Siddique I, Mahmood H, Mohammed-Ali R. Paracetamol overdose secondary to dental pain: a case series. Br Dent J. 2015; 219:E6-E6
Vogel J, Heard KJ, Carlson C, Lange C, Mitchell G. Dental pain as a risk factor for accidental acetaminophen overdose: case-control study. Am J Emerg Med. 2011; 29:1125-1129
Gilbertson RJ, Harris E, Pandey SK, Kelly P, Myers W. Paracetamol use, availability, and knowledge of toxicity among British and American adolescents. Arch Dis Child. 1996; 75:194-198
O'Sullivan LM, Ahmed N, Sidebottom AJ. Dental pain management – a cause of significant morbidity due to paracetamol overdose. Br Dent J. 2018; 224:623-626
Levy B, Paulozzi L, Mack KA, Jones CM. Trends in opioid analgesic–prescribing rates by specialty, U.S., 2007–2012. Am J Prev Med. 2015; 49:409-413
Leader R, Hackett J, Al-Naher A. Supra-therapeutic oral paracetamol overdose in adults: an update for the dental team. Dent Update. 2017; 44:409-414
Nayyer NV, Byers J, Marney C. Identify adults at risk of paracetamol toxicity in the acute dental setting: development of a clinical algorithim. Br Dent J. 2014; 216:229-235
Oscier CD, Milner QJW. Peri-operative use of Paracetamol. Anaesthesia. 2009; 64:65-72
Craig DGN, Bates CM, Davidson JS, Martin KG, Hayes PC, Simpson KJ. Overdose pattern and outcome in paracetammol-induced acute severe hepatotoxicity. Br J Clin Pharmacol. 2011; 71:273-282
Chiew AL, Isbister GK, Duffell SB, Buckley NA. Evidence for the changing regimens of acetylcysteine. Br J Clin Pharmacol. 2016; 81:471-481
Becker DE. Pain management. Part 1: Managing acute and postoperative dental pain. Anesth Prog. 2010; 57:67-79
Moore PA, Ziegler KM, Lipman RD, Aminoshariae A, Carrasco-Labra A, Mariotti A. Benefits and harms associated with analgesic medications used in the management of acute dental pain: an overview of systematic reviews. J Am Dent. 2018; 149:256-265
Denisco RC, Kenna GA, O'Neil MG, Kulich RJ, Moore PA, Kane WT Prevention of prescription opioid abuse: the role of the dentist. J Am Dent Assoc. 2011; 142:800-810
Boyer EW. Management of opioid analgesic overdose. N Engl J Med. 2012; 367:146-155
Malamed SF., 6th edn. St Louis: The CV Mosby Co; 2012
Tobias JD, Leder M. Procedural sedation: a review of sedative agents, monitoring, and management of complications. Saudi J Anaesth. 2011; 5:395-410
Jann M, Kennedy WK, Lopez G. Benzodiazepines: a major component in unintentional prescription drug overdoses with opioid analgesics. J Pharm Pract. 2014; 27:5-16
Kumar PJ, Clark ML., 8th edn. Edinburgh: Saunders; 2012
The Recognition and Management of Patients who Overdose on Analgesics Secondary to Dental Pain Joshua Lopez Mark Greenwood Dental Update 2025 47:5, 707-709.
Authors
JoshuaLopez
BDS, MFDS
DCT Oral and Maxillofacial Surgery, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF
Paracetamol, Ibuprofen and Codeine are all analgesics that patients in dental pain often use in an attempt to manage their symptoms. Consequently, cases of analgesic overdose may present to dental practitioners. It is vital that clinicians are able to identify these cases and assess if transfer to an emergency department is required for assessment, investigations and any necessary treatment. Failing to do so could lead to potentially fatal consequences, and the transfer of patients to the emergency department when not warranted results in a delay in dental treatment for patients, with an added strain on emergency department resources.
CPD/Clinical Relevance: It has been reported that patients are more likely to overdose unintentionally on analgesics secondary to dental pain more than for any other reason, highlighting the importance of recognizing such cases.
Article
Pain of dental origin is one of the leading risk factors for unintentional analgesic overdose requiring hospital admission. One study showed that, over a 2-year period, 41% of admissions for unintentional paracetamol overdose at one hospital were secondary to dental pain.1 Furthermore, a case-control study showed that accidental overdoses of paracetamol are more likely due to dental pain than for any other reason.2 There have been several hypotheses suggesting reasons why dental pain elicits analgesic overdose, such as patients having a poor understanding of analgesic regimens and maximum doses.3 The provision of dental services and the difficulty some patients have accessing dental care cannot be overlooked as a potential factor.1 One study showed that 55% of patients presenting to an emergency department with accidental paracetamol overdose due to dental pain had contacted their dentist prior to presentation, and 14% had contacted the NHS emergency and urgent care services telephone number or the local emergency dental service.4
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