Editorial [Hot Topic: The Administration of Non-Steroidal Anti-Inflammatory Drugs and Selective Cyclooxygenase-2 Inhibitors in Dentistry (Executive Editor: Saynur Vardar)]

Nonsteroidal anti-inflammatory drugs (NSAIDs) are one of the most commonly used medications worldwide to inhibit cyclooxygenase (COX) activity for the treatment of pain and inflammation. Although they are effective in the treatment of pain and inflammation, their routine and long-term administration is limited due to their gastrointestinal and renal side effects. COX isozymes are of great interest to the researchers and drug designers, because they are the main targets of NSAIDs. While the inhibition of COX-2 is related to anti-inflammatory effects, that of COX-1 is associated with the adverse effects. Therefore, new generation selective COX-2 inhibitors (coxibs) have been developed for reducing adverse effects of NSAIDs. Recently, these new anti-inflammatory drugs are being preferred for the treatment of various inflammatory diseases. At the same time, in dentistry, coxibs are prescribed to control dental pain and in the treatment of periodontal diseases, which are still among the major causes of tooth loss, and in the chemoprevention and treatment of oral precancerous and cancerous lesions. This issue of Current Pharmaceutical Design contains five invited review articles. In this issue, the role of COX enzymes and prostaglandins in the pathogenesis of pain, periodontal diseases and oral cancer are reviewed, and the administration of coxibs in dentistry is discussed and compared with that of conventional NSAIDs. Drs. Lee and Dionne from National Institutes of Health and Dr. Rodriquez from Boston University provide an overview on the therapeutic use of selective COX-2 inhibitors for relief of acute pain, largely based on clinical trials in patients undergoing the surgical removal of impacted third molars, with focus on analgesic efficacy and the potential safety associated with their use compared to dual COX-1/COX-2 inhibitors. Dr Lee and co-authors suggest that the design of COX-inhibiting analgesics that suppresses COX-1 activity at early time points at site of injury, suppresses COX-2 expression or its enzymatic activity both in the periphery and in the spinal cord, and also gains access to the spinal cord to suppress COX-1 activity. Drs. Salvi and Lang from University of Berne review the experimental and clinical evidence concerning the role of arachidonic acid metabolites in the pathogenesis of periodontal tissue destruction and the effects of adjunctive systemic or topical administration of selective and non-selective NSAIDs in the treatment of periodontal diseases. According to the authors, the development of topical NSAIDs formulations with an appropriate carrier, an optimal concentration, and in the absence of adverse systemic effects seems to be of particular interest. Compared to systemic administration, this approach would help to improve patient's compliance in long-term NSAIDs administration. In his article, Dr Wang from Boston University focuses on a comprehensive examination and discussion of the potential role of COX-2 in oral cancer development, and the use of COX-2 inhibitors for oral cancer chemoprevention or treatment. The author suggests that the COX-2 inhibitors should be investigated as a new treatment, particularly new chemoprevention agents, for patients who are at high risk for developing oral cancer. Dr. Akarca from Ege University reviews the pathogenesis of gastrointestinal adverse effects of coxibs comparatively with the conventional NSAIDs, and the management and prevention of gastrointestinal adverse effects of coxibs and NSAIDs. Dr Akarca states that patients at high risk or those developing gastrointestinal complications during the course of NSAID treatment can be treated with COX-2 selective inhibitors. Drs. Cheng and Harris from Vanderbielt University provide an overview on the expression of COX-1 and -2 in the kidney, the interaction of COX-2 and renin-angiotensin system, and the influence of COX-2 inhibiton on renal hemodynamics. Renal adverse effects of coxibs and NSAIDs have contraindicated the long-term administration of these drugs in patients with some systemic diseases. The authors recommend the administration of agents with combined lipooxygenase/COX inhibition and agents that combine NSAIDs with a nitric oxide (NO) donor to reduce adverse renal effects. I appreciate the contributions of the authors in preparation of this issue of Current Pharmaceutical Design. All authors are experts in their fields, and have dedicated their valuable time and knowledge to the production of these reviews. I believe that this issue would provide new insights to the researchers in the design and discovery of the new generation coxibs and new formulations with increased analgesic and anti-inflammatory effects, but reduced systemic adverse effects of NSAIDs.