Who exactly is the Tooth Fairy?

Posted by Phil Tangri on July 12, 2016

After Father Christmas is finished making toys at the North Pole, he’ll no doubt be sipping cocktails in Barbados along with the Easter Bunny. So have pity for the poor Tooth Fairy, who has to work all year round without a single day off. That’s real job dedication for you.

Not only does the tooth fairy have an amazing work ethic, but she’s generous too. Thanks to a survey this year, we know that tooth fairy payments have increased by a whopping 40% in the last five years alone. (Or perhaps this is just a sign that the British economy is finally recovering.)

The survey also revealed that the average payment the tooth fairy leaves for a tooth is £2.10. This average varies geographically though. The tooth fairy is the most generous in London, where she leaves £2.50 per tooth, and the stingiest in Newcastle, where she only leaves £1 on average.

So where did the tooth fairy come from?

References to the tooth fairy date as far back as 1908, when a newspaper article at the time said, “If a boy takes his little tooth and puts it under the pillow when he goes to bed, the tooth fairy will come in the night and take it away, and in its place will leave some little gift.” The article goes on to suggest that this ‘little gift’ can be a few pennies. If only our children would be happy with just a few pennies today!

And before this, French children left out their teeth in exchange for money. But it wasn’t a fairy that took their teeth – it’s was mouse instead. The idea was that by letting a mouse take the teeth, the child’s new teeth would be as a strong as mouse’s. At the beginning of the 20h century, Americans crossed the French mouse myth with a Disney-style fairy, and voila – the modern-day tooth fairy was born. So we have the Americans to thank for the modern tooth fairy. Though let’s not be too ready with our praise, because they did also make the horrendous film “Tooth Fairy” with Dwayne “the Rock” Johnson as the titular fairy.

What’s the purpose of the tooth fairy?

Losing a tooth can be a scary experience for a small child, so the tooth fairy is a way to turn a scary experience into an exciting one. After all, who wouldn’t want to wake up with money under their pillow?

And money doesn’t have to be the only thing the tooth fairy leaves – she can also leave a letter as well. A hand-written note from the fairy can certainly make the event more personal to your child. It can also be a chance for the tooth fairy to stress the importance of good dental hygiene. After all, the tooth fairy can sometimes be a stronger influence on children than parents! A letter can also help the tooth fairy discourage children from spending all her money on sweets…

So let’s hear it for the tooth fairy, unsung hero of the dental world. And maybe if we all keep our teeth really clean, she’ll be able to afford a bit of time off to join Father Christmas in the Barbados.

Tags: fairy, tooth, tooth fairy, who is the tooth fairy

Posted in: General Dentistry

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Finding Floss Fiddly? Try Interdental Brushes

Posted by Phil Tangri on June 29, 2016

Daily tooth brushing is an important part of maintaining good oral health. The bristles of a toothbrush are very effective at cleaning accessible areas of the teeth but do not reach interdentally to clean the surfaces where two teeth meet. Dental floss is a common solution and has existed in a similar form for over 200 years when dentists first began recommending silk thread for cleaning between teeth. Some patients are very comfortable using floss but others find it time consuming and somewhat awkward to handle. A 2015 US national survey found that 18% of participants said they would prefer washing a sink full of dishes than flossing their teeth daily. The value of interdental cleaning is still important, so those who feel they can relate to this opinion may be pleasantly surprised by interdental brushes’ ease of use.

Why should I clean interdentally?

Preventing a condition is always preferable to treating it. Dental caries, or tooth decay, is caused by acid from plaque bacteria living on the tooth surface dissolving the tooth’s hard structure. The point of contact of two teeth is a common place for decay to begin because it is not so well cleaned by regular tooth brushing alone, leaving the plaque bacteria behind.

