Q1. Does having the injection hurt? Is there any way to make it hurt less?

Injection pain is a variable that has been measured: a meta-analysis including 20 RCTs in children aged 3–14 years shows that a computer-controlled local anaesthetic delivery system, compared with conventional injection, significantly reduced pain perception on the Wong-Baker scale (SMD = -0.98, p = 0.011) [Fn26], and likewise on heart rate [Fn27]. What has to be read alongside it: the study population was children [Fn25]; on other scales and other injection techniques the results were inconsistent, with some non-significant differences appearing [Fn139]; on other pain assessment parameters no significant differences were observed [Fn140]; the overall certainty of the evidence ranged from very low to moderate [Fn29]; and the authors' own concluding wording is that CCLAD “demonstrates potential” [Fn141]. This article does not extrapolate it into a figure for adults, and does not read it as an established effect. On the agent side, moderate-quality evidence from Cochrane shows that the difference in post-injection pain between different local anaesthetics is very small, and that one of them may be slightly less in that comparison [Fn30] (⚠ neither the main text nor the FAQ of this article lists drug names or concentrations; which one is used is decided by the dentist according to the procedure and the individual's circumstances, and the drug names given in the source are retained in the fact ledger for traceability), and that adverse events were rare [Fn31]. Pain in dental treatment is in any case a common fear among patients, and it can be successfully controlled by local anaesthesia [Fn22]. Which approach is actually adopted has to be assessed by the dentist.

Q2. How long until the anaesthetic wears off? What should I watch for while it has not yet worn off?

The honest answer is that at the level of systematic review there is at present no pooled general figure for this question. One of Cochrane's primary objectives included comparing the speed of onset and duration [Fn32], but the result was that no clinical studies met its outcome definitions [Fn33]. Local anaesthesia itself covers 14 different formulations [Fn24], so the timing will not be a constant. What genuinely needs watching is the window before the anaesthetic wears off: a systematic review including 21 studies, mainly in children aged 6–12 years, notes that soft-tissue injuries secondary to local anaesthesia can cause significant pain and cooperation issues [Fn37], and that effective strategies include early intervention with pharmacological and non-pharmacological approaches [Fn38]. This article provides no procedural instruction and no medication instruction; what to watch for on the day is to be explained by the dentist who gives the injection.

Q3. If I am afraid of the dentist, can I “have it done asleep”? What is the difference between nitrous oxide, sedation and general anaesthesia?

Professionally, “asleep” is not a switch but a set of layers: sedation does not make a person completely unconscious and recovery is quicker [Fn3], and it is divided into the three bands of minimal, moderate (conscious sedation) and deep [Fn4][Fn5][Fn6]; general anaesthesia is the level that affects the whole body and is like a deep sleep [Fn15]. The thickness of the evidence differs from band to band: in the mild-anxiety population of children aged 2–12 years, nitrous oxide has an efficacy of 85–92%, complications under 5% and an onset of 30–60 s [Fn19][Fn73], with full recovery in five minutes [Fn79]; oral sedation is 70–85% for moderate cases in children aged 2–12 years [Fn73][Fn74]; intravenous sedation was measured in a 255-patient implant RCT as having a beneficial effect for haemodynamic changes [Fn75][Fn142]; and general anaesthesia is recorded by the British Society for Disability and Oral Health guideline, in the context of Special Care Dentistry services, as possibly being needed to enable people with severe learning disability or severe dental phobia to receive extensive dental treatment [Fn93], although that guideline states that the available evidence is scarce [Fn77]. What also has to be known: Cochrane's search for randomised controlled studies of “sedation vs general anaesthesia” in patients younger than 18 years found, after three rounds of searching, that not one was eligible [Fn114][Fn116][Fn117]; that population therefore has no head-to-head empirical comparison, and the authors' conclusion is that such studies are still needed [Fn118]; the adult population was not within the search scope of that review [Fn114], and this empty review cannot be read as any conclusion about adults. The non-pharmacological pathway exists just as much: CBT/BT can significantly reduce dental anxiety in adults (DAS mean difference -2.7, low quality of evidence) [Fn129][Fn130]. Which one to choose has to be assessed by the dentist.

🏛 Part of the "reports" topic shelf →

A complete guide to dental anaesthesia, sedation and fear of the dentist: a domain map running from how local anaesthesia works, through the sedation spectrum, to the assessment of anxiety｜證據鏈

km 編輯部2026-08-13About 46 min read

#證據鏈 #牙醫領域 #麻醉 #兒童

本頁是〈A complete guide to dental anaesthesia, sedation and fear of the dentist: a domain map running from how local anaesthesia works, through the sedation spectrum, to the assessment of anxiety〉的事實單元帳：每一條主張對應的來源、證據等級、地域與期間、原文引句與限制，逐條攤開。

A complete guide to dental anaesthesia, sedation and fear of the dentist: a domain map running from how local anaesthesia works, through the sedation spectrum, to the assessment of anxiety｜證據鏈

F-Units (fact-unit ledger)

Expand the F1–F30 fact ledger (each item: source # / confidence / basis / geo / period / caveat)

F1｜The four official categories of anaesthesia (local / regional / general / monitored sedation) and the three depth levels of sedation (minimal / moderate, that is conscious sedation / deep); sedation is different from full anaesthesia, does not make a person completely unconscious and recovery is quicker; monitored sedation is explicitly listed as usable for dental work

Corresponding Fn: Fn1, Fn3, Fn4, Fn5, Fn6, Fn11, Fn12, Fn13, Fn14, Fn15, Fn16, Fn17, Fn18
Source #: #S01｜confidence: high｜basis: official_statement (U.S. NIH/NLM MedlinePlus patient-education page; measured live on 2026-08-06, HTTP 200, 90,744 bytes)｜geo: universal｜period: the version of the page retrieved on 2026-08-06
caveat: this is definitional description at the level of patient education, not a clinical operating standard; this article uses only its terminological classification, and does not use it to make any claim about effect or safety. Under the “whole line global” revision, this item is universal patient-education content from a U.S. federal agency (it carries no U.S.-specific institutional claim), so geo is marked universal. What that page lists is three discrete levels (Minimal / Moderate (conscious) / Deep); the wording “continuum” does not appear in the original, and there is no qualifying subject “dental sedation” either — the 2026-08-06 correction round changed the TL;DR from “dental sedation is a continuum running from light to deep rather than a single switch [Fn1]” to wording that matches the original, “sedation comes in three levels, minimal, moderate and deep, and is different from full anaesthesia [Fn1]”; the same wording in the portable reading of section 1-1 and in the opening sentence of FAQ Q3 was likewise changed to the layered description; the word “spectrum” is retained only in purely editorial framing such as the heading of section 4, where it carries no [Fn] and makes no factual claim.

F2｜Anaesthesia is generally safe but there can be risks (especially general anaesthesia); the officially listed risks include heart rhythm problems, breathing problems, an allergic reaction to the anaesthesia, temporary confusion (which can last several days in some people over the age of 60, and briefly in children after waking up), and awareness under general anaesthesia (usually hearing sounds, occasionally feeling pain, and rare); the advice is to discuss the benefits and risks with a health care provider

Corresponding Fn: Fn101, Fn102, Fn103, Fn104, Fn105, Fn106, Fn107
Source #: #S01｜confidence: high｜basis: official_statement｜geo: universal｜period: the version of the page retrieved on 2026-08-06
caveat: this is a “list” of risks rather than incidences; that page provides no quantified frequency for any of the items, and this article makes no probability statement about them.

F3｜Pain in dental treatment is a common fear among patients and can be successfully controlled by local anaesthesia; Cochrane included 123 studies with 19,223 participants, covering 14 different formulations, and did compare differences in the success of anaesthesia between formulations; adverse events were rare

Corresponding Fn: Fn22, Fn23, Fn24, Fn31, Fn34
Source #: #S04｜confidence: high｜basis: peer_reviewed (Cochrane systematic review and meta-analysis, PMID 29990391)｜geo: universal｜period: Cochrane Database Syst Rev, 2018 (searched to 2018-01-31)
caveat: the quality of most results in that review was rated low to moderate; the specific agent combinations in its comparison of success rates are not repeated item by item in this article (they belong to the medication layer). There are also 34 studies “awaiting classification (full text unobtainable)”, and the authors state that assessing them might change the conclusions.

F4｜Cochrane's primary objectives include comparing the speed of onset and duration, but for the comparisons assessing onset and duration no clinical studies met its outcome definitions

Corresponding Fn: Fn32, Fn33
Source #: #S04｜confidence: high｜basis: peer_reviewed (PMID 29990391)｜geo: universal｜period: Cochrane Database Syst Rev, 2018
caveat: this item is a statement of an evidence gap, not a statement of effect. The anchor file P21-anchors.md marks #05 as the core anchor for “how long until the anaesthetic wears off” and describes it as “having duration as a comparison objective”; that description covers only the Objectives section and not the negative result in the Main results section. This article takes the results section of the original as authoritative (see item 2 of “Editorial rulings and record of anchor-file corrections”).

