title: A comparison of topical ketorolac, systemic flurbiprofen, and placebo for the inhibition of bone loss in adult periodontitis.
abstract: Systemic non-steroidal anti-inflammatory drugs (NSAIDs) have been shown to reduce alveolar bone loss in periodontitis. This study assesses the efficacy of a topical NSAID rinse, containing ketorolac tromethamine as the active agent. Adult periodontitis patients (n = 55) were studied in this 6-month randomized, double blind, parallel, placebo and positive-controlled study. Each patient had a least 3 sites at high risk for bone loss as assessed by low dose bone scan. Groups, balanced for gender, were assigned to one of three regimens: bid ketorolac rinse (0.1%) with placebo capsule; 50 mg bid flurbiprofen capsule (positive control) with placebo rinse; or bid placebo rinse and capsule. Prophylaxes were provided every 3 months. Monthly examinations assessed safety, gingival condition, and gingival crevicular fluid PGE2. Standardized radiographs were taken at baseline and at 3 and 6 months for digital subtraction radiography. A significant loss in bone height was observed during the study period in the placebo group (-0.63 +/- 0.11; P < 0.001), but not in the flurbiprofen (-0.10 +/- 0.12; P = 0.40) or ketorolac rinse (+0.20 +/- 0.11 mm; P = 0.07) groups. Nested ANOVA revealed that ketorolac and flurbiprofen groups had less bone loss (P < 0.01) and reduced gingival crevicular fluid PGE2 levels (P < 0.03) compared to placebo. ANOVA suggests (P = 0.06) that ketorolac rinse preserved more alveolar bone than systemic flurbiprofen at the dose regimens utilized. These data indicate that ketorolac rinse may be beneficial in the treatment of adult periodontitis.
authors.affiliation: Department of Periodontics, University of Alabama School of Dentistry, Birmingham, USA.
authors.forename: M K
authors.initials: MK
authors.lastname: Jeffcoat
authors.forename: M S
authors.initials: MS
authors.lastname: Reddy
authors.forename: S
authors.initials: S
authors.lastname: Haigh
authors.forename: W
authors.initials: W
authors.lastname: Buchanan
authors.forename: M J
authors.initials: MJ
authors.lastname: Doyle
authors.forename: M P
authors.initials: MP
authors.lastname: Meredith
authors.forename: S L
authors.initials: SL
authors.lastname: Nelson
authors.forename: M B
authors.initials: MB
authors.lastname: Goodale
authors.forename: K R
authors.initials: KR
authors.lastname: Wehmeyer
mesh_terms: D000328:Adult; D016301:Alveolar Bone Loss / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D000704:Analysis of Variance; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D003774:Dental Plaque Index; D015232:Dinoprostone / Q000032:analysis; D004311:Double-Blind Method; D005260:Female; D005480:Flurbiprofen / Q000627:therapeutic use; D005883:Gingival Crevicular Fluid / Q000737:chemistry; D006801:Humans; D007375:Interleukin-1 / Q000032:analysis; D020911:Ketorolac Tromethamine; D008297:Male; D008875:Middle Aged; D009067:Mouthwashes / Q000627:therapeutic use*; D010512:Periodontal Index; D010518:Periodontitis / Q000150:complications / Q000188:drug therapy*; D011859:Radiography; D018709:Statistics, Nonparametric; D013382:Subtraction Technique; D014046:Tolmetin / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000097:blood / Q000627:therapeutic use; D016896:Treatment Outcome; D014325:Tromethamine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D007375:Interleukin-1; D009067:Mouthwashes; D014325:Tromethamine; D020911:Ketorolac Tromethamine; D005480:Flurbiprofen; D014046:Tolmetin; D015232:Dinoprostone