CRITICAL SUMMARIES A higher incidence of dry socket may be related to the use of oral contraceptives after impacted mandibular third-molar extraction A critical summary of Xu JL, Sun L, Liu C, Sun ZH, Min X, Xia R. Effect of oral contraceptive use on the incidence of dry socket in females following impacted mandibular third molar extraction: a meta-analysis. Int J Oral Maxillofac Surg. 2015 Sep;44(9):1160-1165. Yumi Ogata, DDS, DMD, MS; Yong Hur, DDS, DMD, MS Systematic review conclusion. Oral contraceptive use may increase the incidence of dry socket in women after impacted mandibular third-molar extraction. Critical summary assessment. The results of this systematic review summarizing the evidence from 12 articles reporting on 16 studies suggest that female patients using oral contraceptives have a higher risk of developing dry socket as a postoperative complication consecutive to the extraction of their impacted mandibular third molars compared with female patients not using this contraceptive method. Evidence quality rating. Limited evidence. Clinical question. In female patients undergoing impacted mandibular third-molar extraction, does the use of oral contraceptives increase the incidence of alveolar osteitis (also known as dry socket [DS]) compared with female patients who do not use oral contraceptives? Review methods. The authors searched 3 electronic databases (MEDLINE via PubMed, the Cochrane Library, and Elsevier Sci- enceDirect) for relevant articles published up to April 2014 without language restriction. Included studies were cohort studies in humans whose investigators reported full-text data to evaluate the effect of oral contra- ceptive use as a risk factor for the development of DS. Two reviewers independently performed data extraction. The primary outcome was the incidence of DS. Two reviewers independently conducted quality as- sessments of the included studies by using the Newcastle-Ottawa Scale; they resolved disagreements through consensus with a third reviewer. They determined the model (random-effects or fixed-effects) to pool the results from the studies on the basis of the statistical significance of the Cochran Q test for heteroge- neity. The authors assessed hetero- geneity using the Cochran Q test and the I 2 statistic. To explore the sources of heterogeneity, the authors con- ducted a subgroup analysis according to the unit assessed (tooth or patient), the region in which the study was performed, and the intervention. The authors evaluated publication bias using the Egger test and the funnel plot. Main results. The authors included 12 articles that reported on 16 studies published from 1974 through 2010 in the final meta- analysis. The investigators of all the included studies used a cohort design with a duration of follow-up between 2 and 8 days. The quality of the included studies was relatively low owing to the lack of age information and the discrepancies in age between the members of test groups and con- trol groups in several studies. Meta- analysis results suggested that women who underwent surgical extraction of their impacted mandibular third molars and who used oral contracep- tives may have had a 2 times greater risk of developing DS as a complica- tion, than did women who did not use oral contraceptives (relative risk, 1.80; 95% confidence interval [CI], 1.33-2.43). The result of the Cochran Q test for heterogeneity was statisti- cally significant, and the I 2 statistics showed the presence of moderate heterogeneity (P ¼ .027; I 2 ¼ 44.8%). The results of subgroup analyses failed to explain the apparent heterogeneity on the basis of the unit of observation assessed and the region in which the ORIGINAL CONTRIBUTIONS 840 JADA 147(10) http://jada.ada.org October 2016
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