Resumen
Objetivo: Recopilar y sintetizar las evidencias disponibles sobre el control de la ansiedad durante los procedimientos odontológicos mediante la sedación consciente, a partir de una revisión bibliográfica en las principales bases de datos con el fin de contribuir a la toma de decisiones del cirujano dentista en la práctica clínica. Revisión bibliográfica: La sedación consciente es altamente efectiva cuando está indicada, ya que permite alcanzar los objetivos de los procedimientos odontológicos con menos trauma para el paciente y mayor comodidad. Sin embargo, la prescripción de estos medicamentos es menor de lo esperado, especialmente en Brasil, donde hay un bajo índice de prescripción y recomendación de técnicas de sedación, junto con una prescripción irracional que contribuye a la automedicación y a efectos adversos en los pacientes. Consideraciones finales: La sedación consciente en procedimientos odontológicos mediante el uso de fitoterapéuticos, receptores benzodiazepínicos, óxido nitroso y oxígeno (o técnicas combinadas) proporciona control de la ansiedad, el miedo y la fobia, garantiza la seguridad del operador durante el tratamiento, además de promover mayor comodidad para el paciente y una experiencia mejorada. De esa manera, es indispensable que el cirujano dentista se base en principios científicos y adquiera habilidades para manejar las técnicas de sedación.
Referencias
ANDRADE ED. Terapêutica Medicamentosa em Odontologia. 3ª ed. Artes Médicas Editora, 2014; 4: 37-43.
ARAÚJO J, et al. Effectiveness and Safety of Oral Sedation in Adult Patients Undergoing Dental Procedures: protocol for a systematic review, Reino Unido. BMJ Open, 2018; 8: 1-5.
SHLEY P, et al. Sedation of Children Undergoing Dental Treatment. Cochrane Database of Systematic Reviews, 2018; 2018: 12-17.
ATTRI J, et al. Conscious Sedation: Emerging Trends in Pediatric Dentistry. Anesthesia: Essays and Research, 2017; 11: 2.
BAAKDAH R, et al. Pediatric Dental Treatments with Pharmacological and Non-Pharmacological Interventions: a cross‐sectional study. BMC Oral Health, 2021; 1-9.
BARASUOL J, et al. Abordagem de Pacientes com Ansiedade ao Tratamento Odontológico no Ambiente Clínico. Rev. Assoc. Paul. Cir. Dent, 2016; 70.
BATISTA T, et al. Medo e ansiedade no tratamento odontológico: um panorama atual sobre aversão na odontologia. Salusvita, 2018; 37: 449-469.
BEDELOĞLU E. Evaluation of the Effect of Conscious Sedation on Patient Satisfaction and Pain After Wisdom Tooth Extraction. Journal of stomatology, oral and maxillofacial surgery, 2022; 123,3.
COOKE M, TANBONLIONG T. Sedation and Anesthesia for the Adolescent Dental Patient. Dent Clin North Am, 2021; 65(4): 753-773.
CONWAY A, et al. Midazolam for Sedation Before Procedures in Adults and Children: a systematic review update. Systematic Reviews, 2021; 10,1.
CORCUERA-FLORES J, et al. Current methods of sedation in dental patients - a systematic review of the literature. Medicina oral, patologia oral y cirugia bucal, 2016; 21,5: 579-86.
SILVA AM, COSTA HS. Estágio no Departamento de Odontopediatria da Universidade da Flórida: um relato de experiência. Revista da ABENO, 2018; 18(1): 93-102.
DANTAS L, et al. Effects of passiflora incarnata and midazolam for control of anxiety in patients undergoing dental extraction. Med Oral Patol Oral Cir Bucal, 2017; 58-63.
FARAH G, et al. Assessment of Valeriana officinalis l. (Valerian) for Conscious Sedation of Patients During the Extraction of Impacted Mandibular Third Molars: A Randomized, Split-Mouth, Double-Blind, Crossover Study. Journal of oral and maxillofacial surgery: official journal of the American Association of Oral and Maxillofacial Surgeons, 2019; 1-1.
FIORILLO L. Conscious Sedation in Dentistry. Medicina, 2019; 55(12): 778.
FONSECA L, et al. Herbal Medicinal Products from Passiflora for Anxiety: An Unexploited Potential. The Scientific World Journal, 2020; 1-18.
FONTOURA RA. Terapêutica e Protocolos Medicamentosos em Odontologia. 1ª ed. São Paulo: Editora Napoleão Ltda., 2013; cáp. 07.
FRIEDMAN H, et al. Pharmacokinetics and Pharmacodynamics of Oral Diazepam: Effect of dose, plasma concentration, and time. Clinical pharmacology and therapeutics, 1992; 52,2.
JAIN S, et al. Midazolam use in Pediatric Dentistry: a review. J Dent Anesth Pain Med, 2020; 1-8.
KHAN A, et al. Anti-anxiety Properties of Selected Medicinal Plants. Current pharmaceutical biotechnology, 2022; 1041-1060.
KHINDA V, et al. Nitrous Oxide Inhalation Sedation Rapid Analgesia in Dentistry: An Overview of Technique, Objectives, Indications, Advantages, Monitoring, and Safety Profile. International journal of clinical pediatric dentistry, 2023; 16,1.
LEANNE T, et al. Comparison of Dental Benzodiazepine Prescriptions from the U.S., England, and Australia from 2013 to 2018. American Journal of Preventive Medicine, 2021; 73-79.
LINO P, et al. Anxiolytics, Sedatives, and Hypnotics Prescribed by Dentists in Brazil in 2010. BioMed research international, 2017; 1-4.
MALAMED SF. Manual de Anestesia Local. 6ª ed. GEN Guanabara Koogan, 2021; 10: 131-143.
MECCATTI V, et al. Os benefícios da fitoterapia na Odontologia. Research, Society and Development, 2022; 11: 3.
OARES M, et al. Comparison of Three Anxiety Management Protocols for Extraction of Third Molars with the Use of Midazolam, Diazepam, and Nitrous Oxide: A Randomized Clinical Trial. Journal of oral
and maxillofacial surgery: official journal of the American Association of Oral and Maxillofacial Surgeons, 2019; 77: 1-8.
MONTEIRO M, et al. Fitoterapia na prática clínica odontológica: produtos de origem vegetal e fitoterápicos, 2021; 58-77.
MULLER T, et al. Effectiveness and Safety of Nitrous Oxide in Pediatric Dentistry: a review of Clinical Studies. Journal of oral investigations, 2018; 7: 88-111.
PHADRAIG C, et al. Pharmacological Behaviour Support for Adults with Intellectual Disabilities: Frequency and Predictors in a National Cross-Sectional Survey. Community Dentistry and Oral Epidemiology, 2018; 1-7.
RAJA S, et al. The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises, 2020; 161: 1976-1982.SIVARAMAKRISHNAN G, et al. Nitrous Oxide and Midazolam Sedation: A Systematic Review and Meta-Analysis. Anesthesia Progress, 2017; 64: 59–65.
BERG F, et al. Effects of Alprazolam and Lorazepam on Catecholaminergic and Cardiovascular Activity During Supine Rest, Mental Load and Orthostatic Challenge. Psychopharmacology, 1996; 128: 21–30.
ZAFFINA S, et al. Nitrous Oxide Occupational Exposure in Conscious Sedation Procedures in Dental Ambulatories: a pilot retrospective observational study in an Italian pediatric hospital. BMC Anesthesiology, 2019; 19,1.
