Are female patients using oral contraceptives undergoing wisdom teeth removal at higher risk of dry socket?

An interesting article titled “A higher incidence of dry socket may be related to the use of oral contraceptives after impacted mandibular third-molar extraction” appears in the Oct. 2016 issue of JADA by Yumi Ogata and Yong Hur (Volume 147, Issue 10, pp. 840-842). The article discusses some of the issues surrounding whether in female patients undergoing impacted mandibular wisdom teeth removal, if the use of oral contraceptives increase the incidence of alveolar osteitis (also known as dry socket) when compared with female patients who do not use oral contraceptives.

The researchers explore 3 electronic databases (MEDLINE via PubMed, the Cochrane Library, and Elsevier ScienceDirect) for relevant articles published up to April 2014. Two reviewers independently conducted quality assessments of the included studies by using the Newcastle-Ottawa Scale and resolve any disagreements through
consensus with a third reviewer. The authors included 12 articles that reported on 16 studies published from 1974 through 2010 in the final meta analysis. The quality of the included studies was relatively low because of the lack of age information and the discrepancies in age between the members of test groups and control groups in several studies.

Meta analysis results suggested that women who underwent removal of their impacted mandibular wisdom teeth and who used oral contraceptives may have had a 2 times greater risk of developing dry socket as a complication, when compared to women who did not use oral contraceptives. The authors did not detect any publication bias. As such dentists and oral surgeons should take caution when performing surgical extraction of wisdom teeth in women on birth control pills.

In the JADA commentary it says there are other risk factors that may affect the incidence of dry socket after wisdom teeth and cites a 2015 systematic review that suggested that other risk factors include smoking, surgical trauma, single-tooth extractions, age, sex, medical history, systemic disorder, extraction site, amount of anesthetic, operator experience, antibiotic use before surgery, difficulty of the surgery, previous surgical site infection, and inadequate irrigation. They also state that using chlorhexidine before or after extraction or placing chlorhexidine gel in the sockets of extracted teeth has been shown to be beneficial in preventing dry socket. In the commetary the authors also go into some reasons why the study may not be entirely accurate. This includes not using the Newcastle-Ottawa Scale properly and that the studies lacked information about the types or concentration of the oral contraceptives used.

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