Investigating the Efficacy of Dexmedetomidine as an Adjuvant to Local Anesthesia in Dentistry: Systematic Review and Meta Analysis

Background and Objectives: Dexmedetomidine has been considered an effective adjunct to dental local anesthetics. Uncertainty about its efficacy and safety in dental use still remains. This study is primarily designed to evaluate the effectiveness and safety of dexmedetomidine as an adjunct to local anesthesia in dental procedures. Methods: A meta-analysis of controlled trials assessed the effects of dexmedetomidine as an adjunct to local anesthesia in dental procedures, focusing on anesthesia duration and onset time. Studies were identified via multiple databases, and methodological quality was evaluated using ROBINS-I and Cochrane Risk of Bias tools. RevMan V.5.1 was used for heterogeneity analysis, sensitivity analyses, pooling mean differences (MD) and risk ratios (RR) with 95% confidence intervals (CI), and assessing publication bias. Results: This meta-analysis included sixteen clinically controlled trials involving 658 patients ( n =877 samples). Adding dexmedetomidine significantly reduced onset time by 48.78 seconds (95 % CI : -64.22 to -33.35 seconds) and prolonged analgesia duration by 31.10 minutes (95 % CI : 13.77 to 48.43 minutes). It also significantly increased postoperative analgesic duration by 186.19 minutes (95 % CI : 109.09 to 263.29 minutes). Hemodynamic analysis revealed non-significant changes in heart rate, intraoperative systolic and diastolic pressures, and oxygen saturation. It is important to note that minor heart rate and blood pressure fluctuations did not lead to clinically significant hypotension or bradycardia during dental procedures. Conclusions: Dexmedetomidine enhances dental local anesthesia by providing quicker onset, longer duration, improved postoperative pain management, and a favorable safety profile, though further research is needed to address variability.