Home Ahead of print Instructions
About us Current issue Subscribe
Editorial board Archives Contact us
Search Submit article Login 
Print this page Email this page

 Table of Contents  
ORIGINAL ARTICLE
Year : 2013  |  Volume : 10  |  Issue : 2  |  Page : 86-90

Analgesics prescription in Nigerian dental healthcare services


Department of Periodontics, University of Benin, Benin City, Edo State, Nigeria

Date of Web Publication7-Dec-2013

Correspondence Address:
Clement C Azodo
Room 21, 2nd Floor, Department of Periodontics, Prof A. O. Ejide Dental Complex, University of Benin Teaching Hospital, Private Mail Bag - 1111, Ugbowo, Benin City, Edo State
Nigeria
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0331-8540.122768

Rights and Permissions
  Abstract 

Introduction: Alleviation of pain is considered high priority care and service in dental and medical practice worldwide. The study was conducted to evaluate analgesics prescription among dentists in Nigeria. Materials and Methods: This descriptive cross-sectional study was conducted among dentists attending continuing education courses in Nigeria organized by the Faculty of Dental Surgery of the National Postgraduate Medical College of Nigeria and Regional Centre for Oral Health Research and Training Initiatives for Africa. Results: Out of the 150 questionnaires distributed, 138 questionnaires were returned giving a 92.0% response rate. Males constituted 88 (63.8%) while the remaining 50 (36.2%) were females. The most common prescribed analgesic among the respondents was paracetamol 54 (39.1%). Factors that influenced the choice of prescribed analgesics among the respondents in descending order were severity of pain or intended pain, patient medical condition, type of procedure, age of the patient, delayed treatment, economic status, uncertainty of diagnosis and patient request Conclusion: The non-opioid analgesics specifically paracetamol was the most commonly prescribed by the respondents and the choice of analgesics was influenced by variety of factors .

Keywords: Analgesics, continuing education, dentists, prescription


How to cite this article:
Azodo CC, Umoh AO. Analgesics prescription in Nigerian dental healthcare services. Niger J Basic Clin Sci 2013;10:86-90

How to cite this URL:
Azodo CC, Umoh AO. Analgesics prescription in Nigerian dental healthcare services. Niger J Basic Clin Sci [serial online] 2013 [cited 2021 Dec 2];10:86-90. Available from: https://www.njbcs.net/text.asp?2013/10/2/86/122768


  Introduction Top


Pain is a leading cause of morbidity worldwide justifying the rapidly growing demand for safe and effective pain management. [1] It has been reported that unrelieved pain exerts negative influences on the physical and mental health, social and intimate relations, sleep and daily tasks performance, work productivity and financial well-being. [2]

Pain has been consistently identified as the most common reason for seeking dental attention and an inevitable sequela of some dental treatment because it is a feature of infection and inflammatory oral diseases, which are the predominant oral diseases affecting mankind. [3],[4],[5],[6] The reduction of pain with intricate improvement of clinical outcomes makes pain management, an integral part of dental practice. Pain control is therefore an essential service and duty of dentists, and the appropriate selection and use of the analgesics will facilitate the delivery of this service with the optimal safety and efficacy. [7] Proper pain management, which includes expert knowledge about analgesics, is an essential element of dentistry and noted deficiencies have prompted authors to recommend the development of prescribing guidelines and educational initiatives as a way of encouraging the rational and appropriate use of analgesics in dentistry. [8] Although, Nigeria has the National Drug Policy, which insist on rational prescription, there is no specific guidelines on analgesics prescription in dentistry in Nigeria. [9] The development of pain management strategies, which will equip dentists with additional treatment options in providing effective pain relief, is important because an experience of poorly managed pain related to dental treatment can lead to avoidance or postponement of treatment by patients. [10]

In dental healthcare services, analgesics of opioids (narcotics) and non-narcotic types (non-steroidal anti-inflammatory drugs (NSAIDs) and paracetamol) are among the most commonly prescribed drugs among dental patients accounting for 33.8-43.7%. [8],[11],[12],[13] The optimal benefit of analgesics prescribed for the relief of acute pain, postoperative pain and chronic pain and for controlling adjunctive intra-operative pain and mitigation of post-operative pain could only be harnessed with the adoption of rational prescription. [14]

Reye's syndrome which is a rare condition that most often affects children and teenagers recovering from a viral infection and manifesting with detrimental liver and brain effects is linked with aspirin thereby hampering the use of such analgesics in children. [15] However, studies on drug prescription relating to analgesics among dentists are scarce in the literature despite the increasing availability of analgesics and issues of rational drug prescription. The objective of the study was to evaluate analgesics prescription among dental in Nigeria.