F5｜A computer-controlled local anaesthetic delivery system (CCLAD) significantly reduced injection pain perception in children aged 3–14 years: Wong-Baker scale SMD = -0.98 (p = 0.011), heart rate SMD = -0.25 (p = 0.013); subgroup analysis showed a significant reduction compared with conventional IANB; heterogeneity was high and moderate respectively; results on other scales and injection techniques were inconsistent, with some non-significant differences; no significant differences were observed in other pain assessment parameters; only 5 studies were at low risk of bias and the certainty of evidence ranged from very low to moderate; the authors' concluding wording is that CCLAD “demonstrates potential”

Corresponding Fn: Fn25, Fn26, Fn27, Fn28, Fn29, Fn139, Fn140, Fn141
Source #: #S03｜confidence: moderate｜basis: peer_reviewed (systematic review and meta-analysis of 20 RCTs, PMID 40254248)｜geo: universal｜period: J Dent, 2025 (including RCTs published between 2015-01 and 2024-11)
caveat: the population is limited to children aged 3–14 years; extrapolation to an adult effect is prohibited. The two reverse limits in the original (some non-significant differences on other scales and injection techniques; no significant differences in other pain assessment parameters) were raised from the caveat into the main text and the FAQ in the 2026-08-06 correction round [Fn139][Fn140]; the authors' concluding wording is potential rather than an established effect, and the subheading and the opening FAQ answer in this article have been downgraded to match [Fn141]. This item is a population-level result at device level and constitutes no device recommendation.

F6｜The difference in post-injection pain between 4% articaine and 2% lidocaine is very small; lidocaine may cause slightly less post-injection pain (moderate-quality evidence)

Corresponding Fn: Fn30
Source #: #S04｜confidence: moderate｜basis: peer_reviewed (PMID 29990391)｜geo: universal｜period: Cochrane Database Syst Rev, 2018
caveat: the original measured a continuous variable on a 170 mm Heft-Parker visual analogue scale; this article does not repeat its millimetre values or dose information. It constitutes no medication instruction.

F7｜Self-inflicted soft-tissue injury in children after local anaesthesia: 574 records screened down to 21 studies (9 RCTs / 6 case reports / 6 cohorts), with the population mainly aged 6–12; it can cause significant pain and cooperation issues; effective strategies include early pharmacological and non-pharmacological intervention; the interventions compiled include phentolamine mesylate (2 studies), intraoral appliances (2 studies) and photobiomodulation (2 studies)

Corresponding Fn: Fn35, Fn36, Fn37, Fn38, Fn39, Fn40, Fn41
Source #: #S05｜confidence: moderate｜basis: peer_reviewed (systematic review, PMID 40856087)｜geo: universal｜period: Adv Clin Exp Med, 2026 (searched to 2024-10)
caveat: the authors state that the included studies varied greatly in design, sample size and duration, that effect sizes and confidence intervals were inconsistently reported, and that there is methodological heterogeneity and potential reporting bias. This article repeats no dose, route or timing for any drug.

F8｜Adverse reactions to local anaesthesia are usually a reaction to adrenaline, vasovagal syncope or overdose toxicity; patients with a true allergy are sometimes treated under general anaesthesia

Corresponding Fn: Fn42, Fn72
Source #: #W22｜confidence: moderate｜basis: peer_reviewed (review including case reports, PMID 29952645)｜geo: universal｜period: Anesth Prog, 2018
caveat: the PublicationType of this paper includes Case Reports, so its level of evidence is below that of a systematic review; this article uses only its directional statement of differential classification, and cites none of the management detail or alternative drug usage in its cases.

F9｜Local anaesthetic systemic toxicity (LAST) is a rare but potentially fatal complication; there are clinically significant discrepancies between guideline sources on the recommended upper limits of dose; the additive toxicity of combined amide agents is underappreciated; intravenous lipid emulsion is the specific rescue therapy for severe / cardiovascular LAST, while airway support and oxygenation remain the priority intervention; patient-specific factors substantially lower the effective toxic threshold; a structured differential diagnosis is required in order to separate it from the more common dental emergencies

Corresponding Fn: Fn44, Fn45, Fn46, Fn47, Fn48, Fn49
Source #: #S12｜confidence: moderate｜basis: peer_reviewed (narrative review, PMID 42505765)｜geo: universal｜period: Dent J (Basel), 2026 (searched to 2026-05)
caveat: this is a narrative review, not a systematic review; the original states explicitly that its source hierarchy is specific to the UK prescribing and regulatory context, so this article takes only its universal statements about mechanism and process, takes none of its dose values and none of its country-specific regulatory recommendations. This item constitutes no medication instruction.

F10｜The three classes of mechanism for allergic reactions in dental practice: immediate type mediated by IgE, delayed type mediated by sensitised T lymphocytes, and pseudoallergic reactions; the importance of cross-reactions; triggers include local anaesthetics (lidocaine, benzocaine), antibiotics (penicillins, cephalosporins), latex (gloves, rubber dam), acrylic materials, and metal alloys containing nickel / chromium / cobalt

Corresponding Fn: Fn50, Fn51, Fn52, Fn53, Fn54, Fn55
Source #: #S11｜confidence: high｜basis: peer_reviewed (systematic review, PMID 39954171)｜geo: universal｜period: Clin Rev Allergy Immunol, 2025
caveat: the abstract provides no incidence for any of the triggers; this article uses only its classification and its list, and makes no frequency statement.

F11｜True local anaesthetic allergy involving IgE-mediated reactions and anaphylaxis is rare, has been identified only in case reports, and accounts for less than 1% of adverse local anaesthetic reactions; most reactions are non-allergic, or are allergy to other sources such as preservatives and excipients; misclassification can lead to unnecessary avoidance of local anaesthetic drugs or to delay of surgery

Corresponding Fn: Fn2, Fn56, Fn57, Fn62
Source #: #W17｜confidence: high｜basis: peer_reviewed (review, PMID 35482282)｜geo: universal｜period: Clin Rev Allergy Immunol, 2023
caveat: “less than 1%” is an overall statement in the review, and the original supplies no pooled calculation for that proportion; this article uses only its order of magnitude and makes no precise inference. The limit must not fall away: the <1% in the original is plainly limited to true allergy “involving IgE-mediated reactions and anaphylaxis”, and does not cover delayed-type (type IV) true allergy (the 25-year articaine stocktake in F12 contains 5 confirmed type IV cases) — the 2026-08-06 correction round restored this limit in the TL;DR and in the adverse-effects list of section 7 (previously it was retained only in section 3-2 and FAQ Q4), and the wording at all four places in the article is now consistent.

F12｜A 25-year stocktake of true allergy to articaine (2000-01 to 2024-12): 10 case reports and 6 case series, amounting to 29 patients confirmed by standard allergological procedures; 20 were immediate type (type I) and 5 delayed type (type IV); cross-reactivity with other amides was reported in 3 cases; the authors conclude that true allergy is exceedingly rare

Corresponding Fn: Fn58, Fn59, Fn60, Fn61
Source #: #W18｜confidence: moderate｜basis: peer_reviewed (review, PMID 40422600)｜geo: universal｜period: Dent J (Basel), 2025
caveat: the design is a compilation of cases already published in the literature, it depends on reporting, and it can only demonstrate that “confirmed cases are extremely few”, which is not the same as having measured a population incidence; 4 cases do not record the type of allergy. This item covers articaine only.

F13｜Results of standardised diagnosis for suspected local anaesthetic allergy: of 24 referred cases at a single allergy centre, 3 were considered allergy after standardised skin testing and drug challenge testing; 3 cases (12.5%) who had been positive on previous skin tests were excluded through the standardised procedure; the remainder were classified as psychosomatic reactions 29.1%, symptoms of sympathetic stimulation 12.5%, vasovagal syncope 8.3% and so on; the conclusion is that true allergy is rare and that the great majority of self-reporting patients can have it ruled out

Corresponding Fn: Fn43, Fn63, Fn64, Fn65, Fn66
Source #: #W21｜confidence: low (for each percentage) / moderate (for direction and process)｜basis: peer_reviewed (retrospective series, PMID 38186148)｜geo: universal｜period: enrolment from 2017-03 to 2022-02
caveat: a single medical centre, only 24 people, retrospective design, and a highly uneven sex distribution (3 male / 21 female); the denominators of the percentages are extremely small, so this article uses only its direction and its process, and population inference is prohibited.

F14｜The diagnostic pathway: detailed history-taking about prior reactions is the opening and key step; suspected immediate-type allergy can be assessed with skin prick and intradermal testing followed by graded challenge; suspected delayed type can be assessed with patch testing

Corresponding Fn: Fn67, Fn68, Fn69
Source #: #W17｜confidence: high｜basis: peer_reviewed (PMID 35482282)｜geo: universal｜period: Clin Rev Allergy Immunol, 2023
caveat: this is a statement at the level of process, and it records no sensitivity or specificity for the tests; this article does not advise anyone to arrange testing on their own initiative.

F15｜Alternative direction for those with confirmed amide allergy: chloroprocaine (an ester anaesthetic) is suggested for patients with confirmed amide allergy; the choice of local anaesthetic must be tailored to each patient's medical condition

Corresponding Fn: Fn70, Fn71
Source #: #S13｜confidence: moderate｜basis: peer_reviewed (comprehensive review, PMID 41710613)｜geo: universal｜period: Saudi J Anaesth, 2026 (searched 2000-01 to 2025-04)
caveat: this is a compilation of clinical recommendations in a review, not an original comparative trial; this article does not repeat its detailed drug preferences for individual systemic diseases, nor any dose. It constitutes no medication instruction. The original names one single drug (Chloroprocaine) and does not recommend the whole ester family — the 2026-08-06 correction round changed the generalisation “switch to an ester drug” in the contraindications of section 7 and in FAQ Q4 back to naming chloroprocaine, and noted that benzocaine, which is likewise an ester, is listed in #S11 as one of the triggers of dental allergy [Fn54], so promotion to the level of a drug class is prohibited.

