[The role of COX-2 in dentistry. Past or future?]

Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used to inhibit cyclooxygenase (COX) activity within the scope of pain and inflammation therapy. Although these pharmaceuticals are effective in the treatment of pain and inflammation, their routine and long-term administration is limited due to their side effects (e.g., gastrointestinal and renal complications, inhibition of platelet aggregation). COX isoenzymes are of great scientific interest, since these drugs are the main targets of NSAIDs. While the inhibition of COX-2 is related to anti-inflammatory effects, the use of COX-1 might be associated with adverse reactions. Therefore, new generation selective COX-2 inhibitors have been developed to reduce possible side effects. Recently, these new anti-inflammatory drugs have been used for the treatment of various inflammatory diseases. At the same time, COX-2 inhibitors appear promising for control of dental pain and for supportive treatment of inflammatory periodontal diseases. The superior analgesic and sustained efficacy, along with the reduced side effects of COX-2 inhibitors (compared to NSAIDs) have been revealed in numerous clinical studies, in particular after oral surgery. Moreover, NSAIDs have been used for periodontal therapy, and evidence from animal experiments and clinical trials has documented that NSAIDs seem to stabilize periodontal conditions by reducing the rate of alveolar bone resorption. This article reviews the use of NSAIDs and COX-2 inhibitors in dental medicine for pain control and periodontal therapy.