Identifying adults at risk of paracetamol toxicity in the acute dental setting: development of a clinical algorithm

Paracetamol misusing to dental pain: a case-report and recommandations for treatment

Introduction: The paracetamol is the most widely used painkiller to dental pain. Patients self-medicating with paracetamol for dental pain had 12.8 more times lead to overdose than patients with other pains. The aim of this work was to propose a standardized management in case of paracetamol overdose from a clinical case report. Observation: A 56-year-old man was referred to the General Emergency Department because he had ingested 32 grams of paracetamol in less than 24 hours due to a dental pain. He was in a state of haemodynamic and hypothermic shock. He was placed on the liver transplant list due to fulminant hepatitis. The dental check-up found juxta-pulpal carious lesions on the four wisdom teeth which were removed before the transplantation. Conclusion: Paracetamol overdose is one of the leading causes of liver failure. The estimated toxic dose was 150 mg/kg/day or about 10 g/day. N-acetylcysteine treatment should be leaded early, between 8 and 10 hours after ingestion. The paracetamol-aminotransferase, as a risk prediction tool, reproductibles methods and biomarkers can identify overdoses and lead to a faster medical care. Information campaigns and warning articles on overdosing risk must be continued to strengthen the prevention message for the population.

Association of Gender, Painkiller Use, and Experienced Pain with Pain-Related Fear and Anxiety among University Students According to the Fear of Pain Questionnaire-9

Anxiety and fear are determinants of acute and chronic pain. Effectively measuring fear associated with pain is critical for identifying individuals’ vulnerable to pain. This study aimed to assess fear of pain among students and evaluate factors associated with pain-related fear. We used the Fear of Pain Questionnaire-9 to measure this fear. We searched for factors associated with fear of pain: gender, size of the city where the subjects lived, subject of academic study, year of study, the greatest extent of experienced pain, frequency of painkiller use, presence of chronic or mental illness, and past hospitalization. We enrolled 717 participants. Median fear of minor pain was 5 (4–7) fear of medical pain 7 (5–9), fear of severe pain 10 (8–12), and overall fear of pain 22 (19–26). Fear of pain was associated with gender, frequency of painkiller use, and previously experienced pain intensity. We found a correlation between the greatest pain the participant can remember and fear of minor pain (r = 0.112), fear of medical pain (r = 0.116), and overall fear of pain (r = 0.133). Participants studying medicine had the lowest fear of minor pain while stomatology students had the lowest fear of medical pain. As students advanced in their studies, their fear of medical pain lowered. Addressing fear of pain according to sex of the patient, frequency of painkiller use, and greatest extent of experienced pain could ameliorate medical training and improve the quality of pain management in patients.

A study to assess the prevalence of unintentional paracetamol overdose among patients presenting in dental pain in primary care

Introduction Paracetamol is a very commonly used medication for the treatment of dental pain in the UK. Our study aimed to assess patient awareness of maximum doses and investigate the prevalence of overdosing on paracetamol from recommended doses.Method We asked patients attending dental practices in south London for pain appointments. We collected 100 responses over two months from January to March 2019.Results Approximately 85% of patients used paracetamol when self-medicating for pain relief and approximately one in four patients were unaware of the correct doses. Thirty-seven percent of patients answered with an incorrect response and 2% of participants indicated they had overdosed on paracetamol in the past 24 hours.Discussion From the information, we developed a patient information leaflet, a checklist for clinicians and posters to educate patients when trying to self-medicate for pain relief from dental pain in future.Conclusions It is important for the general dental practitioner to help patients become aware of maximum doses to reduce risks of liver hepatotoxicity and chronic liver damage - a complication of paracetamol overdosing and poisoning - and to be educated on how to manage a suspected overdosed patient presenting to primary care.

Supra-Therapeutic Oral Paracetamol Overdose in Adults: An Update for the Dental Team

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. 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).

Summary of: Paracetamol overdose secondary to dental pain: a case series

INTRODUCTION

There have been documented cases of serious and life-threatening health effects due to patients taking unintentional analgesia overdose secondary to dental pain. We aimed to determine firstly what proportion of unintentional paracetamol overdose cases admitted to an acute medical assessment unit (MAU) were secondary to dental pain, secondly what proportion of such cases encountered barriers to accessing emergency dental care and finally what clinical burden such cases placed on the hospital services.

METHOD

The clinical coding department provided information to allow appropriate identification and data collection from patient discharge summaries and case notes of all unintentional paracetamol overdose cases secondary to dental pain over a 24 month period (1 March 2012 to 28 February 2014).

RESULTS

One hundred and sixteen admissions were identified specifically for unintentional paracetamol overdose. Dental pain accounted for 48 (41%) of all cases. Females (67%) were twice as likely to be admitted, compared to males (33%), with a mean age of 36 years and four months. Thirty-two (63%) non-dentally registered and all nine (100%) registered patients were unable to access timely emergency dental care before their admission. Forty cases (83%) were referred to the hospital oral and maxillofacial services (OMFS). Thirty-seven (93%) patients underwent elective outpatient dental extractions and the remaining three (7%) patients were admitted for intravenous antibiotics, incision and drainage and dental extractions. All patients were treated under local anaesthetic.

CONCLUSION

Dental pain is the single most common cause of acute medical admission secondary to unintentional paracetamol overdose. Patients registered with a general dental practitioner (GDP), as well as those not registered with a GDP, had difficulty accessing timely emergency primary dental care.