Abstract
Background: Acute dental pain is a common presentation to emergency departments (ED) and urgent care services throughout New Zealand. Currently, there are no clear analgesic guidelines in Waitaha/Canterbury for clinicians to provide appropriate and evidence-based pain management for those suffering from acute dental pain. International evidence of dental pain-related prescribing indicates an over-reliance on opioid-based analgesia. We sought to retrospectively audit what analgesic medications were being prescribed and whether they reflected internationally established best-practice medication guidelines. Depending upon the results, recommendations for clinical practice of acute dental pain management may be sought. The primary aim was to review the current medications prescribed to manage the participants' acute dental pain. The secondary aim was to compare the prescribed pharmacological treatments to that of international gold-standard guidelines for the management of acute dental pain care.
Method: This study used a retrospective clinical audit to sample a representative, random number of patients over a 12-month period of acute dental pain presentations to the ED. It was anticipated that between 500 and 1000 patients were seen in a year. Statistically, between 10 and 20% of participants were assumed to represent whether best-practice analgesia was being prescribed. Data collection was undertaken at a tertiary Emergency Department in New Zealand.
Findings and outcome: A total of 710 individuals were seen in the ED with acute dental pain in one year, and a sample of 100 (53 males and 47 females) was used for this study. Ethnicity data reflected a cross-section of New Zealand society in this sample. Overall, the findings established that the Christchurch Hospital's Emergency Department was prescribing appropriate analgesia and managing acute dental pain in line with international best practices. Key findings in this audit were the disparity in dental health across Māori and Pasifika who presented statistically higher to the ED in comparison to other groups. However, treatment regimens between ethnicities did not differ. Based upon results from this study, it is recommended that a written analgesic guide be added to the Canterbury Health pathways 'toothache' pathway