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-kappaB) 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.

Figure 1. Mechanisms of pain

Created with BioRender.com. With regard to the mechanism of pain formation in the oral cavity, a distinction is made between: provoked pain, prolonged provoked pain, spontaneous pain, continuous pain, nocturnal pain, throbbing (pulsating) pain, fresh pain, acute pain, and radiating pain.

Figure 2. Types of orofacial pain

Created with BioRender.com. With regard to the cause of pain in the oral cavity, we distinguish the following types of orofacial pain: dentin hypersensitivity, pain caused by inflammation of the temporomandibular joint, Munchausen syndrome, orthodontic pain, pain resulting from cancer located in the area of the head and neck, pain arising from general diseases, pain caused by inflammation of nerves, postoperative pain, inflammation of the pulp and periapical tissues, and pain arising from inflammation of the oral mucosa.

Figure 3. Effects of NSAIDs on cyclooxygenase

Created with BioRender.com. The mechanism of action of NSAIDs is connected with the inhibition of cyclooxygenase (COX), which blocks the conversion of arachidonic acid to proinflammatory prostaglandins. NSAIDs reduce inflammation and pain in periodontitis/mucositis or after oral surgery. Although COX exists in 2 isoforms (COX-1 and COX-2), COX-2 is responsible for proinflammatory effects, while COX-1 serve mainly physiological functions. Therefore, most NSAID adverse effects are associated with COX-1 inhibition including gastrointestinal damage, liver damage or cardiovascular complications.