F16｜Performance of nitrous oxide (N₂O/O₂) in children aged 2–12 years: 85–92% efficacy in mild anxiety, complications under 5% (such as nausea), onset in 30–60 s, full recovery in five minutes, suited to short procedures; adverse events under 5% overall, with nitrous oxide relatively safer for outpatient use; the systematic review included 25 studies with approximately 12,500 participants

Corresponding Fn: Fn19, Fn73, Fn78, Fn79, Fn80, Fn81
Source #: #S08｜confidence: low-moderate｜basis: peer_reviewed (systematic review, PMID 41694161)｜geo: universal｜period: Cureus, 2026 (searched 2015–2025)
caveat: 85–92% corresponds to the “mild anxiety” subgroup and must not be applied to people with moderate or severe anxiety; the population is children aged 2–12 years, and extrapolation to adults is prohibited. That review used qualitative synthesis rather than meta-analysis because of heterogeneity, and the authors state limitations including protocol variability and a limited number of RCTs; the included designs mix RCTs, cohorts and retrospective studies.

F17｜Performance of oral sedation in children aged 2–12 years: 70–85% success for moderate cases; midazolam offers stronger amnesia but with 5–10% paradoxical excitation; hydroxyzine is suited to low-risk adjuncts; combined use can raise this to 88–95% and cut dropouts by 40–50%

Corresponding Fn: Fn74, Fn82, Fn83, Fn84
Source #: #S08｜confidence: low-moderate｜basis: peer_reviewed (PMID 41694161)｜geo: universal｜period: Cureus, 2026
caveat: the same population and methodological limits as F16. The drug names are repeated from the literature; this article provides no dose, route or timing of administration, and it constitutes no medication instruction.

F18｜RCT of intravenous sedation in dental implant surgery: 255 consecutive implant patients randomised into an intravenous sedation with local anaesthesia group (n=123) and a local anaesthesia only group (n=132); systolic and/or diastolic blood pressure was significantly higher in the non-sedation group; the results section records that this regimen stabilised haemodynamics and contributed to patient safety; the wording of the conclusion section is narrower, recording only that intravenous sedation had a beneficial effect for haemodynamic changes during implant surgery

Corresponding Fn: Fn75, Fn85, Fn86, Fn87, Fn142
Source #: #S06｜confidence: moderate｜basis: peer_reviewed (randomised controlled trial, PMID 22167437)｜geo: universal｜period: Int J Oral Maxillofac Implants, 2011
caveat: the outcome variables are haemodynamic indices, not complication rates or survival; it is a single RCT from 2011, and no equivalent later meta-analysis was retrieved in this round. The phrase “contributed to the safety of the patient” sits in the RESULTS section of the original and not in the CONCLUSION section — the 2026-08-06 correction round changed “the authors' conclusion says” in the main text to “the results section says”, and added the narrower wording of the conclusion section [Fn142]; this is the same standard applied consistently as in section 4-7 of this article (taking a sentence from outside the conclusion as the authors' conclusion is prohibited). It must not be rewritten as any assurance of safety. This article does not repeat the doses of the drug combination used.

F19｜Recovery time after sedation by continuous infusion: a prospective observational study of 46 ASA grade I or II patients, quantified by the bispectral index and the post-anaesthetic discharge scoring system; the conclusion in the original carries a conditional premise — “if approximately 50 minutes of midazolam conscious sedation was properly controlled, patients could be discharged within ‘approximately’ 90–110 minutes from the start of administration”, that is going home within about 40–60 minutes after awakening; those under 18 years old, with a history of drug allergies, with a BMI of 26 or more, or in regular use of antipsychotic / psychotropic / hypnotic substances were excluded

Corresponding Fn: Fn20, Fn88, Fn89, Fn90, Fn91, Fn92
Source #: #S07｜confidence: low-moderate｜basis: peer_reviewed (prospective observational study, PMID 41717147)｜geo: universal｜period: Cureus, 2026 (enrolment from 2019-12 to 2021-07 at a single university-affiliated hospital)
caveat: a single institution, 46 people, observational design (not an RCT); the exclusions are broad, and applying the time figures to the excluded populations is prohibited. That time interval is bound to the sedation duration of approximately 50 minutes in that study, and the wording of the original is “approximately” — the 2026-08-06 correction round restored the conditional clause and the word “approximately” in sections 4-4 and 4-8; writing it again as an unconditional fixed interval is prohibited, as is reading it as “a sedation procedure of any length takes 90–110 minutes”. This article repeats none of its dosing or infusion parameters.

F20｜Guideline positioning of general anaesthesia in special care dentistry (adult services): it may be needed to support care, for reasons including enabling people with severe learning disability or severe dental phobia to receive extensive dental treatment; guidance is needed because of the potential risks, implications and costs involved; it is presented as overarching principles plus six key sections covering the patient pathway from referral through to after the procedure; it stresses comprehensive, person-centred assessment and planning; the guideline itself states that little evidence is available and that the recommendations are based mainly on the expert consensus of the working group

Corresponding Fn: Fn21, Fn77, Fn93, Fn94, Fn95
Source #: #S02｜confidence: high (framework) / low (effect side)｜basis: clinical_guideline (clinical guideline of the British Society for Disability and Oral Health, PMID 35061301; PublicationType includes Practice Guideline)｜geo: universal｜period: Spec Care Dentist, 2022
caveat: the original states explicitly that “there is little evidence and the recommendations are based mainly on expert consensus”, so this item may serve only as a decision framework and must not serve as evidence of effect or safety. The scope of the guideline is adults within Special Care Dentistry (SCD) services (the original AIM: for adults within SCD services), and extrapolation to the general adult dental population is outside what this article claims — the 2026-08-06 correction round restored this service context in four places: the table in section 5-4, FAQ Q3, the indications in section 7 and the opening of section 8; writing it again as a context-free general rule that “the guideline accepts general anaesthesia for severe dental phobia” is prohibited.

F21｜Morbidity after oral surgery under general anaesthesia in children: the leading indication by share was caries and its complications (up to 91.0%), followed by lack of cooperation / anxiety / fear (39.8–47.9%); prevalence of treatment reached 87.7% in the special-needs group and 63.3% in healthy patients; 43.0–98.9% experienced discomfort within the first 24 hours, the main reason being pain (14.0–95.0%); the conclusion is a very low risk of major complications but an almost universal occurrence of minor complications

Corresponding Fn: Fn76, Fn96, Fn97, Fn98, Fn99, Fn100
Source #: #S14｜confidence: moderate｜basis: peer_reviewed (systematic review, PMID 35961509)｜geo: universal｜period: J Stomatol Oral Maxillofac Surg, 2023 (searched to 2022-02-23)
caveat: the ranges are extremely wide (pain 14.0–95.0%, for instance), reflecting differences in measurement and definition between the included studies; taking a midpoint or making individual predictions is prohibited; the population is children, and extrapolation to adults is prohibited. The original also records that no association could be established between comorbidity and the procedures performed.

F22｜Comparison of twelve international guidelines on conscious sedation in paediatric dentistry: complete convergence in the core safety domains (patient assessment, monitoring, training of professionals); convergence of 91.67% on discharge criteria and 83.33% on contraindications; substantial variation in pharmacological protocol, with only 16.67% providing a complete description of drugs and doses; route of administration and emergency equipment appear in 66.67% and 50% respectively; the conclusion is that foundational safety principles are consistent while pharmacological and procedural recommendations are significantly heterogeneous, and that this variability may contribute to differences in practice and uncertainty among practitioners

Corresponding Fn: Fn108, Fn109, Fn110, Fn111, Fn112, Fn113
Source #: #S09｜confidence: high｜basis: peer_reviewed (comparative analysis and evidence mapping study of guidelines, PMID 41976973)｜geo: universal｜period: J Clin Med, 2026 (searched to 2023-12)
caveat: this paper is a comparative study of guidelines, not a guideline itself; the issuing bodies and years of the twelve compared guidelines are not listed one by one in the abstract, and this article does not quote their individual contents one by one. The convergence percentages describe “whether the guidelines cover that domain”, not clinical effect. Subject and population limits: the title and the inclusion criteria of the original are both guidelines on conscious sedation in pediatric dentistry; they do not cover adult sedation, and they do not cover general anaesthesia — the 2026-08-06 correction round added this limit to section 4-6 (including the section heading), section 4-8, the population list in section 6, the contraindications in section 7 and every citation in the list of questions in section 8; the unqualified formulation “twelve international guidelines” is prohibited from appearing again, as is extrapolating any convergence percentage into a guideline consensus for adults or for general anaesthesia.