  Materials and Methods Top


A total of 150 questionnaires were distributed to dentists that attended the continuing education courses organized by Faculty of Dental Surgery of the National Postgraduate Medical College of Nigeria (NPMCN) in Lagos State and the Regional Centre for Oral Health Research and Training Initiatives (RCORTI) for Africa (Formerly Inter Country Centre for Oral Health for Africa) in Jos Plateau State of Nigeria. The continuing education course by Faculty of Dental Surgery was a revision course for dentists attempting different categories of Fellowship examination ranging from primaries, part I to part II examinations while that by RCORTI was on atraumatic restoration (ART). The selection of this group of dentists was to ensure that the participants were actively practicing dentists because they are the group that attends continuing education courses. All the participants at the courses except those that did not consent were included in the study. The questionnaire elicited information on demography, most commonly prescribed analgesics, factors influencing the choice of prescribed analgesics, knowledge of contraindication of NSAIDs, knowledge of antidote for narcotic overdose, knowledge of suicidal dose for paracetamol and the analgesics that cause Reye's syndrome. Paracetamol being commonly available analgesics without gastrointestinal and nervous side effect could be abused in the self-medication of dental pain to the extent of ingesting toxic doses. The knowledge of suicidal dose for paracetamol among dentists is important in preventing such mortality and for effective advice to the public. Ethical approval was not sought, however, voluntariness of participation was adhered to and informed consent was obtained from all participants after having been informed of the objective of the study. The questionnaire were distributed to the participants during the course and collected at the end of the day. The data was analysed using Statistical Package of Social Science (SPSS version 17.0). Test of significance was done using Chi-square statistics. P < 0.05 was considered significant. The knowledge of contraindications of NSAIDs was categorized as good, fair and poor knowledge during the data analysis. Participants who correctly reported ≥6 contraindications were deemed as having good knowledge, those that reported 3-5 and 0-2 contraindications were grouped as fair and poor knowledge, respectively.


  Results Top


Out of the 150 questionnaires distributed, 138 of them were returned giving a 92.0% response rate. Males constituted 88 (63.8%) while the remaining 50 (36.2%) were females. A total of 88 (63.8%) of the respondents have practiced for less than 10 years and 88 (63.8%) have not attended any postgraduate course on prescription. The most common prescribed analgesics by the respondents was paracetamol by 54 (39.1%) of the respondents [Figure 1]. Factors that influence the choice of prescribed analgesics among the respondents in descending order were severity of pain or intended pain, patient medical condition, type of procedure, age of the patient, treatment had to be delayed, economic status, uncertainty of diagnosis and patient request [Table 1].
Table 1: Factors influencing the choice of prescribed analgesics among the respondents

Click here to view
Figure 1: The most common prescribed analgesics among the respondents

Click here to view


Correct knowledge about Reye's syndrome and antidote for narcotic overdose was found among the 76 (55.1%) and 72 (52.2%) of the respondents, respectively. Only 36 (26.1%) exhibited correct knowledge about the suicidal dose of paracetamol [Table 2].
Table 2: Knowledge of Reye's syndrome, suicidal doses of paracetamol, antidote of narcotic overdose among the respondents

Click here to view


A total of 38 (27.5%) of the respondents had good knowledge of contraindication to the prescription of NSAIDs analgesics. This good knowledge was higher more among male, younger dentists and those that reported attendance of continuing medical education (CME). However, this was not statistically significant [Table 3].
Table 3: Knowledge of contraindication to the prescription of non-steroid anti-inflammatory drugs analgesics among the respondents

