Does the Menstrual Cycle Effect the Possibility of Developing a Dry Socket After Wisdom Teeth Removal?

An interesting study is described exploring the possibility of the menstrual cycle affecting the possibility of developing a dry socket after wisdom teeth removal. This study is presented in the article titled ” Effect of Menstrual Cycle on Frequency of Alveolar Osteitis in Women Undergoing Surgical Removal of Mandibular Third Molar: A Single-Blind Randomized Clinical Trial,” by Majid Eshghpour, Naser Mohammadzadeh Rezaei, and AmirHossein Nejat, appearing in the Journal of Oral and Maxillofacial Surgery (vol. 71, pp. 1484-1489, 2013). The article explores the association of between the menstrual cycle and the frequency of dry socket (alveolar osteitis).

The authors report that various studies have shown a chance ranging from 5-30% of the possibility of developing a dry socket (alveolar osteitis) after wisdom teeth removal. (See the complications page of this website to see more on dry sockets http://www.teethremoval.com/complications.html) In the study the authors point out that the risk factors of developing a dry socket include

1. the experience of the surgeon
2. the amount of trauma during surgery
3. the difficulty of the surgery
4. the age of the patient
5. smoking habits
6. inappropriate irrigation during surgery
7. pre-operative infection
8. use of local anesthetics
9. use of oral contraceptives

It is also mentioned that gender has shown a conflicting effect on the risk of developing a dry socket.

The authors set out to explore if the extraction of mandibular wisdom teeth in women during their menstrual periods differs from extractions performed when women are in their mid-cycle with regard to the development of a dry socket. Further, the authors set out to explore the relationship amongst dry socket with regards to whether the women having wisdom teeth extracted were taking oral contraceptives or not (and how this was affected by the menstrual and mid cycle).

In the study a total of 145 female patients in Iran underwent a total of 290 wisdom teeth extractions. The study was single-blind and the patients had both mandibular wisdom teeth extracted; however, one tooth was extracted during the menstrual period and the other tooth was extracted during the middle of the cycle. The postoperative examiner was unaware of the menstrual cycle status of the patients. A total of 66 female patients were taking oral contraceptives and in this case one tooth was extracted during the menstrual cycle and the other during the middle of the cycle. The tooth that was decided to be extracted during either the menstrual cycle or during the middle of the cycle was decided by a coin flip.

A total of 68 cases of dry socket occurred after the 290 extractions (23.45%). Of these 68 cases 48 (70.6%) occured during mid-cycle and 20 (29.4%) occurred during menstruation.  The authors found that the frequency of dry socket was significantly higher in oral contraceptive users than in nonusers in the middle of the menstrual cycle. However, no statistically significant difference was observed between oral contraceptive users and nonusers during menstruation. Numerous potentially confounding factors were attempted to be controlled by the researchers. The authors believe that the use of oral contraceptives can increase the risk of developing dry socket. They suggest that in the cases of elective wisdom teeth extractions patients schedule their visit during their menstrual cycle. (Note, they don’t suggest stopping oral contraceptives as the risk of dry socket between oral contraceptive use and non-use was not statistically significant during the menstrual cycle).

Regarding potential explanations for the results, the authors suggest that the higher frequency of dry socket during oral contraceptive use could be due to increased fibrinolytic activity. The authors also mention how the level of estrogen is at its lowest during menstruation. The authors note how estrogen has the potential to enhance fibrinolytic activity. In addition, the increase of estrogen by the use of oral contraceptives can play a role in more development of dry sockets with oral contraceptive use.