COX-2 Inhibitors in Dental Pain Management

Abstract

Pain is a major symptom in many dental procedures. Studies show consistently that pain, including dental pain, is not effectively treated; management of pain is a critical and challenging component in dentistry. Improvement and efficacy on the treatment depends on knowing which treatments are the most effective. Knowing how well an analgesic works and its associated adverse effects is fundamental to clinical decision. The aim of this review is to provide information to the dentistry field on the treatment of dental pain specifically with COX-2 inhibitors providing a useful guide to dentist on controlling pain. Therefore, nonsteroidal anti-inflammatory drugs (NSAIDs) are the most commonly prescribed analgesic agents in surgical outpatients. Major limitations of NSAIDs are their gastrointestinal (GI) adverse events (perforation, ulceration, and bleeding), impairment of hemostatic function, and renal failure (with long-term therapy). A new class of NSAIDs, COX-2 selective inhibitors (Coxibs), have been developed with the aim of reducing the GI adverse events of traditional NSAIDs while maintaining their effective anti-inflammatory and analgesic properties.

Nationwide Etoricoxib Injection Clinical Experience (NICE): Real-World Evidence in Indian Patients

“…Paracetamol or nonsteroidal anti-inflammatory drugs (NSAIDs) are first-line treatments for the management of mild-to-moderate acute pain [ 6 , 7 ]. Nonselective NSAIDs inhibit both cyclooxygenase (COX)-1 and COX-2, whereas selective COX-2 NSAIDs have a higher selectivity for COX-2 [ 8 ].…”

“…The selectivity ratio (COX-1/COX-2 IC50) represents the drug concentration needed for the inhibition of each prostaglandin-synthase isozyme activity by 50% [ 8 ]. However, their structure, properties, and ability to inhibit COX-1 and COX-2 isoenzymes determine whether they have a greater antipyretic, anti-inflammatory, or analgesic action [ 7 ]. The analgesic effect of NSAIDs is thought to be mediated mainly through the inhibition of COX-2.…”

“…The analgesic effect of NSAIDs is thought to be mediated mainly through the inhibition of COX-2. COX-2 selective NSAIDs inhibit the COX-2 isoenzyme responsible for prostaglandin production, which is involved in the pathway of pain, inflammation, and fever [ 6 , 7 ]. COX-2 selective inhibitors are safe in asthma patients and do not impair platelet function or increase the risk of blood loss in surgeries such as total knee joint replacement, compared to the increased risk of bleeding associated with nonselective NSAIDs [ 8 - 10 ].…”

Evaluating the efficacy of Etoricoxib in reducing post-operative pain associated with minor oral surgery. A randomized clinical trial

“…Dental pulp or the periodontal ligament might be the source of dental pain (a toothache). Dental pain is profound, and somatic, and presents a variety of central excitatory consequences and effects [1]. On the other hand, Trigeminal nerve-innervated muscles may develop trigger points, autonomic effects, and spasm induction because of referred pain.…”

“…When oral tissue is injured, the inflammatory response is triggered, releasing a variety of inflammatory and pain mediators. Peripheral nociceptors are more sensitive to and excited by mediating substances such as prostaglandins and bradykinins, which typically exhibit little natural action underneath usual circumstances [1].…”