Oral surgery and Implantology - Department of biomedical and neuromotor science (DIBINEM), University of Bologna, Via San Vitale 59, 40125, Bologna, Italy.
Sedation and Emergency in Dentistry Human Centered Project (HCP), The holistic treatment of the dental patient - University of Padua, Via Giustiniani 2, 35128, Padova, Italy.
BMC Oral Health. 2020 May 28;20(1):155. doi: 10.1186/s12903-020-01136-0.
Dental anxiety is a condition associated with avoidance of dental treatment and increased medical and surgical risks. This systematic review aims to summarize available evidence on conscious sedation techniques used for the management of Dental anxiety in patients scheduled for third molar extraction surgery, to identify best approaches and knowledge gaps.
A comprehensive search was conducted including MEDLINE/Pubmed, EMBASE, SCOPUS, clinicaltrials.gov and the Cochrane Database of Systematic Reviews through March 2019. Only randomized controlled trials were included. PRISMA guidelines were followed. Risk of bias was appraised as reported in the Cochrane Handbook for Systematic Reviews of Interventions.
Seventeen RCTs with a total of 1788 patients were included. Some aspects limited the feasibility of a meaningful meta-analysis, thus a narrative synthesis was conducted. Conscious sedation was associated with improvement in Dental anxiety in six studies. One study reported lower cortisol levels with midazolam vs. placebo, while another study found significant variation in perioperative renin levels with remifentanil vs. placebo.
This review found inconclusive and conflicting findings about the role of Conscious sedation in managing Dental anxiety during third molar extraction surgery. Relevant questions remain unanswered due to the lack of consistent, standardized outcome measures. Future research may benefit from addressing these limitations in study design.
牙科焦虑症是一种与避免牙科治疗和增加医疗及手术风险相关的病症。本系统综述旨在总结可用于管理接受第三磨牙拔除手术患者的牙科焦虑症的意识镇静技术的现有证据，以确定最佳方法和知识空白。
通过 2019 年 3 月对 MEDLINE/Pubmed、EMBASE、SCOPUS、clinicaltrials.gov 和 Cochrane 系统评价数据库进行全面检索，仅纳入随机对照试验。遵循 PRISMA 指南。按照 Cochrane 干预措施系统评价手册评估偏倚风险。
共纳入 17 项 RCT，总计 1788 例患者。一些方面限制了进行有意义的荟萃分析的可行性，因此进行了叙述性综合分析。在六项研究中，意识镇静与牙科焦虑症的改善相关。一项研究报告米唑安定与安慰剂相比皮质醇水平降低，而另一项研究发现瑞芬太尼与安慰剂相比围手术期肾素水平存在显著差异。
本综述发现，在管理第三磨牙拔除手术期间的牙科焦虑症方面，意识镇静的作用尚无定论且相互矛盾。由于缺乏一致、标准化的结局测量指标，相关问题仍未得到解答。未来的研究可能受益于解决研究设计中的这些局限性。
