Paracetamol Misuse and Dental Pain: Results from the French Observational DAntaLor Study

Aims: To evaluate the risk of hepatotoxicity due to unintentional paracetamol misuse in patients with acute dental pain. Methods: A prospective multicenter observational survey was performed in patients consulting, without appointment, the odontology departments of three main French hospitals in the Lorraine region over a 3-month period. Patients were asked to fill out a medical questionnaire while seated in the waiting room. Those who completed the questionnaire, had dental pain, and took paracetamol were included in the DAntaLor study. Misuse was defined as a daily dose of more than 4 g of paracetamol per day. The risk of hepatotoxicity was considered high if the supposed ingested dose was above the threshold of 150 mg.kg-1.24h-1, 125 mg.kg-1.24h-1, or 100 mg.kg-1.24h-1 over periods of 24, 48, and 72 hours, respectively. Hepatotoxicity was suspected in the presence of clinical symptoms. Results: Of the 1,810 patients consulting the odontology departments, 741 were included in the study. Painkillers were used in 74.4% of the cases, and paracetamol was taken by 81.7%. Paracetamol was self-medicated in 85.5% of the patients and misused by 6.0%. Clinical symptoms were observed in 1.6% of the patients with no paracetamol misuse. For patients consuming more than 4 g per day and experiencing mild unspecific clinical symptoms of hepatotoxicity, the suspected ingested dose category was below one of the three previously defined thresholds for 11.8% and was above for 40.0%. Conclusion: Patients with dental pain are at risk of paracetamol overdose and hepatotoxicity. Keywords: acetaminophen, acute dental pain, misuse, paracetamol, unintentional intoxication