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The Recognition and Management of Patients who Overdose on Analgesics Secondary to Dental Pain Joshua Lopez Mark Greenwood Dental Update 2024 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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