Gingivitis is the technical term for inflamed gums. Gums can become irritated from products released by bacteria living on the nearby teeth. Reducing bacterial numbers by cleaning between the teeth can prevent the onset of gingivitis. Gingivitis may also progress to periodontitis when the bacteria are allowed to mature. Their products then begin to irritate deeper than the gums and onto the tooth’s bone support. Periodontitis is in fact the most common cause of tooth loss in adults.

What are interdental brushes?

Interdental brushes are small brushes that are able to fit between the teeth. As the brush is gently pushed through the space, a correctly sized brush will fill the space to give a superior clean to a thin piece of floss.

Many styles of interdental brushes are available. Some are held between the thumb and forefingers, others have longer handles and right angle heads if the user prefers. The spacing between our teeth varies around our mouths so the size of the bristle heads is important. The largest size that passes through a space comfortably will provide the most effective clean by brushing against the sides.

How do I use interdental brushes?

The use of interdental brushes before or after tooth brushing is open to debate, but as each instrument cleans a different part of the tooth you will see the benefits whichever you favour. Some patients only use interdental brushes as a tool when they have food trapped, but interdental brushing should form part of a daily oral hygiene regime.

Find the size of the interdental brush that fits snugly through the tooth gap and hold it comfortably in your hand.

Enter the brush between the teeth, starting in a logical sequence not to leave any tooth spaces out.

Rinse the brush between insertions as to avoid transferring debris between teeth. You will also see on the bristles what was once being left behind on the teeth after tooth brushing.

Most brands of interdental brushes are reusable so just like a regular toothbrush, keep it on the side and replace it when the bristles begin appearing worn.

Even if using interdental brushes gently and correctly sized, you may still experience some discomfort and/or bleeding when you first begin their use. This can be a sign of sore gums (gingivitis) and you will be benefiting greatly from continuing with the routine. Gingivitis is reversible so once the teeth have had fewer bacteria for several days, the symptoms of inflammation will begin to disappear. If you do remain concerned, please speak with your dentist.

TePe is one of the many interdental brush brands available here in the UK that we as dentists would recommend. Their short YouTube video however gives some insight into the general use of interdental brushes.

If you have any further questions, your dentist or hygienist will be happy to help.

Tags: interdental brush, Interdental brushing, interdental cleaning, tepe, tepe interdental brush

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What to do with a chipped tooth

Posted by Phil Tangri on May 6, 2016

Imagine you’re out bowling with friends. You strut to the lane with the ball, swing your arm back, and – smack! You’ve accidentally hit your friend in the face! Now she has a chipped front tooth. So what do you do?

How can a tooth chip?

A tooth can chip when you:

Bite down on something hard
Fall and hit your mouth on the ground
Get hit in the mouth

Incisors often chip after a blow to the mouth, because of their vulnerable position at the front of the mouth. Molars are more susceptible to chipping when chewing hard foods.

What’s it like to have a chipped tooth?

You will usually quickly notice the sharp area with your tongue. A chipped tooth probably won’t hurt unless the broken piece is large.

What to do if you’ve chipped a tooth

Phone your dentist as soon as possible to make a non-emergency appointment. A chipped tooth is only a non-emergency and may not need treatment at all. But you should still see your dentist because she will be able to file down the chipped area and check for any hidden damage.
Bring the tooth fragment to the dentist appointment because she may be able to reattach it. In the meantime, store the fragment safely in a container and cover it with milk or saliva.
Take an over-the-counter pain reliever if the tooth is painful.
Rinse your mouth with salt water as a natural disinfectant.
If your damaged tooth is now sharp and jagged, cover it with wax paraffin or sugarless gum to prevent it cutting your tongue, lips and cheeks.
Avoid chewing hard food with the injured tooth because it may cause more of the tooth to break off.

At the dentist

The dental treatment you will require will depend on the severity of the damage.

