Effect of Tranexamic Acid on Post-Operative Pain and Alveolar Osteitis Following Dental Extraction—A Systematic Review and Meta-Analysis of RCTs

Alveolar osteitis (AO) and postoperative pain are common complications after dental extractions. Excessive fibrinolysis leading to premature clot loss contributes to AO. Tranexamic acid (TXA), an antifibrinolytic agent, may stabilize post-extraction blood clots and reduce AO, although evidence from randomized controlled trials (RCTs) remains inconsistent. This systematic review and meta-analysis evaluated the effectiveness of topical TXA in preventing AO and reducing postoperative pain following dental extractions. PubMed, Embase, Scopus, and CENTRAL were searched from inception to June 2025 using terms related to “dental extraction” and “tranexamic acid”. Only English-language human studies were included. Eligible studies were RCTs assessing topical TXA versus placebo, saline, or plain gauze, reporting AO and/or pain outcomes. Non-RCTs, in vitro or animal studies, and trials lacking relevant outcomes or controls were excluded. Two reviewers independently screened and selected studies. Following PRISMA guidelines, two reviewers extracted data and assessed risk of bias with the Cochrane RoB-2 tool. Pooled analyses used random-effects models, with risk ratios (RRs) for AO and standardized mean differences (SMDs) for pain. AO was defined as exposed bone, foul odor, or persistent pain after day 3. Pain was measured on the Visual Analogue Scale (VAS) on days 3 and 7. Five RCTs (378 patients) were included. TXA significantly reduced AO incidence compared with controls (RR = 0.49; 95% CI: 0.32–0.76; p = 0.001; I2 = 0%), indicating a ~50% risk reduction. Pain outcomes showed no significant differences on day 3 (SMD = −0.36; 95% CI: −0.95 to 0.24; p = 0.24; I2 = 84%) or day 7 (SMD = −0.43; 95% CI: −1.34 to 0.48; p = 0.36; I2 = 93%). Topical TXA significantly reduces the risk of AO after dental extraction, while its effect on postoperative pain remains inconsistent. Its safety, accessibility, and low cost support its use as a preventive adjunct in dental extractions. Further standardized, high-quality RCTs are needed to clarify its role in pain management.