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Effectiveness and safety of oral sedation in adult patients undergoing dental procedures: a systematic review.

  • 2021-01-25
  • BMJ open 11(1)
    • Jimmy de Oliveira Araújo
    • Cristiane de Cássia Bergamaschi
    • Luciane Cruz Lopes
    • Caio Chaves Guimarães
    • Natalia Karol de Andrade
    • Juliana Cama Ramacciato
    • Rogério Heládio Lopes Motta

Study Design

Type
Systematic Review
Sample size
n = 327
Population
adult patients undergoing dental procedures
Methods
Systematic review of randomised clinical trials (RCTs) comparing oral use of benzodiazepines and other medications with placebo or other oral agents

Objectives

It can be challenging to manage patients who are anxious during dental procedures. There is a lack of evidence regarding the effectiveness and safety of oral sedation in adults. This study evaluated the effectiveness and safety of oral sedation in patients undergoing dental procedures.

Design

Systematic review.

Methods

Randomised clinical trials (RCTs) compared the oral use of benzodiazepines and other medications with a placebo or other oral agents in adult patients. A search of the Cochrane (CENTRAL), MEDLINE (via Ovid), EMBASE (via Ovid) and Cumulative Index to Nursing and Allied Health Literature (via Ovid) databases was conducted, without any restrictions on language or date of publication. The primary outcomes included the adverse effects and anxiety level. The secondary outcomes included sedation, satisfaction with the treatment, heart rate, respiratory rate, blood pressure and oxygen saturation. Reviewers, independently and in pairs, assessed each citation for eligibility, performed the data extraction and assessed the risk of bias. A narrative synthesis of the data was provided.

Results

A number of RCTs (n=327 patients) assessed the use of benzodiazepines (n=9) and herbal medicines (n=3). We found good satisfaction with treatment after the use of midazolam 7.5 mg or clonidine 150 µg and reduced anxiety with alprazolam (0.5 and 0.75 mg). Midazolam 15 mg promoted greater anxiety reduction than Passiflora incarnata L. 260 mg, while Valeriana officinalis 100 mg and Erythrina mulungu 500 mg were more effective than a placebo. More patients reported adverse effects with midazolam 15 mg. Diazepam 15 mg and V. officinalis 100 mg promoted less change in the heart rate and blood pressure than a placebo.

Conclusions

Given the limitations of the findings due to the quality of the included studies and the different comparisons made between interventions, further RCTs are required to confirm the effectiveness and safety of oral sedation in dentistry.

Prospero registration number

CRD42017057142.

Research Insights

  • Passion Flower→Reduced Anxiety

    Valeriana officinalis 100 mg and Erythrina mulungu 500 mg were more effective than a placebo

    Effect
    Beneficial
    Effect size
    Small
    Dose
    100 mg
  • Valerian→Reduced Anxiety

    Valeriana officinalis 100 mg and Erythrina mulungu 500 mg were more effective than a placebo

    Effect
    Beneficial
    Effect size
    Small
    Dose
    100 mg
  • Valerian→Reduced Blood Pressure

    Diazepam 15 mg and V. officinalis 100 mg promoted less change in the heart rate and blood pressure than a placebo

    Effect
    Neutral
    Effect size
    Small
    Dose
    100 mg
  • Valerian→Reduced Heart Rate

    Diazepam 15 mg and V. officinalis 100 mg promoted less change in the heart rate and blood pressure than a placebo

    Effect
    Neutral
    Effect size
    Small
    Dose
    100 mg

Adverse Events Reported

  • Valerian→change in heart rate and blood pressure

    Diazepam 15 mg and V. officinalis 100 mg promoted less change in the heart rate and blood pressure than a placebo.

    Finding
    Reported
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