INFLUENCE OF PHARMACOLOGICAL MANAGEMENT OF ANXIETY ON PAIN DURING ENDODONTIC TREATMENT: A SYSTEMATIC REVIEW

Abstract

The negative connotation of endodontic procedures can increase the patient's anxiety and, consequently, the occurrence of pain. The aim of this systematic review was to answer the question: Does the pharmacological management of anxiety influence the occurrence of pain during root canal treatment? Electronic databases (MEDLINE/PubMed, Cochrane Library, Web of Science, Scopus, EMBASE and Open Gray) were searched until February 2021. Only randomized controlled trials (RCTs) were included. The Cochrane risk of bias tool for randomized clinical trials (RoB 2) was used to assess the included studies. The overall quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool. Initial screening of the databases resulted in 510 studies, of which 43 were excluded because they were duplicates. Of the 457 eligible articles, ten studies met the inclusion criteria and were selected for full text reading. Six studies were excluded for not having evaluated pharmacological interventions. Four studies were included, and an additional study was retrieved from its references. One RCT was classified as presenting an uncertain risk of bias, three as low risk of bias, and one as high risk of bias. GRADE analysis demonstrated a low quality of evidence. It is possible to conclude that benzodiazepines do not influence on pain occurrence during endodontic procedures. However, nitrous oxide gas decreased the occurrence of intraoperative pain.