F23｜Comparison of sedation with general anaesthesia for dental treatment in patients younger than 18 years: the original Cochrane review screened out 16 studies for possible inclusion, none of which was eligible once the full texts were obtained; the 2012 update added none; the 2015 update found 2 studies which were likewise ineligible; the authors conclude that randomised controlled studies are needed to quantify differences in morbidity and cost

Corresponding Fn: Fn114, Fn116, Fn117, Fn118
Source #: #S15｜confidence: high｜basis: peer_reviewed (Cochrane systematic review, PMID 26413895)｜geo: universal｜period: Cochrane Database Syst Rev, 2015 (first published 2009, updated 2012 and 2015)
caveat: this item is an “empty review” (no eligible included studies); it is a statement of an evidence gap, not evidence of effect for either side. Population limit: the title of the original is patients younger than 18 years and the inclusion criteria are children and adolescents up to 18 years of age — the 2026-08-06 correction round restored this age limit in the concluding sentence and heading of section 4-7, in the third row of the table in section 5-4 and the text after it, and in FAQ Q3; writing it again as the general rule that “there is no head-to-head empirical comparison between sedation and general anaesthesia” is prohibited; the adult population was not within the search scope of that review, so this empty review can prove neither that such evidence exists for adults nor that it does not.

F24｜The phrase “sedation may lead to reduced morbidity and cost” comes from the background section of that Cochrane review (historical context and research motivation), not from its research findings

Corresponding Fn: Fn115
Source #: #S15｜confidence: high｜basis: peer_reviewed (PMID 26413895)｜geo: universal｜period: Cochrane Database Syst Rev, 2015
caveat: this item is a record of a correction to citation position. The anchor file P21-anchors.md describes #16 as “explicitly stating that the use of sedation can reduce the incidence of morbidity and cost”; that sentence in fact sits in the BACKGROUND section and is in the conditional mood (may lead to), and set beside the negative result in Main results it must not be read as a conclusion (see item 3 of “Editorial rulings and record of anchor-file corrections”).

F25｜Global estimated prevalence of dental fear and anxiety in adults: 31 population-based studies, 72,577 adults 18 years of age or older; DFA 15.3% (95%CI 10.2–21.2), high DFA 12.4% (95%CI 9.5–15.6), severe DFA 3.3% (95%CI 0.9–7.1); higher among women and younger adults; 28 of the 31 studies were at high risk of bias; the instruments used affect the prevalence measured

Corresponding Fn: Fn7, Fn8, Fn9, Fn10, Fn119, Fn120
Source #: #W16｜confidence: moderate｜basis: peer_reviewed (systematic review and meta-analysis, PMID 33711405)｜geo: universal｜period: J Dent, 2021 (searched to 2020-03)
caveat: 28 of 31 studies were at high risk of bias, and only 3 at low risk; the confidence intervals are wide (DFA 10.2–21.2); the authors state that the measurement instrument affects prevalence, so the figures must not be compared across scales. 15.3% / 12.4% / 3.3% are three separate pooled estimates, not a nested stratification of one sample — the 2026-08-06 correction round deleted the self-made subtraction “a difference of about 12 percentage points” in section 5-1 (the original authorises no such arithmetic), and replaced it with the three figures set side by side plus a note that they must not be subtracted.

F26｜Assessment of dental anxiety uses validated scales as a threshold: the inclusion criteria of the systematic review name the Dental Anxiety Scale (DAS) and the Dental Fear Survey (DFS), or meeting psychiatric diagnostic criteria for dental phobia

Corresponding Fn: Fn121
Source #: #S10｜confidence: high｜basis: peer_reviewed (systematic review, PMID 23659254)｜geo: universal｜period: Eur J Oral Sci, 2013
caveat: this is a statement of inclusion criteria, not an appraisal of scale validity; this article does not claim that any one scale is better.

F27｜Form and reliability of the Modified Dental Anxiety Scale (MDAS): five items, total score 5 to 25; in the validation of that version in 230 oral surgery patients the internal consistency was high (Cronbach's alpha = 0.92); scores were significantly higher in women and in those with previous distressing medical or dental experiences; the correlations with age and with frequency of dental visits were also significant

Corresponding Fn: Fn122, Fn123, Fn124, Fn125, Fn126, Fn127
Source #: #W20｜confidence: moderate (form and reliability) / low (extrapolation of any value)｜basis: peer_reviewed (scale validation study, PMID 26173721)｜geo: universal｜period: Minerva Stomatol, 2015
caveat: this is a validation study of a single language version, and the participants were limited to an oral surgery population; the authors state this as a limitation and note that it might not represent anxiety prevalence in the general dental population. This article uses it only to explain the form of the instrument and the order of magnitude of its reliability.

F28｜Psychological treatment of dental anxiety in adults: a systematic review of 10 RCTs; CBT/BT brought a significant reduction in anxiety (DAS mean difference -2.7), but based on low quality of evidence; there was also some support that CBT/BT improves acceptance of treatment more than general anaesthesia does (low quality of evidence); the summing-up is that behavioural interventions can help adults but that more well-designed studies are needed

Corresponding Fn: Fn128, Fn129, Fn130, Fn131, Fn132
Source #: #S10｜confidence: low-moderate｜basis: peer_reviewed (systematic review, PMID 23659254)｜geo: universal｜period: Eur J Oral Sci, 2013
caveat: the authors mark low quality of evidence twice; only 10 RCTs; it is comparatively old (2013), and this round did not replace it with an updated version (see the self-check section). It must not be rewritten as “proven effective”.

F29｜Review of clinical trials for reducing dental anxiety in adults (the title and central subject of the original are “Efficacy of Hypnosis on Dental Anxiety and Phobia”): 19 clinical trials (1979–2021), covering various forms of CBT, relaxation training, benzodiazepine premedication, self-hypnosis by audio therapy, hypnotherapy and nitrous oxide sedation; CBT delivered in its various forms (including single-session treatment) showed the most evidence for efficacy in reducing anxiety; because the methods were highly heterogeneous only 5 studies entered the meta-analysis, and the application of hypnosis showed contrasting results; the authors also state that the results of the systematic review are promising and that hypnosis can be regarded as a powerful and successful method for anxiety reduction, while there are also studies with a small or even slightly negative effect; they recommend a more consistent use of methods to examine anxiety for hypnosis research

Corresponding Fn: Fn133, Fn134, Fn135, Fn136, Fn137, Fn138
Source #: #W19｜confidence: low-moderate｜basis: peer_reviewed (systematic review and meta-analysis, PMID 35624907)｜geo: universal｜period: Brain Sci, 2022 (including trials published 1979–2021)
caveat: only 5 studies entered the meta-analysis, and the hypnosis results are contradictory; the drug item (benzodiazepine premedication) is merely one of the treatments listed as reviewed, and this article cites none of its effect figures and gives no medication instruction. Source-positioning disclosure: this article uses it to support a comparative statement about CBT, but it is a review whose subject is hypnosis — the 2026-08-06 correction round disclosed its title and central subject plainly in the main text of section 5-3 [Fn133] and added the authors' positive statement about hypnosis [Fn138], so as not to form a selective citation that takes only the side unfavourable to hypnosis.

F30｜The variables making up the cost of sedation and general anaesthesia (staff training, monitoring, emergency equipment, recovery time, extent of the procedure) can be derived from the domains covered by the guidelines and from the recovery time in the observational study; the professional guideline also plainly lists cost alongside risks and implications as a reason why guidance is needed

Corresponding Fn: Fn108, Fn109, Fn112, Fn90, Fn93, Fn94, Fn4, Fn5, Fn6 as cited in that section (no independent new fact)
Source #: #S09 / #S07 / #S02｜confidence: moderate (logic of the make-up)｜basis: clinical_guideline / peer_reviewed｜geo: universal｜period: see the corresponding items
caveat: this item is only a derivation of the “make-up and variables” of cost; it contains no amount and no country-specific reimbursement rule; for differences between countries' systems see domain article P12 and the corresponding TW canonical cards. The coverage of #S09 is confined to guidelines on conscious sedation in paediatric dentistry [Fn108] — the 2026-08-06 correction round deleted the cross-procedure extrapolation in section 4-8 that it “means sedation and general anaesthesia require staff with corresponding training to be present” (that study does not compare general anaesthesia guidelines), attaching #S09 to the conscious sedation side and Fn94 of #S02 to the general anaesthesia side; the unsourced causal sentence “the deeper the level, the higher the monitoring requirement” in the same section was deleted at the same time and replaced by the questioning prompt “which band is being used this time, and how monitoring is arranged is a matter that can be confirmed with the dentist”.

Compliance note

This article is a domain explanation of the nature of health education and medical news, intended to help readers understand the classification of dental anaesthesia and sedation, the strength of the evidence and the directions in which questions can be asked; it does not solicit attendance for treatment, and it contains no promotion of any clinic, person or service.
The article quotes no actual prices, lists no amounts and contains no price inducement of any kind; the cost passage explains only the make-up and the variables.
The article provides no medication dose, no route of administration, no timing of administration and no advice about stopping any medicine; drug names that appear in it are terms repeated from the cited literature, they constitute no medication instruction, and no product or device is recommended.
The article uses no promise of therapeutic effect, no absolute wording and no exaggerated comparative wording, and contains no patient testimonial and no identifiable case.
Wherever a procedure is mentioned, the indications, the possible adverse effects and the contraindications have been disclosed (see section 7); that disclosure is presented as recorded in international literature and professional guidelines, and this article does not take the regulations of any particular country as its normative basis (the geo_scope of this article is global; local regulatory requirements are in the corresponding TW canonical cards).
The actual method of treatment and its effect vary from person to person and have to be assessed by a dentist. Whether any given form of anaesthesia or sedation is suitable, what depth is used, and which pre-procedure investigations are needed, must in every case be assessed in person by a qualified dentist (together with anaesthesia professionals where necessary).
Most of the figures cited in this article carry explicit population limits (children / a particular ASA grade / a particular degree of anxiety), and these are marked item by item in each passage; readers should not apply them to themselves.
⚠ This article is a draft. It has not yet passed the machine gate, cross-architecture adversarial review or the commander's own verification, and publication is prohibited.

