Alveolar osteitis and oral contraceptive use

Anti-epileptic drugs can influence the effectiveness of contraceptive drugs

Alveolar osteitis (dry socket) is a common complication following dental extractions. Alveolar osteitis is reported following about 2% of routine extractions and between 20-30% of third molar extractions. The aetiology of alveolar osteitis is not fully understood and oral contraceptive use is considered to be a risk factor.

The aim of this review was to assess the risk of alveolar osteitis (AO) in oral contraceptive users.


Searches were conducted in the PubMed/MEDLINE, Embase, and Cochrane Library databases. Observational human studies (case- controls, cross-sectional, prospective, and retrospective cohorts) and clinical trials   comparing clinically diagnosed alveolar osteitis were considered. Two reviewers independently searched, selected, and extracted data from the studies. Three reviewers independently assessed study quality using the NIH, Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Subgroup analyses were conducted for postoperative antibiotics, opioid or nonopioid analgesics, smoking status, decade of study publication, and menstrual cycle.


  • 17 studies (13 prospective, 1 cross-sectional, 1 retrospective, 2 clinical trials) were included.
  • 12 studies also included male patients
  • All the studies were considered to be of good methodological quality.
  • 15 studies involving a total of 4285 female patients contributed to the meta-analysis.
  • Of the 4285 patients 1366 (88%) females used oral contraceptives 2919 (68.12%) did not.
  • Meta-analyses showed and increased risk of developing AO in female oral contraceptive (OCP) users, RR = 98 (95%CI:1.42 to 2.76) compared to female non-OCP users.
  • A number of other subgroup meta-analyses were undertaken, and these are shown in the table below.
Comparison No. of studies Relative risk (95% CI)
AO in Females (OCP and Non-OCP Users) vs. Males 11 1.45 (1.10 to 1.90)
AO in Female Non-OCP Users vs. Males (Non-OCP Users) 11 1.11 (0.82 to 1.49)
AO in Female OCP Users vs. Males 11 2.33 (1.74 to 3.13)
AO among Female OCP Users Who Were Prescribed Postoperative Analgesics.  (NSAIDs only) 6 2.13 (1.25 to 3.64)
AO among Female OCP Users Who Were Prescribed Postoperative Analgesics.  (Opioids & NSAIDs) 3 1.53 (0.42 to 5.62)
AO among Females OCP Users Who Were Prescribed NO Post-Operative Antibiotics 4 2.07 (1.05; to 4.11)
AO among Females OCP Users Who Were Prescribed Post-Operative Antibiotics 6 1.97 (1.07 to 3.64)


The authors concluded: –

Oral contraceptive (OCP) use significantly elevated the risk of AO in females. Females who did not take OCPs had a similar risk of developing AO compared to males, suggesting that OCP use is a potential effect modifier. Neither postoperative antibiotics use nor the type of postoperative analgesic significantly affected AO incidence in those taking OCPs.


A recent scoping review by Ghosh et al 2021, looked at aetiological factors for AO identifying a number of factors which demonstrated a significant effect on AO in some studies. These included, impaired immune response, age, flap design, drainage, smoking, oral contraceptive use, difficulty of extraction, mid-menstrual cycle, operator experience.  This new review aimed to look at oral contraceptive use and menstrual cycle. The authors searched 3 major databases identifying 17 mainly observational studies a majority of which were prospective. The authors assessed all 17 studies as being of good methodological quality. However, a number of other potential risk factors are linked with AO and only 7 of the 17 studies measured other potential confounders.  Study sample sizes ranged from 16 to 245 patients with65% of studies justifying the sample size of providing a power calculation. Overall, the review suggests that oral contraceptive use is a risk factor for alveolar osteitis potential doubling of the risk. This review focuses on AO following third molar extractions which are known to have a higher risk of AO so the findings might not be relevant to routine extractions. Future studies should be well conducted and reported, follow relevant international guidance, and collect data on other important risk factors that have been associated with AO.


Primary Paper

Tang M, Gurpegui Abud D, Shariff JA. Oral Contraceptive Use and Alveolar Osteitis Following Third Molar Extraction: A Systematic Review and Meta-Analysis. Int J Dent. 2022 Nov 1;2022:7357845. doi: 10.1155/2022/7357845. PMID: 36389647; PMCID: PMC9643054.

Other references

Ghosh A, Aggarwal VR, Moore R. Aetiology, Prevention and Management of Alveolar Osteitis-A Scoping Review. J Oral Rehabil. 2022 Jan;49(1):103-113. doi: 10.1111/joor.13268. Epub 2021 Oct 22. PMID: 34625985.

Dental Elf – 14th Dec 2012

Traumatic extraction carries a high risk of a painful dry socket



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