Investigating the efficacy of dexmedetomidine as an adjuvant to local anesthesia in dentistry: systematic review and meta-analysis.

Abstract

Dexmedetomidine (DEX) 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 DEX as an adjunct to local anesthesia in dental procedures. This study followed PRISMA guidelines. The protocol was registered in PROSPERO (CRD420251035026). Outcomes were onset time, anesthesia duration, postoperative analgesia duration, post operative pain, sedation, and adverse events. Searches covered PubMed, Cochrane Library, Ovid, Embase, Web of Science, and Google Scholar. Risk of bias was assessed with Cochrane RoB 2 and ROBINS-I. RevMan 5.1 pooled mean differences and assessed heterogeneity. Sensitivity analyses and publication bias were examined in Comprehensive Meta-Analysis v3.7. Certainty of evidence was rated with GRADE. This meta-analysis encompassed sixteen controlled clinical trials comprising 658 participants. The addition of DEX decreased onset time by 48.78 s (95% CI: 64.22 to 33.35 s, p < 0.00001). This reduction is unlikely to be clinically significant in routine dental practice. DEX extended anesthesia duration by 31.10 min (95% CI: 13.77 to 48.43 min, p = 0.0004), and prolonged postoperative analgesic duration by 186.19 min (95% CI: 109.09 to 263.29 min, p < 0.00001), although both findings demonstrate substantial uncertainty due to unexplained heterogeneity (I² = 94% and 99%, respectively). Hemodynamic evaluation revealed no clinically significant alterations in heart rate, intraoperative systolic and diastolic pressure, and oxygen saturation (p > 0.05 for all parameters). Minor variations in heart rate and blood pressure did not advance to hypotension or bradycardia. Dexmedetomidine as an adjunct to dental local anesthesia may reduce onset time, extend anesthesia duration, and postoperative analgesia with a favorable hemodynamic safety profile; however, substantial unexplained heterogeneity and modest sample size limit confidence in these estimates. Current evidence does not support routine clinical use; standardized, adequately powered trials are needed before definitive recommendations can be made.