Source list

Date of retrieval / live measurement: 2026-08-06 (all sources measured live on the same day with curl / PubMed E-utilities, HTTP 200; the verbatim spans passed programmatic comparison)

Sources already verified in the anchor file (`ida-pillars/anchors/P21-anchors.md`)

#	basis	Title	Source	PMID / URL
#S01	official_statement	Anesthesia (MedlinePlus Health Topic)	U.S. National Library of Medicine (NIH)	https://medlineplus.gov/anesthesia.html
#S02	clinical_guideline	The use of general anaesthesia in special care dentistry: A clinical guideline from the British Society for Disability and Oral Health.	Spec Care Dentist, 2022 (PublicationType: Practice Guideline)	PMID 35061301｜https://pubmed.ncbi.nlm.nih.gov/35061301/
#S03	peer_reviewed	Comparison of injection pain levels using conventional and computer-controlled local anesthetic delivery systems in pediatric dentistry: A systematic review and meta-analysis.	J Dent, 2025	PMID 40254248｜https://pubmed.ncbi.nlm.nih.gov/40254248/
#S04	peer_reviewed	Injectable local anaesthetic agents for dental anaesthesia.	Cochrane Database Syst Rev, 2018	PMID 29990391｜https://pubmed.ncbi.nlm.nih.gov/29990391/
#S05	peer_reviewed	Diagnosis and management of traumatic injuries in pediatric patients secondary to dental local anesthesia: A systematic review.	Adv Clin Exp Med, 2026	PMID 40856087｜https://pubmed.ncbi.nlm.nih.gov/40856087/
#S06	peer_reviewed	Intravenous sedation and hemodynamic changes during dental implant surgery.	Int J Oral Maxillofac Implants, 2011 (RCT)	PMID 22167437｜https://pubmed.ncbi.nlm.nih.gov/22167437/
#S07	peer_reviewed	Recovery Time Following Continuous Midazolam Infusion During Dental Implant Surgery: A Prospective Observational Study.	Cureus, 2026	PMID 41717147｜https://pubmed.ncbi.nlm.nih.gov/41717147/
#S08	peer_reviewed	Nitrous Oxide and Oral Sedation for Managing Dental Anxiety in Children: A Systematic Review.	Cureus, 2026	PMID 41694161｜https://pubmed.ncbi.nlm.nih.gov/41694161/
#S09	peer_reviewed	International Guidelines on Conscious Sedation in Pediatric Dentistry: A Comparative Analysis and Evidence Mapping Study.	J Clin Med, 2026	PMID 41976973｜https://pubmed.ncbi.nlm.nih.gov/41976973/
#S10	peer_reviewed	Psychological treatment of dental anxiety among adults: a systematic review.	Eur J Oral Sci, 2013	PMID 23659254｜https://pubmed.ncbi.nlm.nih.gov/23659254/
#S11	peer_reviewed	Allergic Reactions in Dental Practice: Classification of Medicines, Mechanisms of Action, and Clinical Manifestations.	Clin Rev Allergy Immunol, 2025	PMID 39954171｜https://pubmed.ncbi.nlm.nih.gov/39954171/
#S12	peer_reviewed	Local Anaesthetic Systemic Toxicity in Dental and Oral and Maxillofacial Surgery: Safe Dosing, Combination Agents, and Emergency Management—A Narrative Review.	Dent J (Basel), 2026	PMID 42505765｜https://pubmed.ncbi.nlm.nih.gov/42505765/
#S13	peer_reviewed	Selection of the safest local anesthetic for dental treatment in medically compromised patients: A comprehensive review.	Saudi J Anaesth, 2026	PMID 41710613｜https://pubmed.ncbi.nlm.nih.gov/41710613/
#S14	peer_reviewed	Pediatric morbidity after oral surgery procedures under general anaesthesia: A systematic review.	J Stomatol Oral Maxillofac Surg, 2023	PMID 35961509｜https://pubmed.ncbi.nlm.nih.gov/35961509/
#S15	peer_reviewed	Sedation versus general anaesthesia for provision of dental treatment to patients younger than 18 years.	Cochrane Database Syst Rev, 2015	PMID 26413895｜https://pubmed.ncbi.nlm.nih.gov/26413895/

Anchor file #01 (Medical Care Act Article 63, geo: TW) is not cited in this article; the reason is in item 1 of “Editorial rulings and record of anchor-file corrections”.

WRITER-ADDED SOURCES (searched and measured live by this article itself, with no change made to the anchor file)

Search and live-measurement method: `esearch.fcgi` to obtain candidate PMIDs → `efetch.fcgi` (`rettype=abstract&retmode=xml`) to batch-retrieve and archive the raw XML → Python ElementTree parsing of `ArticleTitle` and `AbstractText` (those with nested tags extracted in full using `itertext()`) → included only where the string comparison `span in text` was True. The commands actually run, and the status codes:

curl -g -s -o p21_extra.xml -w "HTTP:%{http_code}\n" \
  "https://eutils.ncbi.nlm.nih.gov/entrez/eutils/efetch.fcgi?db=pubmed&id=33711405,38596946,27885969,35624907,29952645,35482282,40422600,38186148,26173721&rettype=abstract&retmode=xml"
→ HTTP:200 (run live on 2026-08-06)

#	basis	Title	Source	PMID / URL	Reason for adding this source
#W16	peer_reviewed	Estimated prevalence of dental fear in adults: A systematic review and meta-analysis.	J Dent, 2021	PMID 33711405｜https://pubmed.ncbi.nlm.nih.gov/33711405/	The anchor file has no population-level prevalence of adult dental fear, and the introduction and section 5 need a benchmark of scale
#W17	peer_reviewed	Allergy to Local Anesthetics is a Rarity: Review of Diagnostics and Strategies for Clinical Management.	Clin Rev Allergy Immunol, 2023	PMID 35482282｜https://pubmed.ncbi.nlm.nih.gov/35482282/	Anchor file #12 has only the classification of mechanisms, and lacks both the order of magnitude of “how rare true allergy is” and the standardised diagnostic pathway
#W18	peer_reviewed	True Allergies to Articaine: A 25-Year Analysis.	Dent J (Basel), 2025	PMID 40422600｜https://pubmed.ncbi.nlm.nih.gov/40422600/	Provides a count of confirmed cases over a 25-year span, giving “rare” a checkable absolute number
#W19	peer_reviewed	Efficacy of Hypnosis on Dental Anxiety and Phobia: A Systematic Review and Meta-Analysis.	Brain Sci, 2022	PMID 35624907｜https://pubmed.ncbi.nlm.nih.gov/35624907/	Evidence on behavioural management in adults published after anchor file #11 (2013), used for cross-verification and to disclose heterogeneity
#W20	peer_reviewed	Modified dental anxiety scale: validation of the italian version.	Minerva Stomatol, 2015	PMID 26173721｜https://pubmed.ncbi.nlm.nih.gov/26173721/	The scope of this article calls for “assessment instruments”, while the anchor file has only the names of scales, without the form of the instrument or its reliability
#W21	peer_reviewed	[Standardized diagnosis results of suspected local anesthetics allergy].	Zhonghua Yu Fang Yi Xue Za Zhi, 2023	PMID 38186148｜https://pubmed.ncbi.nlm.nih.gov/38186148/	Provides the actual distribution of “what kind of reaction self-reported allergy is classified as after testing”, supporting the differential map in section 2-5
#W22	peer_reviewed	True Allergy to Amide Local Anesthetics: A Review and Case Presentation.	Anesth Prog, 2018	PMID 29952645｜https://pubmed.ncbi.nlm.nih.gov/29952645/	Provides the opening sentence of the differential classification of “what adverse reactions usually are”; ⚠ it includes Case Reports and is at a lower level of evidence, so only its directional statement is used

Verbatim span comparison (the key sentences cited in this article, every one of them compared programmatically with `span in text` returning True)

