The role of non-steroidal anti-inflammatory drugs as adjuncts to periodontal treatment and in periodontal regeneration

Jianhan Ren, Melissa Rachel Fok, Yunfan Zhang, Bing Han, Yifan Lin, Jianhan Ren, Melissa Rachel Fok, Yunfan Zhang, Bing Han, Yifan Lin

Abstract

Periodontitis is the sixth most prevalent chronic disease globally and places significant burdens on societies and economies worldwide. Behavioral modification, risk factor control, coupled with cause-related therapy have been the "gold standard" treatment for managing periodontitis. Given that host inflammatory and immunological responses play critical roles in the pathogenesis of periodontitis and impact treatment responses, several adjunctive strategies aimed at modulating host responses and improving the results of periodontal therapy and maintenance have been proposed. Of the many pharmacological host modulators, we focused on non-steroidal anti-inflammatory drugs (NSAIDs), due to their long history and extensive use in relieving inflammation and pain and reducing platelet aggregation. NSAIDs have been routinely indicated for treating rheumatic fever and osteoarthritis and utilized for the prevention of cardiovascular events. Although several efforts have been made to incorporate NSAIDs into the treatment of periodontitis, their effects on periodontal health remain poorly characterized, and concerns over the risk-benefit ratio were also raised. Moreover, there is emerging evidence highlighting the potential of NSAIDs, especially aspirin, for use in periodontal regeneration. This review summarizes and discusses the use of NSAIDs in various aspects of periodontal therapy and regeneration, demonstrating that the benefits of NSAIDs as adjuncts to conventional periodontal therapy remain controversial. More recent evidence suggests a promising role for NSAIDs in periodontal tissue engineering and regeneration.

Keywords: Aspirin; Non-steroidal anti-inflammatory drug; Periodontal regeneration; Periodontitis.

Conflict of interest statement

All the authors declare no competing interests.

© 2023. The Author(s).

Figures

Fig. 1
Fig. 1
The synthesis and effects of PGE2 in periodontitis. COX-1, cyclooxygenase-1; COX-2, cyclooxygenase-2; ILs, interleukins; MMPs, matrix metalloproteinases; NSAIDs, nonsteroidal anti-inflammatory drugs; PGE synthase; PGE2, prostaglandin E2; PGES, PGH2, prostaglandin H2; PLA2, Phospholipase A2
Fig. 2
Fig. 2
A representative application of aspirin-loaded biomaterials in periodontal regeneration. Reproduced with permission from reference [137]. Copyright 2019 Elsevier

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