Is bone wax safe to use on a tooth?

Bone Wax Should Not Be Used on Teeth Due to Risk of Foreign Body Reactions and Impaired Healing

Bone wax is not recommended for use on teeth as it can cause foreign body reactions, impair healing, and lead to complications such as persistent infection and inflammation.

What is Bone Wax?

• Bone wax is a hemostatic agent primarily composed of beeswax and softening agents like isopropyl palmitate or paraffin 1
• It works as a mechanical barrier to seal wounds and control bleeding by occluding blood channels 2
• It is nonabsorbable with no biochemical action and essentially never goes away once applied 2

Risks of Using Bone Wax on Teeth

• Foreign body reactions: Bone wax can trigger inflammatory foreign body reactions in oral tissues, leading to persistent inflammation and complications 3
• Impaired healing: Bone wax is nonresorbable and can negatively influence bone healing in the alveolar region 3
• Infection promotion: The inert nature of bone wax has been reported to promote infection in surgical sites 1
• Granuloma formation: There is always a possibility of foreign body granulomas following bone wax use 2

Appropriate Hemostatic Alternatives for Dental Procedures

• L-PRF (Leukocyte and Platelet-Rich Fibrin): Autologous product that promotes healing and has antibacterial properties 4
• Compression with gauze: Direct pressure with gauze is recommended as a first-line approach for controlling bleeding 4
• Localized vasoconstrictors: Can be used in conjunction with direct pressure for excessive bleeding 4

When Bone Wax Might Be Considered in Oral Surgery (Not for Teeth)

• Bone wax may be used in specific oral surgical procedures when dealing with intraosseous bleeding from larger vessels 4
• If used, it should only be applied for the minimal time needed to achieve hemostasis and then removed 4
• For patients on anticoagulant therapy undergoing tooth extraction, bone wax has been used to stop bleeding from the alveolus, but alternatives should be considered first 5

Best Practices for Dental Hemostasis

• Maintain good oral hygiene practices to prevent gingival inflammation and bleeding 6
• Professional dental cleaning to remove plaque and calculus deposits 6
• For extraction sites, consider L-PRF plugs or membranes packed into the socket to promote healing 4
• Follow infection control guidelines when managing oral bleeding 7

Complications Reported with Bone Wax

• Case reports document persistent discharge from sites where bone wax was used 2
• Delayed migration and discharge of bone wax from the application site, requiring surgical intervention 8
• Histopathologic analysis has confirmed inflammatory foreign body reactions associated with bone wax 3

Key Takeaway

• The use of bone wax directly on teeth is contraindicated due to its nonresorbable nature and potential for adverse reactions
• When hemostasis is needed in dental procedures, alternative methods such as L-PRF, compression, or other resorbable hemostatic materials should be used 4, 6
• If bone wax must be used in oral surgery (not on teeth themselves), it should be applied sparingly, only for the time needed to achieve hemostasis, and care should be taken to avoid accumulation in bony craters 2, 3