Case Report

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

¹ Oral Surgery Resident, Aix Marseille University, APHM, La Timone, Odontology Department, Marseille, France
² DDS, PhD Aix Marseille University, APHM, CNRS, EFS, ADES, La Timone, Odontology Department, Marseille, France
³ Oral Surgeon, Aix Marseille University, APHM, La Timone, Odontology Department, Marseille, France
⁴ DDS, PhD Aix Marseille University, APHM, UMR S910, La Timone, Odontology Department, Marseille, France

^* Correspondence: cyril.debortoli1@gmail.com

Received: 11 April 2021
Accepted: 14 October 2021

Abstract

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.