Does oral contraceptive use affect the incidence of complications after extraction of a mandibular third molar?

Key Points This study shows that women taking oral contraceptives are at increased risk for dry socket and postoperative pain after extraction of a third molar. The higher incidence of dry socket may be related to the fibrinolytic effect of oral contraceptives interfering with blood clotting. As regards the higher incidence of pain, it is possible that oral contraceptives lower the pain threshold for reasons yet unknown. Objective This study investigated whether oral contraceptive use affects the incidence of complications (pain, trismus, dry socket) in women undergoing removal of impacted mandibular third molars. Patients and Method Two hundred and sixty seven women, aged 17 – 45 years, underwent removal of an impacted mandibular third molar. Eighty seven of the women were regular users of oral contraceptives. All patients were evaluated for postoperative pain, trismus and dry socket (localized alveolar osteitis). Results Mean trismus values (measured as maximum interincisal distance) were similar in the two groups of patients. Postoperative pain was significantly more frequent among women taking contraceptives, both on day 1 (30% of women taking contraceptives used analgesics, versus 11% of women not taking contraceptives, p < 0.001) and on day 5 (14% versus 5%, p = 0.024). Similarly, dry socket occurred more frequently among women taking contraceptives than among women not taking contraceptives (11% versus 4%, p = 0.017). Conclusions The results of this study support the view that oral contraceptive use favours the appearance of dry socket and postoperative pain after extraction, but has no effect on trismus.