Minimal: The smallest chips do not require any treatment at all.
Small: A very small chip can simply be smoothed down by your dentist and will not need to be filled.
Medium: For a medium-sized chip, the dentist will either make a filling or reattach the original chipped piece of tooth. If the tooth is a molar, then it might require a crown (a cap that covers your tooth) if the chewing surface is damaged.
Large: A severely broken tooth might mean an exposed nerve. In this case you will probably need a root canal to remove the damaged nerve, as well as a crown or a cap to replace the chipped tooth. This is more serious than a minor chip and you should see a dentist as soon as possible.

What if it’s more serious than a chip?

You should seek the nearest emergency dentist immediately if your tooth is cracked, badly broken or knocked out completely. You can tell when you have a cracked tooth because pain will occur when you release a bite, but not when you bite down. You should also see a dentist immediately if you think you have nerve damage, which is characterised by persistent pain.

Tags: broken tooth, chipped tooth, emergency dentist, emergency dentist birmingham, sharp tooth, Toothache

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Taking Care of Dentures

Posted by Phil Tangri on March 1, 2016

There are lot of denture cleaners on the market, ranging from pastes and creams to solutions and tablets. The consensus is that provided you are following a cleaning regime that works for you and cleanses the dentures appropriately it doesn’t matter which products you rely on. However, here is some advice frequently given to denture wearers on how to successfully care for their dentures.

Take your denture out at night and leave it in a glass of water after following your preferred cleaning regime. If the dentures are left in the mouth overnight, bacteria and fungus may become trapped under the denture and the saliva won’t have an opportunity to clean the mouth. Leaving the dentures in water prevents any warping of the material.
When you take your denture out at night, brush your teeth as normal and then brush the denture with a soft toothbrush or denture brush. Use either soap and warm water or a special denture toothpaste. Never use regular toothpaste on your denture as it contains abrasives that may damage the material.
Place a hand towel either in the sink or on the surface you use to clean your denture as they can easily break if dropped.
Steradent make a range of effervescent denture cleaning solutions. Dentists generally recommend using these solutions according to the instructions a couple of times a week to help remove stains and dirt.
Fixatives can be used to help keep a denture in place but should be removed thoroughly from the denture and mouth at night. Brushing the denture and gums with a soft toothbrush and warm water should be adequate.
If your dentist suspects you have a fungal overgrowth on your denture, usually caused by the fungus Candida albicans, they might recommend leaving your denture in a sodium hypochlorite solution (like Milton or Dentural) for 20 minutes.
If your denture has a special soft lining or a metal base then use a cleaning regime recommended by your dentist as some products, particularly effervescent solutions, may cause damage.
If your denture is still dirty after following the recommended cleaning regimes, your dentist will be able to clean it for you with specialist tools. Mention this to your dentist next time you go.
If your denture causes you any pain, make an emergency appointment at the dentist to have it adjusted. Most adjustments can be made chairside by the dentist, but in some cases the denture may need to be returned to the laboratory for a short period of time.
Never try and adjust your denture yourself. If you have any problems with the denture make an emergency appointment at your dentist.
It is still important to visit a dentist, even if you have no teeth, as oral diseases such as bacterial and fungal infections can still affect the soft tissues of the mouth. It is also important to visit a dentist so they can complete the recommended cancer screening that every patient receives during their check up.

Tags: denture, denture cleaning, denture maintenance, dentures

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The Secrets of Teeth Whitening

Posted by Phil Tangri on September 14, 2015

We in Britain are proud of our natural-looking teeth. Just compare us to some of our friends over the pond, who have teeth so white they risk road accidents by dazzling incoming traffic. Teeth whitening is one of the most popular cosmetic dentistry procedures in the good ol’ US of A, but more and more of us in the UK are choosing to get our teeth whitened too. So what do you need to know about teeth whitening?

Searching for whitening home remedies in Google brings up a plethora of ideas, ranging from the plausible (stop smoking) to the not-so-plausible (brush your teeth with a banana peel). Meanwhile supermarket shelves heave with toothpastes claiming to whiten your teeth, but try one at home and you’ll find they’ll only brighten them a shade or two at most. Even mouthwashes are getting in on the act, claiming they can restore your teeth’s natural colour – even though in reality they only remove the most superficial of stains.

