Nitrous oxide or midazolam to tooth extraction? a systematic review

Aim: This systematic review aimed to evaluate the use of midazolam and nitrous oxide in conscious sedation for dental extraction procedures. Methods: A search was conducted in electronic searches Medline/PubMed, Embase, Cochrane Library, Web of Science, grey literature, and the main scientific journals in the area, following PRISMA. Booleans operators were used for the combinations of terms and the search strategy was adapted to each of the databases, (“tooth extraction” OR “molar, third” OR “tooth, impacted” OR “surgery, oral” OR “exodontics” OR “wisdom tooth” AND “nitrous oxide” OR “anesthetics, inhalation” OR “conscious sedation” OR “laughing gas” OR “moderate sedation” AND “midazolam” OR “benzodiazepines” OR “hypnotics and sedatives” OR “sedative effect”). Study Selection and Data Extraction: The inclusion criteria were parallel and crossover RCTs involving patients of any age submitted to tooth extraction at a dental office under local anesthesia. No language restrictions have been imposed until 2023. The exclusion criteria were studies involving patients submitted to extraction in the hospital setting, studies that did not measure anxiety or sedation and studies for which the full text was not available. Results: Where within the eight articles that met the eligibility criteria, no significant differences were found between the methods, in relation to sedation or anxiety. Conclusion: In conclusion, nitrous oxide and midazolam safely ensure good levels of sedation and anxiety control, being pharmacological approaches possible to be used in dental care, even in those more invasive such as, tooth extraction.