The use of COX-2 inhibitors for acute dental pain: A second look.

Abstract

BACKGROUND:

On the basis of their perceived better safety profile compared with other analgesic agents, cyclo-oxygenase-2 (COX-2) inhibitors have been prescribed frequently as first-line agents to treat acute dental pain. However, recently identified cardiovascular adverse reactions associated with these drugs mandate a reappraisal of their use in dental practice. TYPES OF STUDIES REVIEWED. The authors reviewed 18 clinical studies that evaluated the efficacy of a COX-2 inhibitor for the treatment of acute dental pain. All of the studies used the widely established third-molar surgical extraction model to induce postsurgical inflammatory based pain, and all were randomized, double-blinded and placebo-controlled. However, numerous vagaries in overall study design made direct comparisons difficult.

RESULTS:

None of the studies established any of the COX-2 inhibitors as clearly better than ibuprofen, the current gold standard for the treatment of surgically induced dental pain. However, in single-dosing scenarios, the COX-2 inhibitor often demonstrated a longer duration of action compared with ibuprofen.

CLINCAL IMPLICATIONS:

The evidence to date fails to demonstrate any therapeutic advantage to using a COX-2 inhibitor to treat acute dental pain compared with ibuprofen. In the rare event that a COX-2 inhibitor may be appropriate, the clinician must inform the patient of the potential risks, and the drug should be used for the shortest possible time.

• Authors: Michaell A Huber, Geza T Terezhalmy
• Journal: Journal of the American Dental Association (1939) (J Am Dent Assoc) Vol. 137 Issue 4 Pg. 480-7 (Apr 2006) ISSN: 0002-8177 [Print] England
• PMID: 16637477 (Publication Type: Journal Article, Review)

Chemical References

• Analgesics
• Anti-Inflammatory Agents, Non-Steroidal
• Cyclooxygenase 2 Inhibitors

Topics

• Analgesics (adverse effects, therapeutic use)
• Anti-Inflammatory Agents, Non-Steroidal (adverse effects, therapeutic use)
• Cyclooxygenase 2 Inhibitors (adverse effects, therapeutic use)
• Humans
• Toothache (drug therapy)