Here’s the truth about teeth whitening: the real, most effective solution is whitening at your dentist. That’s not the same bleach as under your sink, mind you. We’re talking about dental bleach here. And the best place to start a whitening treatment is in the care of a professional – your dentist.

Teeth whitening in Birmingham can take as little as an hour, thanks to the futuristic technology of ‘laser whitening’. Here, the dentist paints bleach onto your teeth and then shines a laser on them to activate the whitening effect.

A cheaper but much longer method is to wear a mouth guard filled with a whitening gel. The guard must be worn for a few hours every day for several weeks. A trained dental professional should make the mouth guard to ensure it fits properly.

Also, you’ll need to consider that teeth whitening is only temporary. You’ll have to whiten them again after a few months or years as the effect wears off. You can make the whitening last longer by limiting your coffee, tea and red wine intake, as these will all stain your teeth. Also, keep in mind that teeth whitening only works on natural tooth structure. It won’t work on false teeth, fillings, veneers or crowns.

Teeth whitening isn’t available on the NHS because it’s a cosmetic treatment, so you’ll need a private dentist instead. Some beauty salons offer to whiten teeth, but in Britain this practise is illegal, because dental professionals are the only people licensed to do it. This is because the procedure can be dangerous if done improperly: an unqualified practitioner can damage your tooth enamel or even burn your gums with the bleach.

You can also find DIY kits on the internet to whiten your teeth at home, but the NHS doesn’t recommend these either. For one thing, the provided mouth guard might not fit properly, causing bleach to leak into your mouth. So you should always seek a dental professional if you want your teeth whitened, because they understand how to do it properly and safely.

Tags: bleaching, teeth bleaching, Teeth Whitening, tooth bleaching, Tooth Whitening, white teeth, whitening

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5 ways to take better care of your teeth

Posted by Phil Tangri on April 3, 2015

Taking good care of your teeth is important to remove plaque and to reduce the long-term risk of gum disease and tooth decay. Yet despite this, many people only use a regular toothbrush and toothpaste to clean their teeth, even though there are several other additional ways you can use to ensure your teeth stay healthy.

Floss

Dentists recommend that everyone should floss, because it removes plaque and food from between your teeth where your toothbrush simply can’t reach. In fact, you should floss every night before brushing, and you may also need to floss during the day if food gets regularly stuck in your teeth. If you’ve never flossed before, then you should expect some minor gum bleeding when you first start, while your gums get used to the abrasion. Remember to pay special attention to the teeth at the back of your mouth, because these are the teeth hardest to reach, and therefore usually the most neglected.

Mouthwash

Mouthwash is not just for keeping your breath fresh – it can also reduce plaque and gum disease. But don’t make the common mistake of rinsing your mouth with water afterwards, because this will reduce the effectiveness of the mouthwash. Also, be careful when giving mouthwash to young children, because if they are not properly shown how to use it, they may accidentally swallow the rinse.

Electric toothbrush

You may think an electric toothbrush is an unnecessary expense, but they are actually better at removing plaque than regular toothbrushes. Try to buy one with oscillating heads (these are heads that rotate in opposite directions) as this is the most effective type of electric toothbrush.

Brushing properly

Even if you’re brushing your teeth the recommended minimum of two times a day, your efforts could still be going to waste if you’re not brushing them properly. For example, you may be neglecting to brush certain areas well enough, leading to plaque build-up in these areas. If you think this may be the case, then you can buy plaque disclosing tablets, which will help reveal any trouble spots. These tablets will dye any plaque left over after brushing and thereby highlight any areas you missed. But also, keep in mind that you shouldn’t brush with too much force, as this can prematurely wear down the enamel protecting your teeth. If your teeth are sensitive in particular areas, then this could be a sign you’re brushing too hard. Instead, use small circular movements rather than large heavy movements. You can even ask your dentist to watch you brushing your teeth, and they can then advise you on your technique.