Click here to view



  Discussion Top


Analgesics prescription in medical and dental practice contributes to wide spread overuse of these drugs. [16],[17] Analgesics with advantages tempered by undesirable side effects are increasingly available for utilization in the management of pain among dentists. [18] A variety of analgesics were reported as the most commonly prescribed analgesics among the respondents in this study. Aspirin and acetaminophen have been recognized for many years as prototypes of the peripherally acting analgesics of particular importance to dentists because of their role in acute pain treatment on the daily basis. The fact that appropriate dental treatment removes the cause of the pain with rapid resolution of the symptoms may be the reason for predominant prescription of peripherally acting analgesics even when majority of pain among dental patients in Nigeria are of either severe or very severe intensity. [19] The preference of non-narcotics analgesics to narcotics analgesics for all clinical endodontic situations among American endodontists is tandem with this study finding. [20]

Specifically, paracetamol, which possess very effective analgesics with little anti-inflammatory action, was the most common prescribed analgesics among the respondents. This concurred with findings of studies in tertiary hospitals in Karachi, Pakistan [21] and Oral Surgery Clinic in Benin City, Nigeria where paracetamol was the most frequently prescribed analgesics. [22] The fact that paracetamol is an effective analgesic with virtually no adverse effects, except for those related to over dose may have favoured the prescription. NSAIDs provide excellent pain relief due to their anti-inflammatory and analgesic action. Ibuprofen, a propionic acid derivative of NSAIDs, which constitutes the largest group of aspirin alternatives, was the second most prescribed analgesics in this study. Others in descending order include diclofenac, tramadol and piroxicam. This contrasted with findings in primary healthcare units in Brazil where diclofenac, both the sodium and potassium forms, were the most commonly prescribed medications. [23] In comparison, ibuprofen was found to be the most frequently prescribed systemic analgesics and non-opioid analgesics among patients attending the dental outpatient departments at Manipal Teaching Hospital in Nepal, respectively. [8],[13] Despite the high level of prescription of non-centrally acting analgesics exemplified by paracetamol and NSAIDs by the respondents, the knowledge of the suicidal dose of paracetamol, Reye's syndrome and contraindication to the prescription of NSAIDs remained inadequate. The knowledge of the suicidal dose of paracetamol is important as paracetamol overdose for dental pain is increasingly reported [24],[25],[26] emphasizing uniquely position of dentists in fashioning ways to prevent such occurrences. The intricate detail showed that the knowledge in relation to contraindication to the prescription of NSAIDs was higher among males, younger dentist in practice (<10 years' experience) and those respondents that had attended CME rich with analgesics content compared with their counterparts [Table 3]. However, this was not statistically significant and implies that CME alone may not be adequate in correcting the noted deficiency. The development of pain management strategies, prescribing guidelines and educational initiatives recommended by Sarkar et al., [8] and Mehlisch [10] may apply with possible favourable outcome. The influence of education on analgesics knowledge and prescription in this study lent support to the varied prescription of analgesics among endodontists based on board-certification. [20]

Although opioids are the cornerstone for management of moderate-to-severe acute pain, they are frequently underutilized and at lower than effective doses as a result of misconceptions and fears regarding their use. [27] Several undesirable effects of opiods like respiratory depression, urinary retention, sedation, nausea and vomiting, constipation, analgesic tolerance, dependence and addiction hampers the prescription among doctors. [28],[29] In this study, only 8.7% of the respondents commonly prescribed opioids, which contrasted with finding from a study conducted to analyse dental prescribing patterns for analgesics which revealed that respondents still rely on narcotic analgesics for pain relief and generally exceed needed potency and quantities in their prescribing habits. [3] The low prescription of opioids may be responsible for why only 36 (52.2%) of the respondents exhibited good knowledge of antidote for narcotic overdose.

