Komar University of Science and Technology

General Pharmacology II

(Article review assignment)

Prepared By:
Helen sarwar
Banoo Jalal
Pana Ibrahim
Lawan saman
S2

Supervised by: Dr. Shemsu umer

1. Citation
* Singgih, M. F., Huldani, Achmad, H., et al. (2020). A review of nonsteroidal anti-
inflammatory drugs (NSAIDs) medications in dentistry: Uses and side effects.
Systematic Reviews in Pharmacy, 11(5), 293-298.

2. Summary
What is the article about?
This comprehensive review article explores the pharmacological landscape of
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), which serve as the cornerstone
of pain management in modern dentistry. The authors aim to bridge the gap between
complex chemical pharmacology and day-to-day dental practice. The article does
not just list drugs; it categorizes them based on their chemical structures and
mechanisms, explaining how widely used medications like Aspirin, Ibuprofen, and
Diclofenac actually function in the human body. It covers the full spectrum of
NSAID usage, ranging from their primary role in treating acute post-operative pain
(like after a tooth extraction) to managing chronic inflammatory conditions in the
jaw. Furthermore, a significant portion of the text is dedicated to the safety profile
of these drugs, providing a detailed warning system for dentists regarding potential
adverse reactions in vulnerable patients.
What are the main arguments or findings?
The central argument of the paper is that while NSAIDs are chemically diverse
(meaning they look different under a microscope), they all share a unified
mechanism of action: the inhibition of the cyclooxygenase (COX) enzymes.
The authors detail how tissue damage in the mouth releases arachidonic acid,
which COX enzymes usually turn into prostaglandins—chemicals that cause pain,
swelling, and fever. The article finds that the efficacy of an NSAID depends on how
well it blocks this process.
However, the most critical finding relates to "enzyme selectivity." The authors
argue that the side effects are not random bad luck but are predictable based on which
COX enzyme is blocked:
 * COX-1 Inhibition: This enzyme is described as a "housekeeper" that protects the
stomach lining and ensures proper kidney function. When non-selective NSAIDs
(like Aspirin) block this, they stop pain but also strip away the stomach's protection,
leading to ulcers and bleeding.
* COX-2 Inhibition: This enzyme is produced strictly during inflammation. The
authors find that selective COX-2 inhibitors are safer for the stomach but argue they
must still be used with caution due to other potential risks.
The article also categorizes the drugs into families—Salicylates (Aspirin),
Propionic acid derivatives (Ibuprofen, Naproxen), and Acetic acid derivatives
(Diclofenac/Voltaren)—arguing that understanding these families helps dentists
switch drugs if a patient is allergic or unresponsive to one type.

What methods/evidence does the author use?

The authors utilized a narrative review methodology. Instead of conducting a new
clinical trial with patients, they synthesized existing knowledge from a wide range
of sources, including pharmacological textbooks, peer-reviewed journals, and
clinical guidelines. They structured this evidence logically, moving from chemical
structure to mechanism of action, then to clinical indications, and finally to adverse
effects. This method allows them to present a "state of the art" summary that is
accessible to clinicians who may not have time to read hundreds of individual
studies.

3. Analysis/Critique
What are the strengths of the article?
One of the most significant strengths of this review is its practical organization of
"Adverse Effects." rather than listing side effects alphabetically, the authors group
them by organ system: Gastrointestinal, Renal (Kidneys), Cardiovascular, and
Hematologic (Blood). This is incredibly useful for a dentist. For example, if a patient
has a history of kidney disease, the dentist can look at the "Renal" section and
immediately see why NSAIDs might reduce blood flow to the kidneys, causing
failure.
Another strength is the explanation of the "Ceiling Effect." The article clearly
explains that unlike opioids (where taking more drug gives more pain relief),
NSAIDs hit a limit where taking more pills does not stop more pain—it only
increases the toxicity. This is a vital concept for patient safety that is often
overlooked in general summaries.
What are its weaknesses or limitations?
Despite its utility, the article has limitations inherent to a narrative review. It lacks
the statistical weight of a "Systematic Review" or "Meta-Analysis." The authors do
not provide statistical data pooling (like "Odds Ratios" or "Confidence Intervals") to
quantify exactly how much safer one drug is compared to another.
Additionally, the article was published in 2020. While this is recent, the field of
pharmacology moves fast. The review focuses heavily on traditional NSAIDs but
could have provided more depth on the newer generation of specific COX-2
inhibitors and their cardiovascular risks, which has been a controversial topic in
medicine. It also lacks a detailed "dosage guide" for specific dental procedures (e.g.,
exactly how many milligrams to give after a root canal versus a simple filling), which
would have increased its practical value.
Is the argument convincing? Why or why not?
The argument is highly convincing because it is grounded in established
physiological science. The authors do not rely on opinions; they rely on the well-
proven "Arachidonic Acid Cascade." When they claim that NSAIDs cause stomach
ulcers, they explain the why (prostaglandin inhibition leads to less mucus production
in the stomach). This cause-and-effect explanation makes the clinical advice feel
robust and trustworthy. It successfully convinces the reader that prescribing NSAIDs
is a balance of risk and reward, not a simple "one size fits all" decision.
4. Significance
Why is the article important?
This article holds significant importance in the context of the current global
healthcare landscape, particularly regarding the "Opioid Crisis." For decades,
dentists frequently prescribed strong opioids (like Vicodin or Percocet) for dental
pain. This review reinforces the scientific consensus that NSAIDs should be the first-
line therapy, often providing equal or better pain relief for dental issues without the
risk of addiction. It empowers dentists to manage pain effectively using non-narcotic
options.
Furthermore, given the aging population, many dental patients are now on multiple
medications for heart or kidney issues. This article is important because it highlights
drug-drug interactions—such as the danger of mixing NSAIDs with blood thinners
(anticoagulants)—which can be life-saving information in a clinical setting.
How does it contribute to the topic or field?
It contributes by serving as a consolidated educational resource. In dental school,
pharmacology is often taught in the first two years and can be forgotten by the time
a dentist is in practice. This review acts as a "refresher course," condensing complex
biochemistry into clinically relevant warnings. It reinforces the standard of care that
a patient’s medical history—specifically their stomach, kidney, and bleeding
history—must dictate which painkiller they receive.

5. Personal Reflection
What did you learn or find interesting?
I found the concept of "COX Selectivity" most interesting because it highlights a
biological trade-off: the same chemical that causes pain also signals the stomach to
produce protective mucus. I was also surprised to learn that simple NSAIDs can
trigger asthma attacks in certain patients, which really reinforces that dentist must
treat the whole body, not just the teeth.