The use of COX-2 inhibitors for acute dental pain: A second look

Michaell A. Huber, Geza T. Terezhalmy

Research output: Contribution to journalArticlepeer-review

20 Scopus citations


Background. On the basis of their perceived better safety profile compared with other analgesic agents, cyclo-oxygenase-2 (COX-2) inhibitors have been prescribed frequently as first-line agents to treat acute dental pain. However, recently identified cardiovascular adverse reactions associated with these drugs mandate a reappraisal of their use in dental practice. Types of Studies Reviewed. The authors reviewed 18 clinical studies that evaluated the efficacy of a COX-2 inhibitor for the treatment of acute dental pain. All of the studies used the widely established third-molar surgical extraction model to induce postsurgical inflammatory based pain, and all were randomized, double-blinded and placebo-controlled. However, numerous vagaries in overall study design made direct comparisons difficult. Results. None of the studies established any of the COX-2 inhibitors as clearly better than ibuprofen, the current gold standard for the treatment of surgically induced dental pain. However, in single-dosing scenarios, the COX-2 inhibitor often demonstrated a longer duration of action compared with ibuprofen. Clinical Implications. The evidence to date fails to demonstrate any therapeutic advantage to using a COX-2 inhibitor to treat acute dental pain compared with ibuprofen. In the rare event that a COX-2 inhibitor may be appropriate, the clinician must inform the patient of the potential risks, and the drug should be used for the shortest possible time.

Original languageEnglish (US)
Pages (from-to)480-487
Number of pages8
JournalJournal of the American Dental Association
Issue number4
StatePublished - Apr 2006


  • Acute dental pain
  • Adverse drug events
  • Cyclo-oxygenase-2 inhibitor
  • Ibuprofen

ASJC Scopus subject areas

  • Dentistry(all)


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