Effects of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) in Periodontology: A Narrative Review

AbstractBackground: Periodontitis is a chronic inflammatory disease characterized by progressive destruction of the periodontal ligament and alveolar bone. While microbial biofilm initiates disease, the host inflammatory response largely determines tissue breakdown. Prostaglandins particularly prostaglandin (PGE ) are key mediators of periodontal inflammation and osteoclast activation. Non-steroidal anti-inflammatory drugs (NSAIDs), through inhibition of cyclooxygenase (COX) enzymes, reduce prostaglandin synthesis and have therefore been investigated as host-modulatory agents in periodontal therapy.Objective: To provide an expanded, structured, PubMed-style narrative review of the role of NSAIDs in periodontology based on the submitted dissertation, including biological rationale, pharmacology, experimental and clinical evidence, therapeutic implications, safety considerations, and future directions.Methods: A detailed synthesis and academic restructuring of the dissertation content was performed, organizing evidence into mechanistic pathways, animal studies, human trials (systemic and topical), combination host-modulation approaches, implantology considerations, and adverse-effect analysis.Results: NSAIDs consistently reduce gingival inflammatory mediators, particularly PGE levels in gingival crevicular fluid (GCF), and demonstrate the capacity to reduce alveolar bone resorption in experimental models. Human clinical trials show modest short-term improvements when NSAIDs are used adjunctively with scaling and root planing (SRP). Long-term systemic administration shows variable benefits and is limited by adverse effects. Topical delivery systems (e.g., ketorolac rinse, subgingival gels, NSAID incorporated membranes) appear promising due to localized action and reduced systemic risk.Conclusion: NSAIDs represent biologically sound host-modulatory adjuncts in periodontal therapy. However, routine chronic systemic use is not currently justified due to safety concerns and inconsistent long-term outcomes. Localized delivery systems and short-term adjunctive use offer the most clinically rational application pending further high-quality trials.