Selective COX-2 inhibitors offer a therapeutic alternative to the conventional nonselective NSAIDs. Rofecoxib has been demonstrated to be a valuable therapeutic agent in the management of acute orofacial pain. Selective COX-2 inhibitors are also indicated in patients who are likely to undergo surgery or invasive procedures in the near future because these drugs do not prolong the bleeding time. The efficacy of these drugs in the management of chronic orofacial pain is yet to be evaluated. The pharmacoeconomic impact of COX-2 inhibitors must also be considered, as the cost of selective COX-2 inhibitors is considerably higher than the other commonly used NSAIDs. Although it is clear that COX-2 inhibitors offer some advantages over the nonselective NSAIDs in terms of a lower risk of GI toxicity with long-term use, the effects following short-term use are still unclear. Until more data are available, COX-2 inhibitors should be avoided or used with the same caution as for conventional NSAIDs in patients with compromised renal and cardiac function.
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