Analgesics serve majorly as adjunct in management of pain as appropriate dental treatment facilitates the removal of the cause of the pain and rapid resolution of other symptoms. [5] The selection of analgesics must be individualized for each patient, depending on the cause and severity of the pain as well as patients' age and concomitant medical conditions that may alter the drug response. [10],[30],[31] In this study, factors that influence the choice of prescribed analgesics among the respondents in descending order were severity of pain or intended pain, patient medical condition, type of procedure, age of the patient, treatment had to be delayed, economic status, uncertainty of diagnosis and patient request. The severity of pain has been documented as a known fact that influences the choice of analgesics. For example, paracetamol and NSAIDs (ibuprofen, naproxen, diflunisal and others) are the most appropriate choices for the treatment of mild-to-moderate acute dental pain among patients lacking the contraindications for such drugs while opioids are powerful analgesics with significant side effects, which are commonly reserved for severe pain only. [5],[10],[32],[33] On event of analgesics failure, patients take desperate steps to seek pain relief therefore careful selection of effective analgesic regimen based on the amount and type of pain the patient expected to have can prevent the stress and anxiety associated with breakthrough pain. [34],[35] Medical condition may be a contraindication or may alter the metabolism of drugs heightening the chances of toxicity. [33],[36] The major contraindications to NSAIDs prescription, which include ulcer, asthma, allergy, diabetes, gout, influenza, bleeding diathesis, pregnancy and hepatic/renal disease are illustrations of the influence of medical history on analgesics prescription. [32]

Age of patients influences choice of analgesics because of the reported implication in Reyes syndrome. Epidemiological data indicated that aspirin usage during or shortly after these viral diseases like influenza or chickenpox in children increases the risk of developing Reye's syndrome. [37] The non-selective NSAIDs are best avoided in the older patient because of increased tendencies for gastrointestinal bleeding with increasing age. [37] The lower likelihood of children than adults with the same complaint to receive narcotics has been reported. [38] Affordability of drug is part of rational drug prescription and socioeconomic status of individual influence the prescription of analgesics as medical care payment in Nigeria is mostly out of pocket expenses. Socioeconomic background and other demographic factors like patient age have been related to the likelihood of receiving a prescription drug related to a dental visit. [39] Provision of appropriate treatment after dental surgery requires a careful medical history and educated anticipation of the level of pain the patient may encounter. This therefore highlight the influence of types of procedure with accompanying inflammation and anticipated severity of pain and other functional disturbances on analgesics prescription choices and pattern among the respondents. [10]

Although, this study is limited by mode of recruitment and method of selection of participants, the findings could be considered valuable in reference to information on analgesics prescription relating to actively practicing dentists in Nigeria.


  Conclusion Top


A variety of analgesics are prescribed commonly in Nigerian dental healthcare settings and a number of factors influence the choice of these analgesics .The non-opioid analgesics were commonly prescribed by the respondents. Insufficient knowledge relating to analgesics was also documented among the respondents. The development of pain management strategies, prescribing guidelines and educational initiatives are recommended as possible ways to overcoming the noted deficiencies.

Clinical significance

Insufficient knowledge relating to analgesics may impair rational drug prescription with attendant adverse consequences among patients utilizing Nigerian dental healthcare services.

 
  References Top

1.Langford RM. Pain management today-what have we learned? Clin Rheumatol 2006;25 (Suppl 1):S2-8.  Back to cited text no. 1
[PUBMED]    
2.McCarberg BH, Nicholson BD, Todd KH, Palmer T, Penles L. The impact of pain on quality of life and the unmet needs of pain management: Results from pain sufferers and physicians participating in an Internet survey. Am J Ther 2008;15:312-20.  Back to cited text no. 2
[PUBMED]    
3.Aldous JA, Engar RC. Do dentists prescribe narcotics excessively? Gen Dent 1996;44:332-4.  Back to cited text no. 3
[PUBMED]    
4.Ekanayake L, Mendis R. Self reported use of dental services among employed adults in Sri Lanka. Int Dent J 2002;52:151-5.  Back to cited text no. 4
[PUBMED]    
5.Hargreaves K, Abbott PV. Drugs for pain management in dentistry. Aust Dent J 2005;50 (Suppl 2):S14-22.  Back to cited text no. 5
    
6.Ong CK, Seymour RA. An evidence-based update of the use of analgesics in dentistry. Periodontol 2000 2008;46:143-64.  Back to cited text no. 6
    
