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Analgesia

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Analgesia

There is frequently a need for staff to advise patients on how to manage dental pain, for example while waiting to see a dentist.

Before providing a patient with advice on analgesia, it is essential to first establish what pain relief they have already taken, particularly paracetamol, to check for possible overdose. Overdose with paracetamol is dangerous because it can cause hepatic damage that is sometimes not apparent for 4–6 days and can be fatal. Paracetamol is present in many over-the-counter preparations and all paracetamol-containing medications that the patient has ingested should be identified. 

A patient who has ingested a therapeutic excess of paracetamol, according to the following criteria should be referred for assessment in an emergency department.62

  • more than the licensed dose (e.g. 4 g for adults) AND more than or equal to 75 mg/kg in any 24-hour period

or

  • more than the licensed dose (e.g. 4 g for adults) but less than 75 mg/kg/24 hours on each day of the last 72 hours

Note: To avoid underestimating the potentially toxic paracetamol dose ingested by obese patients who weigh more than 110 kg, use a body weight of 110 kg (rather than their actual body weight) when calculating the total dose of paracetamol ingested (in mg/kg). For pregnant patients the potentially toxic paracetamol dose should be calculated using the patient's pre-pregnancy weight.62

Providing self care advice on managing dental pain

A guide to giving self care advice is given below. The delivery of advice on managing dental pain requires suitable training.

Give the patient the following advice on the use of self care measures.

  • Avoid stimuli that precipitate or worsen the pain such as hot or cold foods or cold air.
  • Holding cooled water or crushed ice around the tooth can help some types of dental pain.
  • Severe pain from the mouth or teeth sometimes feels worse when lying flat; therefore, try lying propped up as this might ease the pain.
  • Use painkillers that have successfully provided pain relief for you in the past without adverse effects (e.g. ibuprofen and/or paracetamol), but do not exceed the maximum daily dose.
  • Avoid taking aspirin or ibuprofen as a painkiller if there is bleeding.
  • Always follow the directions on the painkiller information leaflet for dosage and advice on precautions with some medical conditions.
  • Swallow tablets. Do not place tablets next to the affected area because this can damage the tissue.
  • The above advice on painkillers only applies for 24 hours after which you should seek further analgesic advice from a pharmacy, if required.

Advise the patient to call back if the advice provided proves inadequate.

Information for patients about painkillers including paracetamol and ibuprofen is available via the NHS Inform website.

Note that patients can access analgesia, topical anaesthetics and mouthwashes, which may be helpful to manage pain from oral conditions, via the NHS Pharmacy First Scotland service which is available at community pharmacies that dispense NHS prescriptions.

Analgesic prescribing for pain relief

Refer to the SDCEP Drug Prescribing for Dentistry guidance for details of analgesic prescribing and to the British National Formulary for comprehensive information on contraindications, cautions, adverse drug reactions and side effects.