Treatment Plan

Treatment Plan
Conservative methods:

• Oral hygiene: brushing, rinsing
• Chlorhexidine mouthwash (note risk of brown staining)
• Remove dentures at night
• Ice cubes, unsweetened drinks, sugar-free gum for dry mouth
• Saliva stimulants/substitutes if refractory

Medical management:

• Candidiasis: topical miconazole/nystatin, oral fluconazole for severe cases
• HSV: acyclovir 200mg 5x/day (5 days), 400mg 5x/day if immunosuppressed
• Aphthous ulcers: topical corticosteroids, hydrocortisone lozenges, beclomethasone spray
• Pain: topical lidocaine, simple analgesics, WHO pain ladder approach

End of life care:

• Oral moisture every 30-60 mins (water/spray/sponge/ice chips)
• Petroleum jelly for lips
• Room humidification

Referral criteria:

• Concerns regarding oral intake
• Refractory oral pain
• Severe mucositis
• Suspected neutropenic illness
• Severe persistent bleeding ulcers
• Severe HSV/candida
• Prolonged taste changes