Get a regular check-up

Finally, you should see a dentist regularly, because problems are much easier to solve if they’re caught early. The NHS recommends that adults go for a check-up at least every two years, though you will probably need to go more frequently if you have existing problems. Children, on the other hand, should see the dentist at least once a year.

Tags: brushing, Oral Hygiene, teeth, toothbrush

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Volunteering in Cambodia with Dentaid

Posted by Phil Tangri on March 2, 2015

For the month of March 2015 Scott Arms Dental Practice will be donating £1 from every course of treatment to support our Hygienist Amie Kavanagh, who will volunteering in Cambodia with the charity Dentaid.

Dentaid is a charity dedicated to eradicating dental pain across the world. They work in some of the worlds poorest and most remote communities.

In June we are sending our dental hygienist Miss Amie Kavanagh over to Cambodia to volunteer and provide dental treatment within disadvantaged communities. She will be providing pain relieving treatment, fissure sealants and preventative oral health advice to children.

As a practice we are fully supporting Amie and will be fundraising over the next couple of months. As gesture of our support Scott arms dental practice will be donating £1 to Dentaid for every new treatment plan for the month of March.

Please visit Amie’s donation page for more information, and if you can spare the money please help donate to this fantastic charity:

https://mydonate.bt.com/fundraisers/amiehyg

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What is it like to wear a denture?

Posted by Phil Tangri on December 23, 2014

As with all things, getting used to a denture can require a short period of adjustment. If you’ve ever worn braces or a retainer you might be familiar with the sensation of having something foreign in the mouth and the length of time that the body takes to adjust to it. Success with dentures generally requires some perseverance, faith in your dentist and an understanding of which sensations are to be expected:

Living with a denture

Initially you might feel like there is a lot in your mouth and that the dentures are too bulky. It doesn’t take long for the body to adapt to this new sensation with continued use.

Your denture may be slightly uncomfortable at first: the soft tissues in the mouth aren’t used to being in constant contact with materials. With good denture hygiene, the mouth should accept the new dentures within a couple of weeks and soreness will decrease. However, if any discomfort persists or soreness is not manageable, visit your dentist for an emergency appointment to have the dentures adjusted.

Over-the-counter medicaments to ease oral soreness may be useful in the management of denture-related discomfort. However, some of these gels and creams can cause burns if used underneath a denture and should be massaged into the tissues at least half an hour before denture insertion.

In the first few weeks of denture wearing, you might also feel that your tongue has less room, you are producing more saliva than usual and your gag reflex is heightened. These sensations are normal and will diminish with time.

Speaking with a denture

Before leaving with your new denture, your dentist will assess how you speak with it in. Talking with a new denture in place requires practice and reading aloud for the first week can help. You might feel that your dentures are ‘clicking’ or that your voice is altered. With continued use you’ll find that your speech returns to normal again as your cheeks, lips and tongue all adjust to accept the new denture.

Eating with a denture

In most cases, having a well-made denture will allow you to eat the same foods that you could previously. However, when starting out it is best to cut food into small pieces and attempt to eat on both sides of the mouth at the same time to help stabilise the denture. Eating softer foods initially will help you get used to the feeling of eating with a denture in and reduce the likelihood of discomfort; things like cooked vegetables, pasta and mashed potato are recommended.

To begin with, you might feel like your food has lost its flavour. This is usually only transient. Your brain, for a while, will perceive the denture as a foreign object and sensory signals will be received from both the food and the denture together, reducing the impact of flavour. Once the brain adjusts to the presence of the denture, your taste buds will return to normal.