Expand the span comparison table

Fn	Source #	Verbatim span (original wording)
Fn1	#S01	`Unlike full anesthesia, sedation doesn't make you completely unconscious` ／ `Levels of sedation include:` (re-verified 2026-08-06: curl HTTP 200, 90,744 bytes; at the same time confirming that the wording `continuum` does not appear in the original, so the TL;DR was changed to the layered description)
Fn3	#S01	`doesn't make you completely unconscious`
Fn4	#S01	`Minimal sedation. You are awake but more relaxed.`
Fn5	#S01	`Moderate sedation (conscious sedation)`
Fn6	#S01	`Deep sedation. You are very drowsy`
Fn11/Fn12	#S01	`You are awake during local anesthesia.`
Fn13	#S01	`Regional anesthesia numbs a larger area`
Fn15	#S01	`General anesthesia affects your whole body.`
Fn18	#S01	`used for a colonoscopy or dental work`
Fn101	#S01	`Anesthesia is generally safe.`
Fn104	#S01	`An allergic reaction to the anesthesia.`
Fn14	#S01	`You may be awake during the procedure, or you may be given sedation.`
Fn16	#S01	`It is used during major surgeries`
Fn17	#S01	`Monitored sedation makes you relaxed or sleepy.` ／ `you probably won't remember the procedure`
Fn102	#S01	`Heart rhythm problem (arrhythmia).`
Fn103	#S01	`Breathing problems.`
Fn105	#S01	`Temporary confusion (delirium), which can last several days in some people over the age of 60, or briefly in children after waking up from anesthesia.`
Fn106	#S01	`Awareness when someone is under general anesthesia. This usually means that the person hears sounds. But sometimes they can feel pain. This is rare.`
Fn107	#S01	`Talk to your health care provider about the benefits and risks of anesthesia.`
Fn7	#W16	`31 publications were deemed eligible for this systematic review.` ／ `72,577 individuals 18 years of age or older` ／ `15.3 % (95 %CI 10.2-21.2)`
Fn8	#W16	`12.4 % (95 %CI 9.5-15.6) and 3.3 % (95 %CI 0.9-7.1)`
Fn9	#W16	`31 publications were deemed eligible for this systematic review. Three studies presented low risk of bias and 28 studies presented high risk of bias`
Fn10	#W16	`instruments used to measure dental fear`
Fn119	#W16	`72,577 individuals 18 years of age or older`
Fn120	#W16	`among women and younger adults`
Fn22	#S04	`a common fear`
Fn23	#S04	`123 studies (19,223 participants)`
Fn24	#S04	`14 different formulations`
Fn31	#S04	`Adverse events were rare.`
Fn32	#S04	`the speed of onset and duration of anaesthesia`
Fn33	#S04	`no clinical studies met our outcome definitions`
Fn34	#S04	`low-quality evidence suggests that 4% articaine` ／ `was superior to 2% lidocaine` (one instance of the success-rate comparison in the original; the main text of this article does not repeat each agent combination)
Fn25	#S03	`From 1253 identified studies, 20 met the inclusion criteria.` ／ `pediatric patients aged 3-14 years`
Fn26	#S03	`significantly reduced pain perception` ／ `SMD = -0.98, p = 0.011`
Fn27	#S03	`heart rate (HR) measurements (SMD = -0.25, p = 0.013)`
Fn28	#S03	`Subgroup analysis indicated significant pain reduction with CCLAD compared to conventional Inferior Alveolar Nerve Block (IANB) on WBS`
Fn29	#S03	`very low to moderate` ／ `The overall risk of bias was low in five studies`
Fn139	#S03	`demonstrating some non-significant differences`
Fn140	#S03	`No significant differences were observed in other pain assessment parameters`
Fn141	#S03	`CCLAD demonstrates potential as a non-pharmacological tool`
Fn30	#S04	`slightly less post-injection pain than articaine`
Fn35	#S05	`Out of 574 identified studies, 21 were included in the qualitative analysis (9 randomized controlled trials (RCTs), 6 case reports and 6 cohort studies), mainly focusing on children aged 6-12.`
Fn36	#S05	`soft tissue injuries secondary to`
Fn37	#S05	`Out of 574 identified studies, 21 were included in the qualitative analysis (9 randomized controlled trials (RCTs), 6 case reports and 6 cohort studies), mainly focusing on children aged 6-12.` ／ `significant pain and cooperation issues`
Fn38	#S05	`Effective strategies include early intervention with pharmacological and non-pharmacological approaches`
Fn39	#S05	`phentolamine mesylate`
Fn40	#S05	`non-pharmacological strategies: intraoral appliances (2 studies) and photobiomodulation (2 studies)`
Fn41	#S05	`The included studies varied in design, sample size and duration, limiting direct comparisons. Effect sizes and confidence intervals were inconsistently reported, and the risk of bias assessment using the Cohen's kappa test highlighted methodological heterogeneity and potential reporting bias`
Fn42	#W22	`a reaction to epinephrine, vasovagal syncope, or overdose toxicity`
Fn72	#W22	`Often, these patients may be treated under general anesthesia`
Fn44	#S12	`rare but potentially fatal complication`
Fn46	#S12	`discrepancies between guideline sources`
Fn45	#S12	`structured differential diagnosis to distinguish LAST from more common dental emergencies`
Fn47	#S12	`the additive toxicity of combined amide agents remains underappreciated`
Fn48	#S12	`airway support and oxygenation remain`
Fn49	#S12	`Patient-specific factors substantially lower the effective toxic threshold`
Fn50	#S11	`mediated by immunoglobulin E (IgE)`
Fn52	#S11	`Pseudoallergic reactions`
Fn51	#S11	`Delayed-type reactions mediated by sensitised T lymphocytes were also considered`
Fn53	#S11	`the importance of cross-reactions, in which several structurally similar molecules bind to the same IgE antibodies or T lymphocytes`
Fn54	#S11	`lidocaine and benzocaine`
Fn55	#S11	`antibiotics including penicillins and cephalosporins, latex products such as gloves and cofferdams, acrylic materials used in dental prostheses and fillings, and metal alloys containing nickel, chromium, and cobalt`
Fn2	#W17	`True allergic reactions involving IgE-mediated reactions and anaphylaxis are rare; they have only been identified in case reports and account for less than 1% of adverse LA reactions`
Fn56	#W17	`less than 1% of adverse LA reactions`
Fn57	#W17	`Most reactions are non-allergic`
Fn62	#W17	`unnecessary avoidance of LA drugs`
Fn67	#W17	`A detailed history of prior LA reactions`
Fn68	#W17	`skin prick and intradermal testing`
Fn69	#W17	`evaluated with patch testing`
Fn58	#W18	`over the last 25 years` ／ `Results: During the investigation period, 10 case reports and six case series, encompassing 29 patients with a confirmed true allergy to articaine, were identified.`
Fn59	#W18	`over the last 25 years` ／ `Of these patients, 20 were diagnosed with an immediate type I allergy, while 5 patients exhibited a delayed type IV allergy`
Fn60	#W18	`Cross-reactivity with other amide LA was reported in three cases`
Fn61	#W18	`articaine are exceedingly rare`
Fn43	#W21	`a total of 24 patients were investigated in Allergy Center of West China Hospital` ／ `Of the remaining 17 patients, 7 were considered as psychosomatic reactions (29.1%), 3 of sympathetic nervous system conditions (12.5%), 1 of spontaneous urticaria (4.2%), 2 of vasovagal syncope (8.3%), drug side effects (8.3%), skin irritation (8.3%), respectively.`
