title: Paracetamol overdose secondary to dental pain: a case series.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Sheffield Teaching Hospitals NHS Trust, Oral and Maxillofacial Surgery, Charles Clifford Dental Hospital, 76 Wellesley Road, Sheffield, S10 2SZ.
authors.forename: I
authors.initials: I
authors.lastname: Siddique
authors.affiliation: Oral and Maxillofacial Surgery, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF.
authors.forename: H
authors.initials: H
authors.lastname: Mahmood
authors.affiliation: Oral and Maxillofacial Surgery, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF.
authors.forename: R
authors.initials: R
authors.lastname: Mohammed-Ali
mesh_terms: D000082:Acetaminophen / Q000506:poisoning*; D000293:Adolescent; D000328:Adult; D018712:Analgesics, Non-Narcotic / Q000506:poisoning*; D062787:Drug Overdose / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D004739:England / Q000453:epidemiology; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D059408:Pain Management / Q000009:adverse effects* / Q000379:methods; D014098:Toothache / Q000188:drug therapy*; D055815:Young Adult
chemical_list: D018712:Analgesics, Non-Narcotic; D000082:Acetaminophen