If you continue to have trouble eating or speaking with your dentures, trying a denture fixative might be the answer. Apply the fixative like a cream to the fit surface of the denture in accordance with the instructions before inserting: this will help keep the dentures in place and allow you to eat and speak with more confidence.

Check out ourdenture page for more information regarding denture options and how to look after your denture.

Tags: dentures, dentures birmingham, fake teeth, false teeth, tooth replacement

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Walsall Emergency Dentist

Posted by Phil Tangri on August 19, 2014

Emergency practice:

Having once been the designated NHS emergency dental practice for the Birmingham and West Midland area, Scott Arms Dental Practice is well equipped to treat large numbers of emergency patients. Our dentists have extensive experience in all matters of dental emergency and, as a practice, we have treated over 100,000 emergencies in our 20 years of out-of-hours service.

We currently provide the largest service for emergency care in the West Midlands, offering appointments and treating walk-in patients up to 11 o clock at night.

Opening hours and appointments:

Call 0121 357 5000 to arrange an appointment, a walk-in slot, or for 24-hour advice over the weekend.

Emergencies patients can be seen from 9am to 11pm, seven days a week, 365 days a year. We offer a walk-in service during these times, but recommend phoning beforehand (the earlier the better) to arrange an appointment time and avoid a wait. Over the weekend, our dentists’ time is dedicated entirely to emergency patients and even NHS appointments can be offered each day on a first-come-first-serve basis.

If you have a problem between 11pm and 9am on a weekend, telephone our helpline, 0121 357 5000, to speak to one of our nurses; we’ll be able to give you advice on pain management and arrange an appointment for you for the following morning.

Travelling to us:

By bus – Scott Arms Dental Practice is located only five minutes from Walsall town and is easily connected via bus routes 51 and x51, which travel regularly 7 days a week. These same buses also connect both Walsall and Scott Arms Dental Practice to Birmingham city centre.

By train – The nearest railway station is Hamstead station, situated a twenty minute walk or short bus journey away.

By car – The practice is on Walsall road (A34), half a mile from junction 7 of the M6. We have on-site parking and can direct you to nearby car parks if we are full.

Dental emergencies:

Toothache
Abscess
Soft tissue or dental trauma
Oral swellings
Severe pain following a tooth extraction
Broken braces, other orthodontic appliances or dentures
Painful braces, other orthodontic appliances or dentures
Chipped tooth
Lost, loose or displaced tooth
Lost crown, bridge or other dental work
A lost or chipped filling

Managing dental pain at home:

Over-the-counter pain medication may ease a variety of dental pains. Most often recommended are ibuprofen to ease discomfort of an inflammatory nature (such as toothache and soft-tissue trauma) and paracetamol. Stronger analgesics include co-codamol, which contains paracetamol and codeine. For maximum effect, paracetamol and ibuprofen (or co-codamol and ibuprofen) can be taken at staggered intervals. Always read the instructions before taking analgesics and beware of taking paracetamol tablets alongside other paracetamol-containing medications. For more information about paracetamol safety, read our related article.
Alternative anti-inflammatories may be even more effective than ibuprofen; Naproxen (branded Aleve) is a non-steriodal anti-inflammatory like ibuprofen but is often found to work exceedingly well against toothache. Always read the label before consuming and take caution when using Aleve alongside other non-steroidal anti-inflammatories.
Difflam is an oral rinse/spray specifically designed for relief of oral pain. It contains an anti-inflammatory and an anaesthetic to reduce inflammation and provide numbness. Difflam is recommended for sore throats, ulcers and pain following dental surgery. As previously mentioned, read the label before using and speak to your dentist if you intend to use Difflam after any type of dental surgery.
Half a teaspoon of sea salt dissolved in one cup of warm water can be used as a soothing and antibacterial rinse for a number of dental discomforts; any soft tissue lesion (ulcers, abscesses and inflammation associated with wisdom tooth eruption) will benefit from regular salt-water rinses. Take care not to use too much salt, as it can cause irritation.
A hot compress (such as a hot water bottle wrapped in a blanket) may be useful in alleviating muscular pain, often caused by jaw joint disorders or trauma. Cold or hot compresses can also be used to ease toothache, though be sure to only apply for a maximum of ten minutes to avoid a burn.
If you are suffering with dental pain during the night, sleep with an extra pillow under your head; raising the site of pain will slightly reduce the blood flow to the area, thus minimising inflammation.
Both clove oil and vanilla extract have been indicated for topical pain relief from toothache.

