Systematic Review on Antidepressant Use and Bleeding Risk After Dental Extractions: Evidence Gaps and Clinical Implications.

Abstract

<b>Background/Objectives:</b> This review aimed to evaluate whether patients undergoing dental extractions while taking antidepressants experience increased intra-operative or post-operative bleeding compared to patients not taking these medications. <b>Methods:</b> A comprehensive literature search was conducted across PubMed, EMBASE, Web of Science, Scopus, and ClinicalTrials.gov for randomized controlled trials (RCTs) published before 17 August 2025. Studies were included if they compared bleeding outcomes between antidepressant users and non-users undergoing dental extraction procedures. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered with the International Prospective Register of Systematic Reviews (PROSPERO, CRD42025645035). <b>Results:</b> Of 689 studies screened, no RCTs met the eligibility criteria. Only one retrospective study, which did not match the inclusion criteria, identified a 1% incidence of bleeding complications in users of selective serotonin reuptake inhibitors (SSRIs) undergoing invasive dental procedures. However, it lacked a control group and standardized methodology, so this study was included in the discussion section. <b>Conclusions:</b> The lack of high-quality evidence, especially studies examining dynamic coagulation parameters like bleeding time and prothrombin time before and after antidepressant use, highlights a significant gap in the research. These findings emphasize the urgent need for well-designed clinical trials to determine the potential effect of antidepressants on bleeding risk.