A Review of Preclinical and Clinical Studies in Support of the Role of Non-Steroidal Anti-Inflammatory Drugs in Dentistry

Abstract

Patient pain is a common problem faced by dentists and oral and maxillofacial surgeons. Craniofacial pain may be caused not only by inflammation in the teeth, but also various oral, facial, and nerve-related diseases, as well as tumors. Non-steroidal anti-inflammatory drugs (NSAIDs) constitute the basis of the analgesic ladder. According to the World Health Organisation (WHO), NSAIDs are the first-line drugs in relieving pain and inflammation of oral conditions. NSAIDs have been used in almost every field of dentistry. These drugs are applied in conservative dentistry and endodontics, dental surgery, orthodontics, periodontology, and oral mucosal diseases, as well as head and neck oncology. Some of the NSAIDs exhibit additional therapeutic effects, such as inhibition of nuclear factor kappa B (NF-κB) and inducible nitric oxide synthase (iNOS), and reduction of oxidative stress or leukocyte passage to the site of inflammation, which further reduces inflammation in tissues. The topical use of NSAIDs in dentistry is worthy of attention and further research as it will significantly reduce the adverse effects of systemic administration. This article aims to review the preclinical and clinical studies that have supported the role of NSAIDs in dentistry.

Involvement of Oxidative Stress and Nutrition in the Anatomy of Orofacial Pain

“…As reported above, pain and OFP have warning and protective functions, reducing the effects of the noxious stimuli that trigger some reflex responses from the body to the CNS [90,91].…”

“…These points determine the clinical multidisciplinary questions that require many specialists in several scientific fields. Furthermore, many studies suggested that it is very important to start pharmacotherapy early enough for improving the local and general conditions of patients [91].…”

“…COX exists in two isoforms (COX-1 and COX-2); COX-2 is responsible for pro-inflammatory effects, whereas COX-1 has physiological functions [100]. If the analgesics induce COX-1 inhibition, they could determine adverse effects on several systems such as cardiovascular and gastrointestinal systems [91,101]; if the analgesics act on COX-2 expression, they have a much better safety profile than the other substances [102]. Furthermore, some analgesics can act on nuclear factor kappa (NF-kB) and inducible nitric oxide synthase (iNOS) expression, directly and indirectly inducing a reduction in inflammation and oxidative stress [103][104][105][106].…”

“…The multidimensionality of OFP has led specialists to create several divisions of pain stimuli based on the practical aspects of this phenomenon (formation and causes) [91].…”

“…These mechanisms are shown in Figure 5 Based on the formation of pain, nine mechanisms have been identified: provoked pain caused by the mechanical, electrical, thermal, and chemical stimuli [107]; prolonged provoked pain [108]; spontaneous pain due to the inflammation process; continuous pain that corresponds to chronic pain and involves some periods of remission [109]; nocturnal pain due to the horizontal position of the body and sometimes due the inflammation process [110]; throbbing pain linked to the heart rate and due to the inflammation process in the tooth area; fresh pain due to an incident in a tooth or an area adjacent to a tooth [111]; acute pain [110]; radiating pain [112]. These mechanisms are shown in Figure 5 [91]. Based on the causes of pain, several types of OFP have been identified, and they are reported in Figure 6 [91].…”