Eficácia da sedação medicamentosa oral ou sublingual em cirurgias orais menores: revisão sistemática

Abstract

Dental anxiety is one of the main factors hindering the performance of minor oral surgery under local anesthesia, as it may impair patient cooperation during the procedure. In this context, oral or sublingual pharmacological sedation is widely used because of its ease of administration, favorable safety profile, and low cost. However, uncertainty remains regarding its effectiveness and the superiority of specific drugs or administration protocols. The aim of this systematic review was to evaluate the effectiveness of oral or sublingual pharmacological sedation in adults undergoing minor oral surgery with respect to perioperative anxiety reduction, sedation levels, and adverse events. The review was conducted in accordance with the Cochrane Handbook, reported following the PRISMA 2020 guidelines, and prospectively registered in PROSPERO (CRD420261392972). Electronic searches were performed in PubMed, Scopus, SciELO, Web of Science, and Google Scholar. Study selection, data extraction, risk of bias assessment (RoB 2), and certainty of the evidence assessment (GRADE) were performed independently by reviewers. Thirteen randomized controlled trials involving 589 participants were included. Substantial heterogeneity across interventions, comparators, and outcome measures precluded meta-analysis. Moderate-certainty evidence indicated that oral or sublingual pharmacological sedation reduces perioperative anxiety compared with placebo during the intraoperative period in the studies included in this review. In contrast, comparisons with intravenous sedation and among different pharmacological agents provided low- to moderate-certainty evidence, with no consistent evidence supporting the superiority of any intervention. Therefore, although oral or sublingual pharmacological sedation is effective for reducing perioperative anxiety, the available evidence remains insufficient to recommend a specific drug, dose, or administration protocol. Further well-designed randomized controlled trials with adequately powered sample sizes and standardized outcome measures are needed to strengthen the evidence base and inform clinical practice.