthwash if: you have a dry mouth; you are prone to developing mouth ulcers, sores, inflammation or oral thrush; or you have difficulties with swallowing. If you are at risk of aspiration (food/fluid going down the wrong way), use a foam mouth swab to apply the mouthwash to your and inside of your mouth, rather than gargling.

Approximate Product Benefits Precautions Where can I get it? cost Refreshes and cleans Not recommended to USL Medical. 44ml: $6.30 (USL (debrides) sore mouths without use for more than 7 order code: 90011) drying. days unless ($75 minimum order instructed to do so by applies). Contains 1.5% hydrogen peroxide, which has a health professional. antimicrobial and debriding Avoid swallowing. (cleaning) properties. May give a mild Use with a “fizzing” sensation Sage Perox-A-Mint treated mouth swab if unable to due to its “bubbling” Solution gargle. cleaning action. Useful for thinning thickened, sticky . Safe for use on tender oral tissues. Alcohol free.

Approximate Product Benefits Precautions Where can I get it? cost Antibacterial mouthwash Contains alcohol Toothshop website Approx. $16 (236ml) Contains 1.5% hydrogen (6%) so may have a (www.toothshop.co. peroxide, which has drying effect on the nz) antimicrobial and debriding mouth. (cleaning) properties. Not recommended to Useful for thinning thickened, use for more than 7 sticky saliva. days unless Facilitates healing of minor instructed to do so by mouth and gum irritations. a health professional. Colgate Peroxyl Use with a sodium bicarbonate Avoid swallowing. Oral Cleanser treated mouth swab if unable to May give a mild gargle. “fizzing” sensation due to its “bubbling” cleaning action. Antibacterial mouth and throat Not recommended Stocked by many $9 - $14 rinse. for prolonged use pharmacies and (250ml and 300ml Contains , which without consultation supermarkets. sizes available) can help swollen , mouth with a . Capes Medical sores and oral thrush on advice Only effective if Supplies. of dentist or physician. mouth is clean (brush Toothshop website Freshmint variety is teeth first). (www.toothshop.co. recommended, as it has a Contains alcohol (12- nz) slightly less powerful 14%) so may have Colgate Savacol concentration of chlorhexidine drying effect. Mouthwash (0.12% as opposed to 0.2%). May stain tooth (Freshmint variety Reduces gum inflammation. surfaces if used for recommended) Inhibits formation prolonged period. when used for short periods. Approximate Product Benefits Precautions Where can I get it? cost Antibacterial mouth and throat Contains higher Toothshop website Approx. $10 (300ml) rinse. concentration of (www.toothshop.co. Contains chlorhexidine, used chlorhexidine than nz) for swollen gums and mouth Freshmint variety sores on advice of dentist or (0.2%). physician. Not recommended May be less drying than for prolonged use Freshmint or Original Savacol without consultation varieties, as it does not contain with a dentist. alcohol. Only effective if Colgate Savacol mouth is clean (brush Mouthwash – teeth first). alcohol free May stain tooth surfaces if used for prolonged period.

Especially formulated to sooth Stocked by many 240ml: $11 - $17 and relieve dry mouth. pharmacies. 470ml: $16 - $24 Contains natural antibacterial Toothshop website enzymes. (www.toothshop.co. Alcohol free. nz) Helps neutralise mouth odours. Capes Medical Supplies.

Biotene Dry Mouth Mouthwash

Approximate Product Benefits Precautions Where can I get it? cost Especially formulated to sooth Great Smile $15 - $17 and relieve dry mouth. website Alcohol free. (www.greatsmile.co Cleans and protects the mouth .nz) from bacterial plaque. Capes Medical Supplies.

Xerostom Mouthwash

Mouth Moisturisers and Saliva Substitutes

A mouth moisturiser can be applied to the inside of your mouth after cleaning your teeth and mouth, to keep your mouth moist and healthy; apply to lips, inside of cheeks, tongue and around gums and teeth. Mouth moisturisers and saliva substitutes are especially useful if you experience chronic dry mouth (xerostomia), and can aid speaking, chewing and swallowing for people with dry mouth. Dry mouth has many causes including: some , radiotherapy, some medications, smoking, advanced age. Another option for moisturising your mouth that some people find helpful is to apply grape-seed oil or rice- bran oil to the inside of the mouth. You could either use a small spray bottle or apply with a mouth swab. Flavouring such as an essence of your choice can be added to make this more pleasant. Use with caution if you are prone to choking or aspirating on secretions, or have swallowing difficulties. This should be discussed with your SLT before trying. Do not use Vaseline, wool fat or greasy crèmes / gels in the mouth; use only WATER SOLUBLE, MUCOADHESIVE GEL approved for use in mouth and on lips. Vaseline, Petrolatum type products can inflame already dry and cracked lips and should not be used around oxygen.

