Oral contraceptive use associated with increased risk of alveolar osteitis

1. In a meta-analysis of 40 articles evaluating alveolar osteitis (AO), the use of oral contraceptives (OCP) was significantly associated with an increased risk of AO following dental extraction.

Study Rundown: AO is the most common complication following dental extractions associated with persistent severe oral pain, halitosis, and parageusia. The etiology of AO is unclear but is believed to be due to partial or total disintegration of blood clots within the alveolar socket. However, the specific risk factors for AO have yet to be accurately described. The purpose of this meta-analysis was to investigate the role of gender, smoking and the use of OCP as a risk factor for AO.

The study analyzed the results of 40 studies that evaluated AO and OC use. At the conclusion of the study, females who used OCs had a two times higher risk of AO occurrence when compared to those who did not use OC’s. Additionally, females who smoked demonstrated a significantly higher risk of AO compared to non-smokers. This is likely due to the deleterious effects of smoking and estrogens on the fibrinolytic pathways resulting in degradation of blood clots within the alveolar bed. This was one of the largest studies to analyze the association between OCP and AO and was able to combine previous studies with insufficient power. The results of this study support the hypothesis that female patients on OCP as well as with a history of smoking are at increased risk of AO after dental extraction.

Click to read the study in JADA

Relevant Reading: Effect of menstrual cycle on frequency of alveolar osteitis in women undergoing surgical removal of mandibular third molar: a single-blind randomized clinical trial

In-Depth [meta-analysis]: This meta-analysis collected articles from MEDLINE, PubMed, and the Cochrane Library on OCP use and AO. Articles were included in the trial if they evaluated AO and OCP use. Overall, 52 articles met the inclusion criteria. Nine articles were removed because it did not include original research. Fourteen additional articles were excluded due to the lack of control group or lack of raw data in the final publication. Overall, 40 articles were included as part of the meta-analysis. At the conclusion of the trial, female patients demonstrated 1.2 times greater risk of developing AO compared to males. Additionally, 85.7% of all studies analyzed demonstrated a significantly higher risk of AO in patients who smoke compared to non-smokers (p < 0.05). Furthermore, the incidence of AO was significantly higher in patients who use OCP compared to non-OCP users (13.9% versus 7.5%; p < 0.05).

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