Changes in hormone levels may contribute to the pathogenesis of alveolar osteitis, or dry socket, a painful complication of tooth extractions, according to a review published on May 16 in Advances in Oral and Maxillofacial Surgery.
The review highlights the importance of considering a patient’s hormonal levels when planning dental extractions, the authors wrote.
“Preoperative assessment including documentation of COC (combined oral contraceptive) use and menstrual cycle phase may contribute to better risk stratification,” wrote the authors, led by Dr. Ziad Farih of Mohammed VI University of Health Sciences in Casablanca, Morocco.
Although it is common, alveolar osteitis is a painful postsurgical complication following dental extraction. Its occurrence appears to be affected by local and systemic factors, but mounting evidence suggests that hormones may play a significant role in its development, especially in women.
To explore the potential role of hormones in alveolar osteitis, a narrative review of the literature was conducted. Studies published between 2018 and 2025 that had terms like alveolar osteitis, hormones, menstrual cycle, and oral contraceptives were included. Researchers reviewed studies, reviews, and experimental data investigating the link between hormonal variations and the incidence of alveolar osteitis after dental extraction, according to the study.
Of the studies included, a higher incidence of dry socket was reported in women compared with men, especially during ovulation, which is when estrogen levels are at their peak. Also, a heightened risk was seen in women using combined oral contraceptives, with the incidence associated with estrogen exposure and cycle timing, the authors wrote.
“From a physiopathological perspective, elevated estrogen levels enhance fibrinolytic activity through plasminogen activation and inhibition of plasminogen activator inhibitor-1, leading to premature dissolution of the alveolar blood clot and impaired wound healing,” they wrote.
However, the study was not without limitations, including the finite number of randomized trials investigating the exact effect of menstrual cycle phases, the authors wrote.
To better characterize the effect of hormones on coagulation and fibrinolysis within the socket of the extracted tooth, more studies combining biological data and clinical parameters should be conducted, they wrote.
“Consideration of menstrual cycle timing and hormonal contraceptive use may help optimize preventive strategies and reduce the risk of this complication in female patients undergoing dental extractions,” Farih and colleagues wrote.
