Oral Contraceptives and Dry Socket

Q: An oral surgeon has noted an apparent increased incidence of dry socket following tooth extraction in patients taking oral contraceptives. Can you advise me if this has been noted elsewhere and what the mechanism is?

T. Stacy Lloyd, Jr., M.D., Fredericksburg, Va.

 

This question was referred to two consultants whose discussions are as follows:

A: Regarding a suggested causal relationship of oral contraceptives to the problem of dry socket, I am unable to find any support for this observation in the literature. I am not aware that this has been suggested before, nor can I offer a mechanism to explain it.

Contrary to the implications of this observation, oral contraceptives, because of their estrogenic action, may be suspected of actually promoting a more stable blood clot for the following reasons:

1. Oral contraceptives may produce hypercoagulability by increasing the concentration of clotting components or by accelerating clotting mechanisms. They produce changes in fibrinolysin and in blood–clotting factors I, II, VII, VIII, and X (fibrinogen, prothrombin, Spca proconvertin, antihemophilic, and Stuart-Prower, respectively) which are similar to those seen in pregnancy.
2. In his book (Archer, W. H.: Oral Surgery, ed 3, Philadelphia: W.B. Saunders Co., 1961, pp 534-535), Archer states that Harden demonstrated a decreased incidence of dry socket in pregnant women of less than one half that observed in a large series of control patients. Although the study covered only those patients presenting for treatment postextraction, I do not consider this observation to be due to just chance. Archer postulates that with the increased fibrinogen content of the blood in pregnancy, one can anticipate more rapid formation of a clot which is firmer, better organized, and more resistant to breakdown by infection.

The present evidence, though not as strong as we might desire, does not confirm a relationship between oral contraceptives and the development of dry socket.

Edward P. Henefer, D.D.S., Philadelphia

 

A: As far as we know, there is no published study relating an increased incidence of dry socket and the use of oral contraceptives. The relationship is interesting, however, and there is some circumstantial evidence which would suggest, when a study has been done, that there may be a positive correlation. The circumstantial information is based, first, upon the observation that glucose tolerance is decreased when oral contraceptives are utilized. Second, it is obvious that the basic problem in a dry socket is impairment in wound-healing. If one wishes to relate these two seemingly unrelated observations, then it is possible that the pattern described by you may well be correct.

E. Cheraskin, M.D., D.M.D., Birmingham, Ala