The Effects of Non-Steroidal Anti-Inflammatory Drugs (Selective and Non-Selective) on the Treatment of Periodontal Diseases

Abstract

The objective was to review the literature on the effects of selective and non-selective non-steroidal anti-inflammatory drugs (NSAIDs) on the treatment of periodontal diseases. A search of MEDLINE was conducted and articles published in English until December 2003 were included. The results from in vitro and animal experiments as well as from human clinical trials are presented. Non-selective cyclooxygenase-1 (COX-1) inhibitors used in periodontal research include compounds such as aspirin, flurbiprofen, ibuprofen, naproxen and piroxicam. Selective cyclooxygenase-2 (COX-2) inhibitors represent a new group of pharmaceutical products termed "coxibs" that include meloxicam, nimesulide, etodolac and celecoxib. Evidence from animal experiments and clinical trials documents that selective and non-selective NSAIDs are mainly responsible for the stabilization of periodontal conditions by reducing the rate of alveolar bone resorption. This is achieved through local inhibition of both enzymes (e.g. COX-1 and COX-2) responsible for the synthesis of arachidonic acid metabolites. Evidence shows that the effects of NSAIDs drop off rapidly after drug withdrawal. One of the major advantages of selective COX-2 inhibition is the reduction of adverse systemic effects. Although some studies present promising results, no data from long-term, multicenter prospective clinical trials are yet available for determining whether these therapeutic effects can be retained on a long-term basis. Many of these compounds, such as flurbiprofen, are readily absorbed through the gingival tissues. Therefore, the development of topical NSAIDs formulations (e.g. gels, toothpastes, rinses) with a daily application seems to be of particular interest. This may help to further reduce adverse systemic effects of non-selective NSAIDs in the long-term host modulation of periodontitis-susceptible patients.

Prostaglandins and bone: potential risks and benefits related to the use of nonsteroidal anti-inflammatory drugs in clinical dentistry

“…Experimental animals carrying genes that have been made inoperative for COX-2 and PG receptors (knockout mice) have impaired osteoclastogenesis and decreased bone resorption. Elevated secretion of inflammatory cytokines and PGE 2 is related to the bone loss taking place in some inflammatory diseases, including arthritis and periodontitis (3,7,9,10,15,16) and the role of PGs in the pathogenesis of osteoporosis is supported by studies in human and animal models (17).…”

“…Collected data have suggested that NSAIDs have a potential adjunctive role in periodontal therapy (43). The literature was also recently reviewed in order to compare the effects of selective and non-selective NSAIDs on periodontal treatment (15). The authors reported experimental and clinical evidence confirming the beneficial effects of both drug types by reducing the rate of alveolar bone resorption, but suggested that the serious side effects of selective COX-2 inhibitors might preclude their use as adjuncts to periodontal therapy.…”

Effectiveness of an Educational Feedback Intervention on Drug Prescribing in Dental Practice

“…NSAIDs also stabilizes the periodontal condition by reducing the rate of alveolar bone resorption. 29 In our study most commonly prescribed NSAID was Nimesulide in more than 50% of cases followed by Ibuprofen and paracetamol either alone or in combination, before and after intervention. Selection of Nimesulide in our study was the primary choice because of less adverse effects and good tolerability except rare hepatotoxicity (mechanism is not unknown, probably caused by idiosyncratic reaction).…”

Effects of host modulation by nonsteroidal anti-inflammatory drugs on periodontal disease: a systematic review and meta-analysis

“…However, two reviews have found positive effects of NSAIDs on gingival inflammation and periodontal-disease progression by reducing the rate of alveolar bone resorption. 38,39 These conflicting findings are probably due to the bone preservation effect of NSAIDs and it might not be reflected in clinical parameters including PD or CAL. Also, it would take a long time for bony changes to be measurable by periodontal probes.…”