Dental anxiety management: multimodal approach with conscious sedation and anxiolytics

Abstract

Objective: To conduct a narrative review of the literature on the management of anxiety in the dental setting, integrating behavioural care strategies and state-of-the-art pharmacological approaches. Methodology: This was based on the search for and selection of original articles, reviews and contemporary clinical guidelines, published mainly between 2014 and 2026, in the PubMed/MEDLINE, SciELO and BVS databases. Literature Review: This study demonstrated that effective treatment requires a multimodal approach. Non-pharmacological interventions, such as cognitive behavioural therapy and sensory resources, form the basis of care. When these are insufficient, conscious sedation, through the judicious use of benzodiazepines (such as midazolam), the nitrous oxide/oxygen inhalation mixture, or adrenergic agonists (dexmedetomidine), has proven to be highly safe and effective in an outpatient setting. Furthermore, it is evident that the use of high-potency agents for deep sedation, such as ketamine, propofol and fentanyl, requires advanced support infrastructure and a multidisciplinary team. Conclusion: The appropriate management of anxious patients requires the dental surgeon not only to possess technical and surgical expertise, but also in-depth knowledge of pharmacokinetics and pharmacodynamics, ensuring a humanised, individualised clinical practice free from iatrogenic complications.