7.Jeske AH. Prescription opioid abuse: Dental perspectives. Tex Dent J 2005;122:622-30.  Back to cited text no. 7
[PUBMED]    
8.Sarkar C, Das B, Baral P. An audit of drug prescribing practices of dentists. Indian J Dent Res 2004;15:58-61.  Back to cited text no. 8
[PUBMED]    
9.Federal Ministry of Health (FMOH). 2 nd ed. National Drug Policy of Nigeria; 2005. p. 1-25.  Back to cited text no. 9
    
10.Mehlisch DR. The efficacy of combination analgesic therapy in relieving dental pain. J Am Dent Assoc 2002;133:861-71.  Back to cited text no. 10
[PUBMED]    
11.Ciancio S, Reynard A, Zielezny M, Mather M. A survey of drug prescribing practices of dentists. N Y State Dent J 1989;55:29-31.  Back to cited text no. 11
[PUBMED]    
12.Rehan HS, Singh C, Tripathi CD, Kela AK. Study of drug utilization pattern in dental OPD at tertiary care teaching hospital. Indian J Dent Res 2001;12:51-6.  Back to cited text no. 12
[PUBMED]    
13.Sarkar C, Das B, Baral P. Analgesic use in dentistry in a tertiary hospital in western Nepal. Pharmacoepidemiol Drug Saf 2004;13:729-33.  Back to cited text no. 13
[PUBMED]    
14.Dionne RA, Berthold CW. Therapeutic uses of non-steroidal anti-inflammatory drugs in dentistry. Crit Rev Oral Biol Med 2001;12:315-30.  Back to cited text no. 14
[PUBMED]    
15.Starko KM, Ray CG, Dominguez LB, Stromberg WL, Woodall DF. Reye's syndrome and salicylate use. Pediatrics 1980;66:859-64.  Back to cited text no. 15
[PUBMED]    
16.Gómez-Oliván LM, Márquez Rodríguez S, Pontigo Loyola P, Téllez López A, Amaya-Chávez A, Galar-Martínez M. The pescription of drugs in a dental clinic of a Mexican university hospital. Farm Hosp 2007;31:169-72.  Back to cited text no. 16
    
17.Weingarten MA, Ziderman A, Hart J, Enav H, Ahiron S, Politi B. Reducing the use of analgesics in general practice: Evaluation of a health education programme. Patient Educ Couns 1988;11:227-33.  Back to cited text no. 17
    
18.Aldous JA, Engar RC. Analgesic prescribing patterns in a group of dentists. Gen Dent 2000;48:586-90.  Back to cited text no. 18
[PUBMED]    
19.Gbenga Omitola O, Olabisi Arigbede A. Prevalence and pattern of pain presentation among patients attending a tertiary dental center in a southern region of Nigeria. J Dent Res Dent Clin Dent Prospect 2010;4:42-6.  Back to cited text no. 19
    
20.Mickel AK, Wright AP, Chogle S, Jones JJ, Kantorovich I, Curd F. An analysis of current analgesic preferences for endodontic pain management. J Endod 2006;32:1146-54.  Back to cited text no. 20
[PUBMED]    
21.Aslam N, Shoaib MH, Bushra R. Analgesic prescribing in developing countries. Jordan J Pharmaceutical Sci 2010;3:137-44.  Back to cited text no. 21
    
22.Ehigiator O, Odai CD, Obuekwe ON, Azodo CC. Evaluation of drug prescriptions in oral surgery. Nig Hosp Pract 2011;7:77-81.  Back to cited text no. 22
    
23.Mendonça JM, Lyra DP Jr, Rabelo JS, Siqueira JS, Balisa-Rocha BJ, Gimenes FR, et al. Analysis and detection of dental prescribing errors at primary health care units in Brazil. Pharm World Sci 2010;32:30-5.  Back to cited text no. 23
    
