Efficacy of local antibiotics in treating dry socket: systematic review and meta-analysis

Background: Dry socket (alveolar osteitis) is a painful complication following tooth extraction, particularly after mandibular third molar removal. Conventional management relies mainly on antiseptic dressings; however, locally applied antibiotics may provide superior pain control and enhanced healing. Methods: This systematic review and meta-analysis was conducted in accordance with PRISMA and PICO guidelines. Ten randomized controlled trials (RCTs), published between 1998 and 2024, were included, comprising a total of 843 patients. Interventions involved the local application of clindamycin, tetracycline, or metronidazole, compared with placebo or standard treatments. Primary outcomes were pain reduction, assessed using the Visual Analog Scale (VAS), and improvement in socket healing. Results: Pooled analysis demonstrated a significant reduction in pain by Day 3 post-treatment, with a mean difference (MD) of −2.19 (95% CI: −2.50 to −1.88; p < 0.001). Among the antibiotics evaluated, clindamycin showed the greatest analgesic effect (MD = −2.5), followed by tetracycline (MD = −2.1) and metronidazole (MD = −1.8). Healing outcomes also improved significantly, with an overall pooled increase of 33.8% in the antibiotic groups. Moderate heterogeneity was observed (I² = 58%). The certainty of evidence was rated as moderate for pain reduction and low for healing improvement. Adverse events were infrequent and mild, occurring in 6.3% of patients receiving antibiotics and 5.1% of controls, with no serious complications reported. Conclusion: Locally applied antibiotics significantly reduce pain and enhance healing in the management of dry socket compared with conventional treatments. Clindamycin demonstrated the greatest clinical efficacy. These findings support the targeted use of topical antibiotics in selected high-risk patients, although further studies are required to establish standardized dosing protocols.