Other Treatments

Standard Nonsteroidal Anti-inflammatory Drugs (NSAIDs). NSAIDs are agents that block factors that cause inflammation and pain.

• Over-the-counter NSAIDs include aspirin, ibuprofen (Motrin IB, Advil, Nuprin, Rufen), naproxen (Aleve), ketoprofen (Actron, Orudis KT).
• Prescription NSAIDs include ibuprofen (Motrin), naproxen (Naprosyn, Anaprox), diclofenac (Voltaren), tolmetin (Tolectin), ketoprofen (Orudis, Oruvail), indomethacin (Indocin).

The agents have been investigated not only for pain relief in periodontal disease but in slowing the disease process. NSAIDs block inflammatory enzymes triggered by cytokines, the important immune factors in periodontal disease. A number of NSAIDs have been investigated and have been shown to reduce gingivitis and slow progression of periodontal disease.

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In one study, long-term use of oral flurbiprofen (Ansaid) resulted in significantly lower bone loss, although disease progression returned when the drug was stopped.

Investigators are studying rinses, creams, and other topical forms of NSAIDs. For example a cream containing ketoprofen appeared to reduce bone loss. (Ketoprofen is of particular interest because it not only blocks COXs but also another pathway involved in the disease process.)

Warning about NSAIDs: Although NSAIDs work well, long-term use can cause stomach problems, such as ulcers and bleeding, and possible heart problems. In April 2005, the FDA asked drug manufacturers of NSAIDs to include a warning label on their product that alerts users of an increased risk for cardiovascular events and gastrointestinal bleeding.

Bisphosphonates