Analgesic Efficacy of Selective COX -2 Inhibitors in Post Endodontic Pain: A Systematic Review

Abstract

Background: Endodontic treatment is considered a harrowing experience for patients in dental practice. COX-2 is a prime agent in inflammation and cell growth due to its relation with pro- inflammatory cytokines. Non -steroidal anti-inflammatory drugs are the most suited for treatment of post endodontic pain owing to their anti-inflammatory properties with the avoidance of cumbersome side effects such as nausea, vomiting, and respiratory problems associated with opioids. Aim: To assess the clinical efficacy of selective COX -2 inhibitors in comparison with other analgesics for managing postendodontic pain. Methods: This is an updated systematic review of studies between 2000 and 2023. Google Scholar, Web of science, Cochrane and PubMed databases were used to explore studies regarding our subject. The keywords included “selective COX-2 inhibitors; selective non- steroidal anti-inflammatory drug; endodontic pain; meloxicam; etoricoxib; metabolic complications” and were used in various combinations. In addition, original research reporting the clinical efficacy of selective COX -2 inhibitors in managing endodontic pain was evaluated. Full-text publications served as the inclusion criterion. Results: Among 100 articles were obtained, only nine met the inclusion criteria. All the studies were double-blinded randomized clinical trials. The study population was comprised of 1645 patients with endodontic pain. Conclusion: Selective COX -2 Inhibitors was an effective choice in managing endodontic pain. Celebrex was more effective than Celecoxib in relieving post-endodontic pain. When comparing Ibuprofen and Celecoxib, both were equally effective in relieving post-endodontic pain. Celecoxib was more effective than Naproxen in treating post-endodontic pain with minor gastrointestinal effects. Furthermore, etoricoxib considerably reduces post-endodontic pain with a single dosage.