Treatment with paracetamol, ketorolac or etoricoxib did not hinder alveolar bone healing: a histometric study in rats

Abstract

Prostaglandins control osteoblastic and osteoclastic function under physiological or pathological conditions and are important modulators of the bone healing process. The non-steroidal anti-inflammatory drugs (NSAIDs) inhibit cyclooxygenase (COX) activity and consequently prostaglandins synthesis. Experimental and clinical evidence has indicated a risk for reparative bone formation related to the use of non-selective (COX-1 and COX-2) and COX-2 selective NSAIDs. Ketorolac is a non-selective NSAID which, at low doses, has a preferential COX-1 inhibitory effect and etoricoxib is a new selective COX-2 inhibitor. Although literature data have suggested that ketorolac can interfere negatively with long bone fracture healing, there seems to be no study associating etoricoxib with reparative bone formation. Paracetamol/acetaminophen, one of the first choices for pain control in clinical dentistry, has been considered a weak anti-inflammatory drug, although supposedly capable of inhibiting COX-2 activity in inflammatory sites.ObjectiveThe purpose of the present study was to investigate whether paracetamol, ketorolac and etoricoxib can hinder alveolar bone formation, taking the filling of rat extraction socket with newly formed bone as experimental model. Material and methodsThe degree of new bone formation inside the alveolar socket was estimated two weeks after tooth extraction by a differential point-counting method, using an optical microscopy with a digital camera for image capture and histometry software. Differences between groups were analyzed by ANOVA after confirming a normal distribution of sample data. Results and conclusionsHistometric results confirmed that none of the tested drugs had a detrimental effect in the volume fraction of bone trabeculae formed inside the alveolar socket.

Ketorolac Administration Does Not Delay Early Fracture Healing in a Juvenile Rat Model

“…13,29,32 From these previous studies, we believe our dose would have the appropriate capability to prevent callus formation and subsequent fracture healing, if the effect exists in this population.…”

“…In adult rat and rabbit studies, ketorolac administration has been shown to delay bone healing in some studies 13,14,22,27 but not in others. 29,32,33 In adult clinical studies, both Glassman et al 34 and Park et al 36 demonstrated increased nonunion rates in patients undergoing posterior spinal fusion who used ketorolac postoperatively. But Pradhan et al 37 failed to demonstrate any difference.…”

Effectiveness of various non-steroidal anti-inflammatory drugs in pain management of patients with vertebral fracture: A comparative clinical study

“…Although COX2 inhibitors are safer, their possible effects on delay in bone reunion and non-union required study. Various reports on drug dose-dependent effects on bone health have appeared, although in the present study, we did not administer different doses of NSAIDs [18][19][20]. The COX-selectivity of an NSAID governs the efficacy of analgesia as well as bone health.…”

Pulp response of rats submitted to bleaching and the use of different anti-inflammatory drugs

“…Tyl–The animals in this lot received Tylenol 40mg/ml/kg [24] (Paracetamol, Janssen-Cilag Pharmaceuticals Ltda, São Paulo, SP, Brazil). A 500 mg tablet of the drug Paracetamol was diluted in 100 ml of distilled water and administered orally [24]. This solution was given 30 min before the start of the bleaching treatment, then once every 12 h until euthanasia (Table 1).…”