24.Dodd MD, Graham CA. Unintentional overdose of analgesia secondary to acute dental pain. Br Dent J 2002;193:211-2.  Back to cited text no. 24
[PUBMED]    
25.Thomas MB, Moran N, Smart K, Crean S. Paracetamol overdose as a result of dental pain requiring medical treatment-two case reports. Br Dent J 2007;203:25-8.  Back to cited text no. 25
[PUBMED]    
26.Vogel J, Heard KJ, Carlson C, Lange C, Mitchell G. Dental pain as a risk factor for accidental acetaminophen overdose: A case-control study. Am J Emerg Med 2011;29:1125-9.  Back to cited text no. 26
[PUBMED]    
27.Stimmel B. Under-prescription/over-prescription: Narcotic as metaphor. Bull N Y Acad Med 1985;61:742-52.  Back to cited text no. 27
[PUBMED]    
28.Schug SA, Zech D, Grond S. Adverse effects of systemic opioid analgesics. Drug Saf 1992;7:200-13.  Back to cited text no. 28
[PUBMED]    
29.Benyamin R, Trescot AM, Datta S, Buenaventura R, Adlaka R, Sehgal N, et al. Opioid complications and side effects. Pain Physician 2008;11 (2 Suppl):S105-20.  Back to cited text no. 29
    
30.Matzke GR. Clinical consequences of nonnarcotic analgesic use. Ann Pharmacother 1997;31:245-8.  Back to cited text no. 30
[PUBMED]    
31.Fernández-Liz E, Modamio P, Catalán A, Lastra CF, Rodríguez T, Mariño EL. Identifying how age and gender influence prescription drug use in a primary health care environment in Catalonia, Spain. Br J Clin Pharmacol 2008;65:407-17.  Back to cited text no. 31
    
32.Jeske AH. COX-2 inhibitors and dental pain control. J Gt Houst Dent Soc 1999;71:39-40.  Back to cited text no. 32
[PUBMED]    
33.Donaldson M, Goodchild JH. Appropriate analgesic prescribing for the general dentist. Gen Dent 2010;58:291-7.  Back to cited text no. 33
[PUBMED]    
34.Phero JC, Becker D. Rational use of analgesic combinations. Dent Clin North Am 2002;46:691-705.  Back to cited text no. 34
[PUBMED]    
35.Becker DE, Phero JC. Drug therapy in dental practice: Nonopioid and opioid analgesics. Anesth Prog 2005;52:140-9.  Back to cited text no. 35
[PUBMED]    
36.Trapp LD. Oral analgesics in the compromised dental patient: What are the options? J Calif Dent Assoc 1995;23:47-50.  Back to cited text no. 36
[PUBMED]    
37.Haas DA. An update on analgesics for the management of acute postoperative dental pain. J Can Dent Assoc 2002;68:476-82.  Back to cited text no. 37
[PUBMED]    
38.Hauswald M, Anison C. Prescribing analgesics: The effect of patient age and physician specialty. Pediatr Emerg Care 1997;13:262-3.  Back to cited text no. 38
[PUBMED]    
39.Wall TP, Brown LJ, Zentz RR, Manski RJ. Dentist-prescribed drugs and the patients receiving them. J Am Coll Dent 2007;74:32-41.  Back to cited text no. 39
[PUBMED]    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]


This article has been cited by
1 Influence of photobiomodulation on pain perception during initial orthodontic tooth movement
Welinton Lemos RUMÃO,Heloísa Cristina VALDRIGHI,Vivian Fernandes FURLETTI,Giovana Renata GOUVÊA,Milton SANTAMARIA-JR
Revista de Odontologia da UNESP. 2020; 49
[Pubmed] | [DOI]
2 Patterns of drugs prescribed for dental outpatients in Nigeria: findings and implications
Joseph O. Fadare,Kazeem A. Oshikoya,Obitade S. Obimakinde,Abayomi O. Sijuade,Jide M. Afolayan,Adeyinka A. Adeleke,Brian Godman,Damilola O. Ojumu
Acta Odontologica Scandinavica. 2017; : 1
[Pubmed] | [DOI]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Materials and Me...
Results
Discussion
Conclusion
References
Article Figures
Article Tables

 Article Access Statistics
    Viewed6161    
    Printed164    
    Emailed1    
    PDF Downloaded542    
    Comments [Add]    
    Cited by others 2    

Recommend this journal