Sir, I wish to emphasise the importance of checking for painkiller overdoses whenever a patient presents with dental pain.

An 18-year-old recently attended with toothache. On checking self-medication, over the course of several hours he had taken: 12 x 500 mg paracetamol tablets, 10 x 30/500 mg co-codamol tablets and 4 x 30 mg codeine tablets: ie at least 11 g paracetamol and 420 mg codeine, far above the maximum doses of 4 g and 240 mg. A quick call to the local A+E department confirmed his need to be seen urgently. However, the patient did not share this urgency stating he 'did not fancy a four-hour wait' and would go to his GMP in a few days.

Patients with dental pain frequently accidentally overdose on painkillers with a recent study in the BDJ reporting 37% presenting to an A+E department and concluding that this was due to a lack of patient awareness of the potential overdose dangers and inadequate access to dental services.1 In this case the patient had seen an emergency dentist the previous day who advised painkillers but crucially did not advice on dosages.

The former conclusion is however certainly true. The patient overdosed to help him sleep as 'a few tablets weren't good enough'. As they are easily accessible medications he felt there was no danger in taking more than stated on the box. The effects of an overdose often don't present for several days making patients unaware of the potential harm they have caused. This lack of symptoms was also a deterrent from attending the local hospital when advised.

Teaching on basic pain history includes asking patients if they have taken painkillers and how many. Yet do we all do this? Perhaps this relates to the time pressures of NHS dentistry - the practice I work in has 15 minute appointments for an 'Emergency Pain' which appears to be the norm in the area. Is this really enough time to take a full and detailed history as well as examining the patient, performing any investigations and then treatment?

Despite time pressures, this patient reinforced in me the importance of ensuring patients are asked regarding doses of painkillers taken; and when advising painkillers, ensure patients are made aware of the dosage and if needs be the consequences of an overdose.

In order to act holistically, these two quick and easy points should be followed as a matter of routine. After all, taking it to an extreme, the seconds needed to address these simple points have the potential to save someone's life.