Maxillofacial surgeons make urgent call for improved access to dentists
23 April 2018 (Last updated: 23 Apr 2018 11:41)
Maxillofacial surgeons make urgent call for improved access to dentists as self-medication with paracetamol for dental pain cause of accidental overdose.
Self-medication for dental pain with paracetamol is a significant cause of accidental overdose and potential liver failure that has cost Queen’s Medical Centre, Nottingham, over £50,000 in admissions over a two-year period alone, without including the medical care costs, the 2017 British Association of Oral and Maxillofacial Surgeons (BAOMS) Members’ Prize winning study has confirmed.
An average of at least three people a week were admitted through the hospital’s emergency department with accidental paracetamol overdose during the study, which resulted in 123 overnight stays for the dental cases alone. The NHS estimates it costs £400 for an overnight hospital stay and healthcare costs are extra.
The authors of the Dental pain management – a cause of significant morbidity due to paracetamol overdose study are calling for immediate improved access to dentists during the working week and better patient advice on using analgesia for dental pain.
The three oral and maxillofacial surgeons (OMFS), Laura O’Sullivan, Nabeela Ahmed and Andrew Sidebottom, reviewed the cases of 436 patients who attended the emergency department of a large teaching hospital over two years from May 2014 to April 2016. They set out to determine whether dental pain was a key factor in accidental paracetamol overdose, and what the resulting cost and burden to the NHS was.
Co-author and Junior Trainee Laura O’Sullivan said: “Our study revealed that lack of access to emergency dental care is a contributory factor to paracetamol overdose, as well as poor understanding among dental professionals about the safe levels of analgesia self-medication. The study data shows that 55% of the cases we reviewed had contacted their dentist, but had still needed emergency hospital admission.
“The paracetamol dosages, in common with many over-the-counter (OTC) medicines, are not fully appreciated by patients, dentists or GPs. Patients are not aware that staggered overdoses of the painkiller carry a much higher mortality rate than a single large dose. Nearly all the cases of overdose we reviewed (98%) resulted from staggered analgesia doses.”
The use of paracetamol to self-medicate for dental pain relief is increasingly common with the wide availability of the drug from chemists and high street supermarkets. Accidental overdose remains a major public health problem that is causing an increase in emergency hospital admissions and admission to acute liver units.
Co-author and Consultant Andrew Sidebottom explained that self-medication with paracetamol can continue for up to six months before someone finally seeks dental care, but that it’s patient preference that’s driving the choice for paracetamol rather than medical advice: “As few as nine or 10 paracetamol tablets a day can cause liver dysfunction, so it is vital that patients adhere strictly to the instructions on the packet.”
Co-author and Senior Trainee Nabeela Ahmed added that managing the primary cause of pain would reduce the risk of significant ill health from paracetamol overdose: “The data from our study found that 61.5% of the dental cases required admission to the acute medical unit. Offering tailored medication advice will help to keep patients comfortable until an appointment with the dentist is available, and prevent accidental overdose.
“What we found most surprising in the study was that most patients came to the emergency department during the working week, but we have no idea how many patients with dental pain were turned away.”
The on-call maxillofacial team were called in to review the cases where patients were suffering with dental pain caused by a range of issues such as pulpitis (inflammatory dental disease), dental abscess and post-operative dental pain.
“We’ll be using this study to try and influence better dental care across the NHS, and reduce the pressure on NHS beds,” Laura O’Sullivan concluded.
Ends
For further information and interviews contact: Siân Evans on 020 8674 8921 / 07752 414433 or BAOMS
Notes to editors:
The British Association of Oral and Maxillofacial Surgeons (BAOMS) promotes the advancement of education, research and the development of oral and maxillofacial Surgery in Great Britain, and encourages and assists postgraduate education, study and research.
The Dental pain management – a cause of significant morbidity due to paracetamol overdose study by British Association of Oral and Maxillofacial (BAOMS) members Laura O’Sullivan, Nabeela Ahmed and Andrew Sidebottom will be published in full in the British Dental Journal / Volume 224 No 8 / April 27 2018
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