An updated evidence-informed framework for dental sedation: drugs, routes, patient selection, monitoring, and emergency preparedness
TL;DR
No single sedative drug or administration route is universally optimal for all dental patients, but available evidence supports individualized sedation selection based on patient characteristics, procedural requirements, intended sedation depth, clinician competence, and available monitoring and rescue resources.
Abstract
Background Dental sedation facilitates care for patients with anxiety, behavioral challenges, pronounced gag reflexes, special healthcare needs, or complex treatment requirements. This review aimed to integrate current evidence into a clinically applicable framework for individualized sedation planning in dental practice. Methods An evidence-informed narrative review was conducted using PubMed/MEDLINE, Scopus, Web of Science, and the Cochrane Library, covering primarily January 2014 to September 2025. Literature identification and selection were reported with reference to PRISMA 2020 principles. Clinical guidelines, systematic reviews and meta-analyses, randomized controlled trials, observational studies, and relevant clinical literature were synthesized narratively and organized descriptively according to study design and their principal role in the narrative synthesis. Results Evidence supports individualized sedation selection based on patient age, medical and ASA status, airway risk, anxiety and cooperation, procedural requirements, intended sedation depth, clinician competence, and available monitoring and rescue resources. Nitrous oxide-oxygen and midazolam-based techniques are supported for appropriately selected patients requiring minimal-to-moderate sedation. Advanced or deep sedation requires appropriately trained and credentialed personnel, appropriate physiological monitoring, and immediate airway-rescue capability. Dexmedetomidine- and ketamine-based regimens may provide specialized options in selected populations, although protocols and applicability remain heterogeneous. The evidence was integrated into a conceptual framework addressing patient assessment, pharmacological options, monitoring, recovery, and emergency preparedness. Conclusions No single sedative drug or administration route is universally optimal for all dental patients. The available evidence supports individualized sedation selection based on patient characteristics, procedural requirements, intended sedation depth, clinician competence, and available monitoring and rescue resources. Nitrous oxide–oxygen and midazolam-based techniques remain well-supported options for appropriately selected patients, whereas advanced or deep sedation should be reserved for appropriately equipped settings with trained and credentialed personnel.