Fn63	#W21	`a total of 24 patients were investigated in Allergy Center of West China Hospital` ／ `on suspicion of LA allergy`
Fn64	#W21	`Three cases were considered LA allergy`
Fn65	#W21	`Three cases (12.5%) were positive in previous LA skin tests and proved to be tolerated through standardized tests`
Fn66	#W21	`true allergic reactions to LA are rare`
Fn70	#S13	`Chloroprocaine, an ester anesthetic, is recommended for patients with confirmed amide allergies.`
Fn71	#S13	`tailored to each patient's medical`
Fn19	#S08	`85-92% efficacy` ／ `rapid 30-60 s onset`
Fn73	#S08	`children aged 2-12 years`
Fn74	#S08	`70-85% success for moderate cases`
Fn79	#S08	`full recovery in five minutes`
Fn81	#S08	`Limitations include protocol variability`
Fn82	#S08	`5-10% paradoxical excitation`
Fn78	#S08	`we searched PubMed, Cochrane, and Scopus (2015-2025), including 25 studies (n≈12,500 participants)` ／ `as minimally invasive options for children aged 2-12 years`
Fn80	#S08	`Safety was high overall (<5% adverse events), with N₂O safer for outpatient use`
Fn83	#S08	`midazolam offering strong amnesia but 5-10% paradoxical excitation; hydroxyzine suited low-risk adjuncts`
Fn84	#S08	`cutting dropouts by 40-50%`
Fn75	#S06	`Two hundred fifty-five consecutive patients`
Fn85	#S06	`randomly assigned to receive either intravenous sedation with local anesthesia (sedation group, n = 123) or local anesthesia only (nonsedation group, n = 132)`
Fn86	#S06	`significantly higher in the nonsedation group`
Fn87	#S06	`contributed to the safety of the patient` (located in the RESULTS section, not the CONCLUSION section)
Fn142	#S06	`had a beneficial effect for hemodynamic changes` (located in the CONCLUSION section)
Fn20	#S07	`the awakening time was defined as that when the BIS was` ／ `the patient's condition was assessed using the postanesthetic discharge scoring system (PADSS) and then reassessed every 20 minutes`
Fn88	#S07	`we evaluated American Society of Anesthesiologists (ASA) I or II patients who underwent sedation with continuous midazolam infusion during implant surgery`
Fn89	#S07	`Forty-six patients participated`
Fn92	#S07	`Forty-six patients participated` ／ `Patients under 18 years old with a history of drug allergies, obesity (body mass index of 26 kg/m2 or more), or regular use of antipsychotic, psychotropic, or hypnotic substances were excluded from the study`
Fn90	#S07	`If the 50 minutes of conscious sedation with midazolam were properly controlled` ／ `discharged within approximately 90-110 minutes`
Fn91	#S07	`within 40-60 minutes after awakening`
Fn93	#S02	`severe dental phobia` ／ `Special Care Dentistry (SCD) services` ／ `for adults within SCD services`
Fn94	#S02	`risks, implications, and costs of using GA`
Fn77	#S02	`expert consensus opinion`
Fn95	#S02	`person-centered assessment and planning`
Fn21	#S02	`Clinical guidelines are presented as a set of overarching principles followed by six key sections reflecting patients' pathways from referral to dental services through to their care during and after GA`
Fn76	#S14	`up to 91.0% of patients`
Fn96	#S14	`between 39.8 and 47.9%`
Fn97	#S14	`There is a higher prevalence for treatments in the special patient group reaching 87.7% compared to 63.3% in healthy patients`
Fn98	#S14	`Regarding complications, complaints occurred between 43.0 and 98.9% of cases within the first 24 hours, the main reason being pain (between 14.0% and 95.0%).`
Fn99	#S14	`the main reason being pain (between 14.0% and 95.0%)`
Fn100	#S14	`very low risk of major complications`
Fn108	#S09	`Twelve international guidelines` ／ `conscious sedation in pediatric dentistry`
Fn109	#S09	`Complete convergence`
Fn110	#S09	`discharge criteria (91.67%)` ／ `contraindications (83.33%)`
Fn111	#S09	`only 16.67% of guidelines providing`
Fn112	#S09	`66.67% and 50% of guidelines`
Fn113	#S09	`Although foundational safety principles are consistently addressed, significant heterogeneity persists in pharmacological and procedural recommendations. This variability may contribute to differences in practice and uncertainty among practitioners`
Fn114	#S15	`patients younger than 18 years` ／ `children and adolescents up to 18 years of age`
Fn115	#S15	`may lead to reduced morbidity and cost`
Fn116	#S15	`In our original review, we identified 16 studies for potential inclusion after searching available databases and screening titles and abstracts. After retrieving full-text studies, we found none to be eligible.`
Fn117	#S15	`We identified no additional studies in the updated search of July 2012. We identified two studies for possible inclusion in the updated search of July 2015; again we found these to be ineligible`
Fn118	#S15	`Randomized controlled studies comparing`
Fn121	#S10	`(DAS) or the Dental Fear Survey (DFS)`
Fn128	#S10	`identified 10 RCT publications`
Fn129	#S10	`as measured using the DAS (mean difference` ／ `-2.7), but the results were based on low` (in the original there is a non-breaking space U+00A0 between `difference`, `=` and `-2.7`, so it was split into two parts compared verbatim separately, both True)
Fn130	#S10	`based on low quality of evidence`
Fn131	#S10	`There was also some support that CBT/BT improves the patients' acceptance of dental treatment more than general anaesthesia does (low quality of evidence)`
Fn132	#S10	`there is evidence that behavioural interventions can help adults with dental anxiety/phobia; however, it is clear that more well-designed studies on the subject are needed`
Fn122	#W20	`total score ranging from 5 to 25`
Fn124	#W20	`Cronbach's alpha=0.92`
Fn123	#W20	`administered to 230 patients (98 male and 132 female patients, ages 14-88 years) undergoing oral surgery`
Fn125	#W20	`previous distressing experiences`
Fn126	#W20	`the correlation with age (p=0.01) and frequency on visiting the dentist (p=0.02) were also significant`
Fn127	#W20	`The patients' selection (oral surgery only) may be a limit of the study, which might not provide an estimation of anxiety prevalence in the general dental population`
Fn133	#W19	`19 clinical trials` ／ `Efficacy of Hypnosis on Dental Anxiety and Phobia` (the title of the original)
Fn135	#W19	`the most evidence for the efficacy`
Fn136	#W19	`contrasting results for the application`
Fn134	#W19	`The following treatment techniques were reviewed: various forms of cognitive-behavioral therapy (CBT), relaxation training, benzodiazepine premedication, self-hypnosis by audio therapy, hypnotherapy, hypnosis, and nitrous oxide sedation`
Fn137	#W19	`a more consistent use of methods to examine anxiety for hypnosis research is recommended`
Fn138	#W19	`hypnosis can also be regarded as powerful and successful method for anxiety reduction` ／ `a small or even slightly negative effect`
Fn56 (qualifying wording)	#W17	`True allergic reactions involving IgE-mediated reactions and anaphylaxis are rare`