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Caution with Paracetamol in Dentistry

Posted by Phil Tangri on July 10, 2014

As it can be so uncomfortable, dental pain often requires over-the-counter analgesics. Paracetamol is regularly a drug of choice: it is cheap, readily available and comes with minimal side effects. Despite being such a common and easily purchasable drug, accidental paracetamol overdose remains one of the highest causes of both acute liver failure and liver transplants in the UK.

Through a similar mechanism to non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin and ibuprofen, paracetamol can relieve the symptoms of pain, fever and headaches. Though its route of action is less well understood than regular NSAIDs, it is accepted that paracetamol is able to inhibit pathways in the body that lead to the release of prostaglandins, the chemical attributed to these symptoms.

Adverse Effects of Paracetamol

Tooth ache is inflammatory in nature. The anti-inflammatory effect of paracetamol is not as potent as NSAIDs but comes with a lower incidence of gastro-intestinal bleeding, nausea and blood thinning. Despite this, it seems to work just as well as NSAIDs in treating inflammatory tooth ache, possibly due to the effect it has on the central nervous system (1).

Once taken into the body, paracetamol is mostly metabolised by the liver. Initially it is conjugated with glucuronic acid to allow it to be excreted by the kidneys but this pathway is limited and can be exhausted by as little as 8 tablets of paracetamol (1). The remaining drug is converted into a toxic by-product that quickly reacts with a molecule called glutathione so the two can be excreted harmlessly in the urine (2). However, once this final mechanism of protection is used up, the toxic by-product begins to damage the cells of the liver.

Symptoms of paracetamol toxicity varies according to the time of presentation. Early presentation may often include nausea and vomiting; late presentation can show signs of jaundice, impaired consciousness and haemorrhage (2). The toxicity can be treated with acetyl-cysteine, which acts as a paracetamol antidote, but many people still die from paracetamol overdose due to late presentation (2). While incidence of accidental overdose is lower than non-accidental overdose, its mortality rate is often higher due to a decreased awareness about long-term damage and a later presentation in hospital (3).

Some people are more at risk of paracetamol toxicity than others; additional drugs being taken, such as anti-TB medication, and a number of conditions (particularly those damaging to the liver like hepatitis C) can all increase the risk. However, the two most dangerous risk factors in the average patient are often the belief that an over-the-counter drug is relatively harmless and how easy an overdose can be when paracetamol tablets are taken alongside paracetamol-containing medicaments like Lemsip, Night Nurse and Beechams.

The way forward with reducing the harm associated with paracetamol is through further patient education: a great number of people won’t read the precautions on drug instructions so the information needs to come from medical professionals (GPs and dentists) who see the patients taking these drugs and who often prescribe them. It is also the responsibility of professionals to identify the patients who are at a higher risk of paracetamol overdose due to their reliance on it for dental pain relief.

(1) Nayyer, N.V., Byers, J. and Marney, C. (2013) Identyfying adults at risk of paracetamol toxicity in the acute dental setting. BDJ. 216(5): 229-235
(2) Ferrer, R.E., Dear, J.W. and Bateman, N. (2011) Managing paracetamol overdose. BMJ. 342
(3) Craig, D.G., Bates, C.M., Davidson, J.S. et al (2011) Overdose pattern and outcome in paracetamol-induced acute severe hepatotoxicity. Br J Clin Pharmacol 71(2): 273-82

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