A Systematic (Cochrane) Review of Conscious Sedation for Dental Anxiety

Methods: Randomised controlled trials conducted with patients being treated for dental anxiety were identified from the literature. Studies were included where there was comparison of conscious sedation by whatever route in which the comparator was a placebo or other sedation agent.

Results: Three-hundred and thirty-five trials were identified. Of these 37 were considered for further review following which 36 were excluded. Reasons for exclusion were the participant population could not all be considered to have a stable dental anxiety, measuring only state anxiety or lack of anxiety measure post treatment and the lack of using a treatment or placebo control. One trial was thus included in the review. The conscious sedation intervention examined was intravenous Propofol and the comparison was patient-controlled versus clinician-controlled. The 18 adult participants included could be identified as having dental anxiety using the Modified Corah Dental Anxiety Scale. Patient-controlled propofol was deemed to have several advantages over administration controlled by the clinician in terms of using less drug dose (20.8%-29.8%) and patient preference (56% vs. 17%). However, neither condition produced a significant reduction in dental anxiety. The main outcome for this study was completion of dental treatment with no follow-up. The study was not blinded and little mention is made of exactly how participants were selected and how many were eligible for participation.

Conclusions: Despite considerable study of the analgesic, psychomotor and amnesic effects of conscious sedation for dental treatment, there are few good quality studies examining dental anxiety reduction following treatment (i.e. between session). This review confirms gaps in the research literature which mean that currently there is no evidence of effect for conscious sedation as a treatment for dental anxiety.