Product Benefits Precautions Where can I get Approximate it? cost Soothes and moisturises dry or This is a lip and USL Medical. $6.20 (USL order sore lips and mouths. oral moisturiser code: 90007) Water- based mucoadhesive rather than a saliva ($75 minimum substitute. order applies). formula with Vitamin E and coconut oil coats the mouth Relieves symptoms and tongue and helps to reduce of dry mouth, but mouth pain from oral sores. does not increase May be used on lips and inside saliva production. Sage Toothette the mouth. It is recommended Mouth Moisturizer Pleasant spearmint flavour can you see your doctor help to promote saliva and if the cause of your freshen the mouth dry mouth has not been investigated.

A saliva substitute designed to Relieves symptoms May be prescribed $27 - $36 help relieve the difficulties and of dry mouth, but by your doctor. damage associated with does not increase Available from reduced saliva production. saliva production. some pharmacies Contains electrolytes modified It is recommended without to simulate natural saliva. you see your doctor prescription. Pleasant lemon flavour. if the cause of your Capes Medical dry mouth has not Supplies. been investigated. Oralube saliva substitute Product Benefits Precautions Where can I get Approximate it? cost

Especially formulated for relief Relieves symptoms Stocked by most $17 - $22 (42g) of moderate-severe dry mouth. of dry mouth, but pharmacies. Provides long-lasting relief (up does not increase Toothshop website saliva production. to 8 hours). (www.toothshop.co. Bio-active enzymes strengthen It is recommended nz) your saliva’s natural properties. you see your doctor Capes Medical Helps neutralise odours. if the cause of your Supplies. Oral Balance Dry dry mouth has not Mouth Moisturising been investigated. Gel

Especially formulated for relief Relieves symptoms Great Smile $15 - $17 of dry mouth. of dry mouth, but website Soothes tissues while cleaning does not increase (greatsmile.co.nz). and protecting mouth from saliva production. Capes Medical cavities and bacterial plaque. It is recommended Supplies. you see your doctor Xerostom Saliva if the cause of your Substitute Gel dry mouth has not been investigated.

Product Benefits Precautions Where can I get Approximate it? cost A saliva substitute to relieve Relieves symptoms Stocked by some Gel (100g): $17 - symptoms of dry mouth. of dry mouth, but pharmacies. $22 Free from sugar, gluten and does not increase Capes Medical Spray (100ml): alcohol. saliva production. Supplies. Freshens the breath, and It is recommended $17 - $24 relieves unpleasant tastes. you see your doctor Spray is ideal for day use; gel if the cause of your is good for night use. dry mouth has not been investigated. Hamilton Aquae Dry Mouth Gel or

Spray

Developed for the relief of dry Relieves symptoms Tauranga Hospital $50 mouth caused by such of dry mouth, but speech-language as cancer or medical therapy. does not increase therapy department (talk to your Pleasant lemon-lime flavour. saliva production. It is recommended speech-language you see your doctor therapist to order). if the cause of your dry mouth has not been investigated. Mouth Kote Oral Moisturiser

Product Benefits Precautions Where can I get Approximate it? cost Strips which dissolve in the If you are Nil By Supermarkets. $10 mouth, freshening the mouth Mouth, Do NOT and helping to kill germs. use these without Strips may be torn into smaller first speaking to pieces if a whole one is too your SLT, as they strong, or stimulates too much stimulate extra saliva. saliva production. This is a very strong mint product PocketPaks which can leave a burning sensation in sensitive mouths and lips

Foam Mouth Swabs

Foam mouth swabs are useful for cleaning the inside of your mouth, teeth, gums and tongue if you can’t use a or are at risk of aspiration when brushing. Mouth swabs are excellent for cleaning the mouth in-between tooth brushings to gently lift oral debris and help freshen, moisten, and stimulate the oral mucosa to maintain mouth moistness. Please note that mouth swabs are not a substitute for brushing your teeth, and you should still try to brush your teeth twice a day if possible. “Treated” mouth swabs (with sodium bicarbonate or dentifrice) are used by dipping foam head into small amount of water or mouthwash to facilitate cleaning of mouth (see comments below). Dip foam head into small amount of water or mouthwash and “tap” swab against side of glass to remove excess solution in order to minimise “foaming” (treated oral swabs) and excess fluid in the mouth. If you are at risk of aspiration, you can apply mouthwash using “untreated” mouth swabs. Please note, many pharmacies supply lemon and glycerine mouth swabs; these are NOT recommended as they can be very drying and irritating on the mouth. With all foam mouth swabs, check integrity of foam head after use to make sure it is intact and dispose promptly; do not reuse oral swabs.

