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References

Nayyer NV, Byers J, Marney C. Identifying adults at risk of paracetamol toxicity in the acute dental setting: development of a clinical algorithm. Br Dent J. 2014; 216:229-235
Weil K, Hooper L, Afzal Z, Esposito M, Worthington H V, van Wijk AJ, Coulthard P. Paracetamol for pain relief after surgical removal of lower wisdom teeth. Cochrane Database Syst Rev. 2007; (3)
Wood DM, English E, Butt S, Ovaska H, Garnham F, Dargan PI. Patient knowledge of the paracetamol content of over-the-counter (OTC) analgesics, cough/cold remedies and prescription medications. Emerg Med J. 2010; 27:829-833
Rice S. Summary of: Paracetamol overdose secondary to dental pain: a case series. Br Dent J. 2015; 219:262-263
Sullivan IO, Lader D, Seymour CB, Chenery V, Fuller ESK, Sadler K.Leeds, WY: The Health and Social Care Information Centre; 2011
Vogel J, Heard KJ, Carlson C, Lange C, Mitchell G. Dental pain as a risk factor for accidental acetaminophen overdose: a case-control study. Am J Emerg Med. 2011; 29:1125-1129
Siddique I, Mahmood H, Mohammed-Ali R. Paracetamol overdose secondary to dental pain: a case series. BDJ: Nature Publishing Group. 2015; 219:E6-E6
Oscier CD, Milner QJW. Peri-operative use of paracetamol. Anaesthesia. 2009; 64:65-72
Ong CKS, Seymour RA, Lirk P, Merry AF. Combining paracetamol (acetaminophen) with nonsteroidal antiinflammatory drugs: a qualitative systematic review of analgesic efficacy for acute postoperative pain. Anesth Analg. 2010; 110:1170-1179
Graham GG, Scott KF. Mechanism of action of paracetamol. Am J Ther. 2005; 12:46-55
Jóźwiak-Bebenista M, Nowak JZ. Paracetamol: mechanism of action, applications and safety concern. Acta Pol Pharm. 2014; 71:11-23
Remy C, Marret E, Bonnet F. State of the art of paracetamol in acute pain therapy. Curr Opin Anaesthesiol. 2006; 19:562-565
Newton AM. Paracetamol Overdose.: BMJ Publishing Group Limited; 2015
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Supra-therapeutic oral paracetamol overdose in adults: an update for the dental team

From Volume 44, Issue 5, May 2017 | Pages 409-414

Authors

Ross Leader

MB ChB(Hons), BDS(Hons), MFDS RCPS(Glasg), PgDip ClinEd(RCPSG)

Staff Grade in Oral and Maxillofacial Surgery, University Hospital Aintree, Lower Lane, Liverpool, L9 7AL

Articles by Ross Leader

James Hackett

Fourth Year Medical Student, University of Liverpool School of Medicine, Cedar House, Ashton Street, Liverpool, L69 3GE

Articles by James Hackett

Ahmed Al-Naher

MBBS, BSc, MRCP

Clinical Research Fellow CLAHRC NWC, University of Liverpool, Wolfston Centre for Personalized Medicine, 1–5 Brownlow Street, Liverpool, L69 3GL, UK

Articles by Ahmed Al-Naher

Abstract

Paracetamol (acetaminophen) is a commonly used analgesic; its ‘over the counter’ availability, low cost and popularity amongst patients often make it the first choice for dental pain. It is in this that its potential toxicity, made more complicated by the ever extending range of paracetamol-containing products, make the understanding of this medication key to the safe management of patients presenting to surgery with dental pain.

CPD/Clinical Relevance: The purpose of this article is to supply dental practitioners with the knowledge to manage patients who present having taken an oral supra-therapeutic paracetamol overdose. Consideration is given to those patients who can be treated safely in primary care and to those who require transfer to Accident and Emergency (A&E).

Article

Indicated for use in the treatment of mild to moderate pain and fever, and available as an ‘over the counter’ medication, paracetamol (acetaminophen) is widely used as the analgesic of choice in the management of dental pain in the UK.1 Indeed, the 2007 Cochrane review by Weil et al concluded that paracetamol was a safe, effective drug for the treatment of post-operative pain following the surgical removal of lower third molars.2

Being an inexpensive and freely available drug, coupled with the ever extending range of paracetamol-containing preparations, can leave patients with misunderstandings regarding its safety, resulting in cases of unintentional overdose compounding a visit to the dental surgery.3

Unfortunately, the risk of overmedication before presentation is complicated by the prevalence of dental anxiety and the current emergency dental care provisions.4,5 In this, dental pain has been highlighted as a risk factor for paracetamol overdose, with a clinically significant number of patients attending A&E with overuse of non-prescription analgesics secondary to dental pain.4,6 To contextualize, a case series encompassing 116 admissions of unintentional paracetamol overdose to the Medical Assessment Unit at the Northern General Hospital, Sheffield, revealed that 41% were secondary to a cause associated with dental pain.7

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