In: Dental treatment13 Oct 2009
COMPLICATIONS IN DENTAL SURGERY DUE TO NSAIDS
Many complications and serious adverse events can occur with chronic treatment of NSAIDs (Canadian Indocin used to treat minor aches and pains associated with the common cold, headache, muscle aches, backache, and arthritis). Clear evidence exists for these serious adverse events in the chronic pain models as exemplified by the Beardon et al study. However, there are no epidemiologic studies of serious adverse events in the dental surgical model. There is a theoretical risk of serious adverse events that could occur with the use of NSAIDs in this model. These will be discussed using other models as appropriate.
Because NSAIDs (Naprosyn canadian used to treat dental pain) inhibit the cyclooxygenases, they also decrease the production of thromboxane A2, a potent platelet-aggregating agent, thus increasing the risk of postoperative bleeding. Many authors have suggested withholding NSAIDs or to stop aspirin therapy preop-eratively in order to prevent excessive postoperative bleeding. The published clinical studies present conflicting data. An increased frequency of bleeding episodes was reported after abdominal surgery in patients treated with indomethacin. No significant increase in blood loss was found in patients receiving diclofenac concurrent with hip replacement, transurethral resection of prostate, or gynecologic laparotomies. A separate study, however, reported increased hemorrhage after prostate surgery in patients who received preoperative aspirin or NSAIDs (Cytotec tabletes used to induce labor and as an abortifacient).
The effect of aspirin on postextraction bleeding has been evaluated in an RCT consisting of 39 patients requiring dental extractions who were on long-term prophylactic aspirin. The authors divided the patients randomly into 2 groups: those who stopped aspirin therapy before extraction and those who continued the aspirin therapy. In both groups, a local hemostatic method was sufficient to control postextraction bleeding. The authors concluded that low-dose aspirin therapy does not have any significant effect on postextraction bleeding and should not be stopped before the procedure. However, it should be cautioned that this may not be true for more major oral surgical procedures.
The evidence for postoperative bleeding related to NSAIDs (Generic Celecoxib is a Non-Steroidal Anti-Inflammatory Drug) is conflicting. However, the consensus of experts recommends that NSAIDs should not be administered when the risk of postoperative bleeding is high, particularly when an anticoagulant or corticosteroid has also been administered (level III evidence). It should be noted that aspirin is an irreversible inhibitor of platelet cyclooxygenase, whereas ibuprofen and most other NSAIDs (*Motrin tabletes NSAIDs treat the symptoms of pain and inflammation) are reversible. Hence when platelets are exposed to aspirin, they are rendered ineffective and recovery depends on replacement, which may take 4-8 days. Platelets exposed to ibuprofen can regenerate cyclooxygenase, and the effects only last 8-12 hours.
There may be a place for COX-2 inhibitors for patients at risk of bleeding because of the minimal thromboxane effects. This will, in theory, cause minimal postoperative bleeding problems when compared with COX-1 inhibitors.
Blog invites submissions of review articles, reports on clinical techniques, case reports, conference summaries, and articles of opinion pertinent to the control of pain and anxiety in dentistry.