Images courtesy of Sage Products

Product Benefits Precautions Where can I get it? Approximate cost These swabs are treated Mouth swabs are Capes Medical $3.70 pkt 10 + GST. with a dentifrice, a mild single use only. Supplies. tooth and mouth These swabs can cleanser. produce slight foaming in the Dentips sodium mouth, so discuss with dentifrice use with your SLT (light blue – green if you think you colour) may have trouble managing this.

Untreated foam swabs Mouth swabs are Capes Medical 35c each + GST. can be used with single use only. Supplies. mouthwash to freshen, cleanse and stimulate the oral mucosa, cheeks, tongue and lips. Unlike treated swabs, Dentips untreated these swabs don’t mouth swabs foam and contain no (light blue – green cleaning agent. This colour) may be an advantage for some people who have difficulty managing the foam in the mouth.

Product Benefits Precautions Where can I get it? Approximate cost These swabs are treated Mouth swabs are USL Medical. $144 per 200 swabs with sodium bicarbonate single use only. (USL order code: (baking soda), a mild These swabs can 10125) tooth and mouth produce slight ($75 minimum order cleanser, which helps foaming in the applies). balance the natural pH mouth, so discuss of the mouth and use with your SLT

remove dental plaque. if you think you Sage Toothette® Cleaning properties can may have trouble Sodium be further enhanced managing this. Bicarbonate when combined with a mouth swabs 1.5% hydrogen peroxide (green) mouthwash.

Untreated foam oral Mouth swabs are USL Medical. $132 per 200 swabs swab can be used with single use only. (USL order code: mouthwash to freshen, 10124) cleanse and stimulate ($75 minimum order the oral mucosa, applies). cheeks, tongue and lips. Unlike treated swabs, Sage Toothette® these swabs do not Untreated mouth foam and contain no swabs (green) cleaning agent. This may be an advantage for some people who have difficulty managing the foam in the mouth.

Product Benefits Precautions Where can I get it? Approximate cost All inclusive oral care kit These swabs can USL Medical. $29.50 per pack (USL with toothbrush, mouth produce slight order code: 90003) swabs, mouthwash and foaming in the ($75 minimum order mouth moisturiser. mouth, so discuss applies). use with your SLT Includes: if you think you 20 sodium may have trouble bicarbonate treated managing this. mouth swabs, Toothette® Short- 1 ultra-soft term swab system toothbrush, with Perox-a-mint 1 tube sodium solution bicarbonate mouthpaste

(),

1 bottle Perox-a- mint® mouthwash (1.5% Hydrogen Peroxide), 1 tube Toothette® Mouth Moisturiser.

Special and

Product Benefits Precautions Where can I get it? Approximate cost Especially formulated for Use a small Stocked by some $13 - $17 people with dry mouth. amount of pharmacies. Lubricates and replenishes toothpaste and Toothshop website not too much moisture in the mouth. (www.toothshop.co.nz) Low-foaming. water if you are Great Smile website at risk of (www.greatsmile.co.nz) Xerostom Dry aspiration Capes Medical Mouth Toothpaste (foam/saliva Supplies. going down the wrong way).

Product Benefits Precautions Where can I get it? Approximate cost Three headed toothbrush USL Medical. $90 per dozen, or allows the front, back and $7.50 each + GST. biting surfaces of teeth to be cleaned at the same time using a simple back and forth brushing motion. Handle bends for extra safety and covered with soft Surround “rubbery” coating to make it Toothbrush easier to hold. Very useful for people who require others to brush their teeth for them or have difficulty using a standard toothbrush.

How Do I Perform Mouth Cares?

Anyone, including family/whanau and caregivers, can perform mouth cares. Mouth cares should be performed after every meal or snack. If the person is not allowed to eat (NBM), do mouth cares every two hours.

Have ready: Person sitting up or side lying to protect airway. 2-3 Mouthswabs. Mouthwash solution (as determined by SLT, nurse, etc). Toothbrush and toothpaste (if patient has teeth): o Use only a pea-sized amount of toothpaste with no water to decrease foaming and increase abrasive cleaning action.

Dip (the swab in mouthwash)

Squeeze (excess fluid from swab) Wipe (one area of mouth with swab) Bin (the used swab)

Clean the following parts of the mouth, using a new swab until it comes out looking clean:

Top gum, Bottom gum, Roof of mouth, Under tongue, Surface of tongue, Inside of cheeks