Dental pain management- A cause of significant morbidity due to paracetamol overdose

Background Self-medication with paracetamol is common for management of dental pain. Inadvertent paracetamol overdose remains a major public health problem requiring emergency hospital admission, reversal of hepatotoxicity with N-acetylcysteine (NAC) and fluid resuscitation, maxillofacial referrals and potential admission to acute liver units. This retrospective study analysed patients attending the emergency department in a university teaching hospital to determine whether dental pain is a contributory factor in accidental paracetamol overdose and to establish the cost and burden on secondary care services as a result. Method Data collection was carried out by reviewing EDIS (Emergency Department Information System) clinical entries for patients attending over a two-year period (1 May 2014-30 April 2016 inclusive). Results Four hundred and thirty-six cases presented to the emergency department with accidental paracetamol overdose, 164 of which were a direct result of dental pain. Of the dental cases, 61.5% (101) of patients required medical admission, 33% (54) were discharged and 5.5% (9) either self-discharged or refused treatment. Females accounted for 58% (95) of cases, and males 42% (69) with a mean age of 33 years (range 4-71 years). A ratio of 2:1 weekday/weekend attendances was observed. Fifty-fve percent (90) had contacted their dentist before presentation, 14% (23) had contacted 111 (the NHS emergency and urgent care services telephone number) or the local emergency dental service. Twenty-two percent (36) had not sought emergency dental care, and 9% (15) were unspecifed. The on-call maxillofacial team was called in 25% (41) of cases. Thirty-one percent (51) displayed abnormal liver function, 13.4% (22) of cases demonstrated elevated white cell count suggesting possible dental infection. Five patients (3%) were pregnant at the time of presentation. Conclusion Dental pain contributes to a signifcant number of acute medical admissions as a result of accidental paracetamol overdose. These results highlight a lack of public awareness surrounding safe self-medication and inadequate access to timely emergency dental care, which in this cohort appears to be primarily during the working week.