Risk Assessment and Sensitivity Meta-analysis of Estrogen-Related Hormones on Dry Socket Occurence

Objectives: This study conducted a risk assessment and global sensitivity meta-analysis of gender and estrogen-related hormones on dry socket occurrence.
Methods: MEDLINE®/PubMed® was used to identify dental/biomedical literature. No restrictions were placed on timeframe or language. For each study, pairwise comparisons were made for gender, oral contraceptive use, and timing within the menstrual cycle. The number of studies included in this analysis was 24, 29, and 7, respectively. To conduct a comparative analysis and determine whether the factor of interest has a significant effect on dry socket occurrence, the data were graphically analyzed via block plots and quantitatively assessed via the sign-test and the t-test. Sensitivity analyses were also conducted to rank the factors in descending order of risk.

Results: Between genders, a paired comparison could be drawn in 24 studies, describing 32 conditions. In 84.4% of these, females had a higher rate of dry socket. The average difference of the occurrence of dry socket between genders was -4.4%±1.02% (P<0.05). Twenty-nine studies yielded 40 conditions in which paired comparisons of oral contraceptive users and non-users were analyzed. In 32 of 40 (80%) cases, females using oral contraceptives had a higher rate of dry socket. An average difference of 7.9%±2.69% (P<0.05) was observed between oral contraceptive users and non-users. The impact of timing of tooth extraction within the menstrual cycle appears inconclusive, as time intervals reported vary notably between nine conditions. Sensitivity analyses indicated that oral contraceptive use posed the greatest risk for dry socket.
Conclusions: The majority of individual studies had insufficient statistical power to determine whether a particular variable increased the likelihood of developing dry socket. Conversely, global analysis indicated that gender and oral contraceptive use increased the average risk of dry socket occurrence. Oral contraceptive use was the highest risk factor.