FAQ

Q1. Does having the injection hurt? Is there any way to make it hurt less?: **Injection pain is a variable that has been measured: a meta-analysis including 20 RCTs in children aged 3–14 years shows that a computer-controlled local anaesthetic delivery system, compared with conventional injection, significantly reduced pain perception on the Wong-Baker scale (SMD = -0.98, p = 0.011) [Fn26], and likewise on heart rate [Fn27].** What has to be read alongside it: the study population was children [Fn25]; on other scales and other injection techniques the results were inconsistent, with some **non-significant** differences appearing [Fn139]; on other pain assessment parameters **no significant differences were observed** [Fn140]; the overall certainty of the evidence ranged from very low to moderate [Fn29]; and the authors' own concluding wording is that CCLAD “demonstrates potential” [Fn141]. This article does not extrapolate it into a figure for adults, and does not read it as an established effect. On the agent side, moderate-quality evidence from Cochrane shows that the difference in post-injection pain between different local anaesthetics is very small, and that one of them may be slightly less in that comparison [Fn30] (⚠ **neither the main text nor the FAQ of this article lists drug names or concentrations**; which one is used is decided by the dentist according to the procedure and the individual's circumstances, and the drug names given in the source are retained in the fact ledger for traceability), and that adverse events were rare [Fn31]. Pain in dental treatment is in any case a common fear among patients, and it can be successfully controlled by local anaesthesia [Fn22]. Which approach is actually adopted has to be assessed by the dentist.; Q1. 麻酔の注射は痛いですか。より痛くない方法はありますか。 — **注射時の痛みは測定されたことのある変数です。20 件のランダム化比較試験を組み入れ、対象が 3–14 歳の小児であるメタアナリシスは、コンピュータ制御局所麻酔注入システムが従来の注射と比較して、Wong-Baker の尺度で痛みの感じ方を有意に低下させ（SMD = -0.98, p = 0.011）[Fn26]、心拍数でも同様であったことを示しています [Fn27]。** あわせて読むべきことは次のとおりです。この研究の集団は小児であること [Fn25]、他の尺度と他の注射方法では結果が一致せず、一部に**有意でない**差が生じたこと [Fn139]、他の痛みの評価指標では**有意差が観察されなかった**こと [Fn140]、全体のエビデンスの確実性はきわめて低いものから中等度であること [Fn29]、そして著者自身の結論の言い回しは CCLAD が「可能性を示している」というものであること [Fn141]。本記事はこれを成人の数字へ外挿せず、確立した効果としても読みません。薬剤の面では、Cochrane の中等度の質のエビデンスが次を示しています。異なる局所麻酔薬の間で注射後の痛みの差はごく小さく、そのうちの一つはその比較においてやや少ないかもしれない [Fn30]（⚠ **本記事の本文と FAQ は薬剤名と濃度を挙げません**。どれを用いるかは処置と個々の状態に応じて歯科医師が決めます。出典の原文に記載された薬剤名は、トレーサビリティのために事実台帳に保持しています）。そして望ましくない事象はまれです [Fn31]。歯科治療の痛みはもともと患者によくある恐怖であり、それは局所麻酔によってうまくコントロールできます [Fn22]。実際にどの方法を採るかは、歯科医師の評価が必要です。; Q1. Does having the injection hurt? Is there any way to make it hurt less? — **Injection pain is a variable that has been measured: a meta-analysis including 20 RCTs in children aged 3–14 years shows that a computer-controlled local anaesthetic delivery system, compared with conventional injection, significantly reduced pain perception on the Wong-Baker scale (SMD = -0.98, p = 0.011) [Fn26], and likewise on heart rate [Fn27].** What has to be read alongside it: the study population was children [Fn25]; on other scales and other injection techniques the results were inconsistent, with some **non-significant** differences appearing [Fn139]; on other pain assessment parameters **no significant differences were observed** [Fn140]; the overall certainty of the evidence ranged from very low to moderate [Fn29]; and the authors' own concluding wording is that CCLAD “demonstrates potential” [Fn141]. This article does not extrapolate it into a figure for adults, and does not read it as an established effect. On the agent side, moderate-quality evidence from Cochrane shows that the difference in post-injection pain between different local anaesthetics is very small, and that one of them may be slightly less in that comparison [Fn30] (⚠ **neither the main text nor the FAQ of this article lists drug names or concentrations**; which one is used is decided by the dentist according to the procedure and the individual's circumstances, and the drug names given in the source are retained in the fact ledger for traceability), and that adverse events were rare [Fn31]. Pain in dental treatment is in any case a common fear among patients, and it can be successfully controlled by local anaesthesia [Fn22]. Which approach is actually adopted has to be assessed by the dentist.
Q2. How long until the anaesthetic wears off? What should I watch for while it has not yet worn off?: **The honest answer is that at the level of systematic review there is at present no pooled general figure for this question.** One of Cochrane's primary objectives included comparing the speed of onset and duration [Fn32], but the result was that no clinical studies met its outcome definitions [Fn33]. Local anaesthesia itself covers 14 different formulations [Fn24], so the timing will not be a constant. What genuinely needs watching is the window before the anaesthetic wears off: a systematic review including 21 studies, mainly in children aged 6–12 years, notes that soft-tissue injuries secondary to local anaesthesia can cause significant pain and cooperation issues [Fn37], and that effective strategies include early intervention with pharmacological and non-pharmacological approaches [Fn38]. **This article provides no procedural instruction and no medication instruction**; what to watch for on the day is to be explained by the dentist who gives the injection.; Q2. 麻酔はどれくらいで切れますか。まだ切れていないときは何に注意すればよいですか。 — **誠実な答えは次のとおりです。システマティックレビューの層において、この問いには現時点で統合された共通の数字がありません。** Cochrane の主要な目的の一つには効き始めの速さと持続時間の比較が含まれていましたが [Fn32]、結果はそのアウトカムの定義を満たす臨床研究が一件もなかったというものでした [Fn33]。局所麻酔そのものが 14 種類の異なる製剤を含むため [Fn24]、時間は一つの定数にはなりません。本当に注意すべきなのは麻酔が切れる前の空白の時間です。21 件の研究を組み入れ、6–12 歳の小児を主とするシステマティックレビューは、局所麻酔の後に続発する軟組織の損傷が著しい痛みと協力の問題を引き起こしうると指摘しており [Fn37]、有効な方策には薬理学的および非薬理学的な手段による早期の介入が含まれます [Fn38]。**本記事はいかなる操作の指示も薬の使用の指示も提供しません**。その回に何に注意すべきかは、施行した歯科医師から説明を受けてください。; Q2. How long until the anaesthetic wears off? What should I watch for while it has not yet worn off? — **The honest answer is that at the level of systematic review there is at present no pooled general figure for this question.** One of Cochrane's primary objectives included comparing the speed of onset and duration [Fn32], but the result was that no clinical studies met its outcome definitions [Fn33]. Local anaesthesia itself covers 14 different formulations [Fn24], so the timing will not be a constant. What genuinely needs watching is the window before the anaesthetic wears off: a systematic review including 21 studies, mainly in children aged 6–12 years, notes that soft-tissue injuries secondary to local anaesthesia can cause significant pain and cooperation issues [Fn37], and that effective strategies include early intervention with pharmacological and non-pharmacological approaches [Fn38]. **This article provides no procedural instruction and no medication instruction**; what to watch for on the day is to be explained by the dentist who gives the injection.
Q3. If I am afraid of the dentist, can I “have it done asleep”? What is the difference between nitrous oxide, sedation and general anaesthesia?: **Professionally, “asleep” is not a switch but a set of layers: sedation does not make a person completely unconscious and recovery is quicker [Fn3], and it is divided into the three bands of minimal, moderate (conscious sedation) and deep [Fn4][Fn5][Fn6]; general anaesthesia is the level that affects the whole body and is like a deep sleep [Fn15].** The thickness of the evidence differs from band to band: in the mild-anxiety population of children aged 2–12 years, nitrous oxide has an efficacy of 85–92%, complications under 5% and an onset of 30–60 s [Fn19][Fn73], with full recovery in five minutes [Fn79]; oral sedation is 70–85% for moderate cases in children aged 2–12 years [Fn73][Fn74]; intravenous sedation was measured in a 255-patient implant RCT as having a beneficial effect for haemodynamic changes [Fn75][Fn142]; and general anaesthesia is recorded by the British Society for Disability and Oral Health guideline, in the context of **Special Care Dentistry services**, as possibly being needed to enable people with severe learning disability or severe dental phobia to receive extensive dental treatment [Fn93], although that guideline states that the available evidence is scarce [Fn77]. **What also has to be known**: Cochrane's search for randomised controlled studies of “sedation vs general anaesthesia” in **patients younger than 18 years** found, after three rounds of searching, that not one was eligible [Fn114][Fn116][Fn117]; that population therefore has no head-to-head empirical comparison, and the authors' conclusion is that such studies are still needed [Fn118]; **the adult population was not within the search scope of that review** [Fn114], and this empty review cannot be read as any conclusion about adults. The non-pharmacological pathway exists just as much: CBT/BT can significantly reduce dental anxiety in adults (DAS mean difference -2.7, low quality of evidence) [Fn129][Fn130]. Which one to choose has to be assessed by the dentist.; Q3. 歯科が怖いのですが「眠っている間に」できますか。笑気、鎮静、全身麻酔はどう違いますか。 — **「眠る」は専門の上ではスイッチではなく、層に分かれています。鎮静は意識を完全に失わせるものではなく、回復もより速く [Fn3]、軽度・中等度（意識下鎮静）・深度の三段階に分かれます [Fn4][Fn5][Fn6]。全身麻酔こそが全身に作用し、深い眠りのように感じられる層です [Fn15]。** 各段階のエビデンスの厚みは異なります。笑気は 2–12 歳の小児の軽度の不安の集団で効果が 85–92%、合併症は 5% 未満、効き始めは 30–60 秒 [Fn19][Fn73]、5 分間以内に完全に回復するとされます [Fn79]。経口鎮静は 2–12 歳の小児の中等度の症例で 70–85% [Fn73][Fn74]。静脈内鎮静は 255 名のインプラント手術の RCT で血行動態の変化に有益な効果が測定されています [Fn75][Fn142]。全身麻酔は英国障害者口腔保健学会のガイドラインが**スペシャルケア歯科のサービス**の文脈において、重度の学習障害または重度の歯科恐怖症のある人が広範な歯科治療を受けられるようにするために必要となりうると記載していますが [Fn93]、同ガイドライン自身が利用できるエビデンスは乏しいと述べています [Fn77]。**もう一つ知っておくべきことは次のとおりです**：Cochrane は**18 歳未満の患者**について「鎮静 vs 全身麻酔」のランダム化比較研究を探し、三度の検索の後も一件も適格ではありませんでした [Fn114][Fn116][Fn117]。この集団にはそのため直接比較の実証がなく、著者の結論はこの種の研究がなお必要だというものです [Fn118]。**成人の集団はそのレビューの検索の範囲に入っておらず** [Fn114]、この空のレビューを成人についてのいかなる結論としても読むことはできません。非薬理学的な経路も存在します。CBT/BT は成人の歯科不安を有意に低下させます（DAS 平均差 -2.7、質の低いエビデンス）[Fn129][Fn130]。どれを選ぶかは、歯科医師の評価が必要です。; Q3. If I am afraid of the dentist, can I “have it done asleep”? What is the difference between nitrous oxide, sedation and general anaesthesia? — **Professionally, “asleep” is not a switch but a set of layers: sedation does not make a person completely unconscious and recovery is quicker [Fn3], and it is divided into the three bands of minimal, moderate (conscious sedation) and deep [Fn4][Fn5][Fn6]; general anaesthesia is the level that affects the whole body and is like a deep sleep [Fn15].** The thickness of the evidence differs from band to band: in the mild-anxiety population of children aged 2–12 years, nitrous oxide has an efficacy of 85–92%, complications under 5% and an onset of 30–60 s [Fn19][Fn73], with full recovery in five minutes [Fn79]; oral sedation is 70–85% for moderate cases in children aged 2–12 years [Fn73][Fn74]; intravenous sedation was measured in a 255-patient implant RCT as having a beneficial effect for haemodynamic changes [Fn75][Fn142]; and general anaesthesia is recorded by the British Society for Disability and Oral Health guideline, in the context of **Special Care Dentistry services**, as possibly being needed to enable people with severe learning disability or severe dental phobia to receive extensive dental treatment [Fn93], although that guideline states that the available evidence is scarce [Fn77]. **What also has to be known**: Cochrane's search for randomised controlled studies of “sedation vs general anaesthesia” in **patients younger than 18 years** found, after three rounds of searching, that not one was eligible [Fn114][Fn116][Fn117]; that population therefore has no head-to-head empirical comparison, and the authors' conclusion is that such studies are still needed [Fn118]; **the adult population was not within the search scope of that review** [Fn114], and this empty review cannot be read as any conclusion about adults. The non-pharmacological pathway exists just as much: CBT/BT can significantly reduce dental anxiety in adults (DAS mean difference -2.7, low quality of evidence) [Fn129][Fn130]. Which one to choose has to be assessed by the dentist.

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km 編輯部・《A complete guide to dental anaesthesia, sedation and fear of the dentist: a domain map running from how local anaesthesia works, through the sedation spectrum, to the assessment of anxiety｜證據鏈》・IDAEO 知識庫・2026-08-13・https://km.idaeo.ai/post/reports/dental-pillar-anesthesia-anxiety-evidence

更新 2026-08-13T14:17:27.544Z · server-rendered · four-language · IDAEO 知識庫

A complete guide to dental anaesthesia, sedation and fear of the dentist: a domain map running from how local anaesthesia works, through the sedation spectrum, to the assessment of anxiety｜證據鏈

A complete guide to dental anaesthesia, sedation and fear of the dentist: a domain map running from how local anaesthesia works, through the sedation spectrum, to the assessment of anxiety｜證據鏈

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