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A dor e a ansiedade são fatores limitantes relevantes na prática clínica em Medicina Dentária, frequentemente responsáveis por adiamentos ou recusas de tratamento, sobretudo em pacientes adultos. A sedação consciente apresenta-se como uma alternativa eficaz e segura para minimizar estes obstáculos, permitindo a realização de procedimentos com maior conforto e cooperação por parte do paciente. Esta revisão sistemática teve como objetivo analisar criticamente as evidências científicas disponíveis sobre as principais técnicas de sedação consciente — inalatória, oral e endovenosa — aplicadas em adultos no contexto odontológico. A pesquisa foi conduzida segundo as diretrizes PRISMA, com recurso às bases de dados PubMed, ScienceDirect e B-On, abrangendo estudos publicados entre 2015 e 2025. Após aplicação dos critérios de inclusão e exclusão, foram selecionados 11 estudos para análise final. Os resultados evidenciam que o remimazolam, um benzodiazepínico de nova geração administrado por via endovenosa, se destaca pelo seu início de ação rápido, curta duração, perfil de segurança superior e recuperação previsível, tornando-se uma opção promissora para sedação consciente em ambiente ambulatorial. A sedação inalatória com óxido nitroso demonstrou eficácia, reversibilidade imediata e baixos índices de complicações, sendo particularmente indicada para procedimentos curtos em pacientes com ansiedade leve a moderada. Os benzodiazepínicos orais, apesar da maior variabilidade farmacocinética, continuam úteis em contextos específicos. Conclui-se que a escolha da técnica de sedação consciente deve ser individualizada, considerando fatores clínicos, logísticos e preferências do paciente. Ainda que as evidências apoiem a eficácia e segurança destas técnicas, persistem lacunas na padronização dos protocolos e na avaliação de desfechos a longo prazo, o que reforça a necessidade de mais estudos clínicos robustos e metodologicamente consistentes.
Pain and anxiety are significant limiting factors in clinical dental practice, often leading to treatment postponement or refusal, particularly among adult patients. Conscious sedation emerges as an effective and safe alternative to reduce these barriers, enabling dental procedures to be carried out with greater comfort and patient cooperation. This systematic review aimed to critically analyze the available scientific evidence regarding the main techniques of conscious sedation — inhalation, oral, and intravenous — used in adult dental care. The research followed PRISMA guidelines and included studies published between 2015 and 2025, retrieved from PubMed, ScienceDirect, and B-On databases. After applying inclusion and exclusion criteria, 11 studies were selected for final analysis. Results indicate that remimazolam, a new-generation intravenous benzodiazepine, stands out for its rapid onset, short duration, superior safety profile, and predictable recovery, making it a promising option for conscious sedation in outpatient settings. Inhalation sedation with nitrous oxide proved effective, with immediate reversibility and low complication rates, particularly suited for short procedures and patients with mild to moderate anxiety. Oral benzodiazepines, despite their variable pharmacokinetics, remain useful in selected clinical scenarios. It is concluded that the choice of conscious sedation technique should be individualized, considering clinical, logistical, and patient-preference factors. Although the current evidence supports the efficacy and safety of these techniques, significant gaps remain in the standardization of clinical protocols and in the evaluation of long-term outcomes, underscoring the need for further robust and methodologically consistent clinical studies.
Pain and anxiety are significant limiting factors in clinical dental practice, often leading to treatment postponement or refusal, particularly among adult patients. Conscious sedation emerges as an effective and safe alternative to reduce these barriers, enabling dental procedures to be carried out with greater comfort and patient cooperation. This systematic review aimed to critically analyze the available scientific evidence regarding the main techniques of conscious sedation — inhalation, oral, and intravenous — used in adult dental care. The research followed PRISMA guidelines and included studies published between 2015 and 2025, retrieved from PubMed, ScienceDirect, and B-On databases. After applying inclusion and exclusion criteria, 11 studies were selected for final analysis. Results indicate that remimazolam, a new-generation intravenous benzodiazepine, stands out for its rapid onset, short duration, superior safety profile, and predictable recovery, making it a promising option for conscious sedation in outpatient settings. Inhalation sedation with nitrous oxide proved effective, with immediate reversibility and low complication rates, particularly suited for short procedures and patients with mild to moderate anxiety. Oral benzodiazepines, despite their variable pharmacokinetics, remain useful in selected clinical scenarios. It is concluded that the choice of conscious sedation technique should be individualized, considering clinical, logistical, and patient-preference factors. Although the current evidence supports the efficacy and safety of these techniques, significant gaps remain in the standardization of clinical protocols and in the evaluation of long-term outcomes, underscoring the need for further robust and methodologically consistent clinical studies.
Descrição
Palavras-chave
Ansiedade dentária Sedação consciente Óxido nitroso Sedação oral Controle da dor Dental anxiety Conscious sedation Nitrous oxide Oral sedation Pain management