Celecoxib and rofecoxib. The role of COX-2 inhibitors in dental practice

BACKGROUND: In recent years, dental practitioners have relied on ibuprofen and other nonsteroidal anti-inflammatory drugs, or NSAIDs--such as naproxen, diflunisal and ketoprofen--to manage acute and chronic orofacial pain. Two NSAIDs that recently came on the market, celecoxib and rofecoxib, have been developed to limit the adverse effects seen after chronic use of NSAIDs. LITERATURE REVIEWED: The authors have summarized all available publications describing the human pharmacokinetics, clinical pharmacology and known adverse effects of these new specific cyclooxygenase-2, or COX-2, inhibitors. CONCLUSIONS: Although peripherally acting analgesics are remarkably effective, chronic administration of nonselective COX inhibitors has been associated with gastrointestinal ulceration and prolonged bleeding. The authors present the distinctive mechanism of action for these new COX-2 inhibitors, compare their relative anti-inflammatory and analgesic properties and describe their safety profile. They also summarize indications, contraindications and dosing recommendations. CLINICAL IMPLICATIONS: Celecoxib and rofecoxib are valuable dental therapeutic agents for the management of inflammatory joint disorders and associated chronic orofacial pain. Additionally, rofecoxib, with its more rapid onset, may be useful in treating selected cases of acute postsurgical pain.