Non-Cochrane · intervention · PM42120996
Investigating the efficacy of dexmedetomidine as an adjuvant to local anesthesia in dentistry: systematic review and meta-analysis.
Abdu Salah Ameen, Asaad Wafa Ali, Wei Tao, et al. · Systematic reviews · 2026 · PubMed · doi:10.1186/s13643-026-03202-0
Findings
Population People aged 10 years or older undergoing dental procedures under local anesthesia (mostly third molar and premolar extraction)
39 findings
| Dexmedetomidine as an adjuvant to dental local anesthetic (any dose) | Local anesthetic alone or with adrenaline (control) | Diastolic blood pressure (mmHg) All timepoints combined (30 min, 120 min, postoperative) · Dental surgery, mainly inferior alveolar and infraorbital nerve blocks (third molar and premolar extraction) | MD -0.02 [-0.98, 0.94] High 7 studies · 350 participants |
| Dexmedetomidine as an adjuvant to dental local anesthetic (any dose) | Local anesthetic alone or with adrenaline (control) | Systolic blood pressure (mmHg) Intraoperative, 30 min · Dental surgery, mainly inferior alveolar and infraorbital nerve blocks (third molar and premolar extraction) | MD 0.13 [-1.53, 1.80] GRADE not reported 7 studies · 350 participants |
| Dexmedetomidine as an adjuvant to dental local anesthetic (any dose) | Local anesthetic alone or with adrenaline (control) | Onset time of nerve block (seconds) Dental surgery, mainly inferior alveolar and infraorbital nerve blocks (third molar and premolar extraction) · Multivariable meta-regression: intercept Unresolved: the two extractors disagree on this row. | MD (meta-regression coefficient) -67.01 GRADE not reported Studies not reported |
| Dexmedetomidine as an adjuvant to dental local anesthetic (any dose) | Local anesthetic alone or with adrenaline (control) | Systolic blood pressure (mmHg) Postoperative · Dental surgery, mainly inferior alveolar and infraorbital nerve blocks (third molar and premolar extraction) | MD -2.15 [-4.64, 0.34] GRADE not reported 4 studies · 200 participants |
| Dexmedetomidine as an adjuvant to dental local anesthetic (any dose) | Local anesthetic alone or with adrenaline (control) | Onset time of nerve block (seconds) From injection completion to effective sensory block · Dental surgery, mainly inferior alveolar and infraorbital nerve blocks (third molar and premolar extraction) | MD -48.78 [-64.22, -33.35] Moderate Downgraded: inconsistency 8 studies · 560 participants |
| Dexmedetomidine as an adjuvant to dental local anesthetic (any dose) | Local anesthetic alone or with adrenaline (control) | Onset time of nerve block (seconds) Dental surgery, mainly inferior alveolar and infraorbital nerve blocks (third molar and premolar extraction) · Multivariable meta-regression: anesthesia type (non-lidocaine) coefficient | MD (meta-regression coefficient) 6.40 [-29.90, 42.71] GRADE not reported Studies not reported |
| Dexmedetomidine as an adjuvant to dental local anesthetic (any dose) | Local anesthetic alone or with adrenaline (control) | Systolic blood pressure (mmHg) At 120 min · Dental surgery, mainly inferior alveolar and infraorbital nerve blocks (third molar and premolar extraction) | MD 1.65 [-0.68, 3.98] GRADE not reported 3 studies · 150 participants |
| Dexmedetomidine as an adjuvant to dental local anesthetic (any dose) | Local anesthetic alone or with adrenaline (control) | Duration of nerve block (minutes) Dental surgery, mainly inferior alveolar and infraorbital nerve blocks (third molar and premolar extraction) · Meta-regression, lidocaine 2% vs 1% (univariable): coefficient | MD (meta-regression coefficient) -3.9 [-35.1, 27.3] GRADE not reported 12 studies |
| Dexmedetomidine as an adjuvant to dental local anesthetic (any dose) | Local anesthetic alone or with adrenaline (control) | Duration of postoperative analgesia (minutes) From procedure end to first rescue analgesia or pain threshold (VAS 3 or more) · Dental surgery, mainly inferior alveolar and infraorbital nerve blocks (third molar and premolar extraction) | MD 186.19 [109.09, 263.29] Moderate Downgraded: imprecision 4 studies · 270 participants |
| Dexmedetomidine as an adjuvant to dental local anesthetic (any dose) | Local anesthetic alone or with adrenaline (control) | Heart rate (bpm) At 120 min · Dental surgery, mainly inferior alveolar and infraorbital nerve blocks (third molar and premolar extraction) | MD 0.00 [-1.20, 1.20] GRADE not reported 3 studies · 150 participants |
| Dexmedetomidine as an adjuvant to dental local anesthetic (any dose) | Local anesthetic alone or with adrenaline (control) | Duration of nerve block (minutes) From full sensory block to return of sensation · Dental surgery, mainly inferior alveolar and infraorbital nerve blocks (third molar and premolar extraction) · Sensitivity: fixed-effect model | MD 48.44 [44.84, 52.04] GRADE not reported 7 studies · 534 participants |
| Dexmedetomidine as an adjuvant to dental local anesthetic (any dose) | Local anesthetic alone or with adrenaline (control) | Onset time of nerve block (seconds) Dental surgery, mainly inferior alveolar and infraorbital nerve blocks (third molar and premolar extraction) · Meta-regression, DEX concentration >1 ug/mL (univariable): intercept Unresolved: the two extractors disagree on this row. | MD (meta-regression coefficient) -64.51 GRADE not reported Studies not reported |
| Dexmedetomidine as an adjuvant to dental local anesthetic (any dose) | Local anesthetic alone or with adrenaline (control) | Diastolic blood pressure (mmHg) Postoperative · Dental surgery, mainly inferior alveolar and infraorbital nerve blocks (third molar and premolar extraction) | MD 0.56 [-1.60, 2.71] GRADE not reported 4 studies · 200 participants |
| Dexmedetomidine as an adjuvant to dental local anesthetic (any dose) | Local anesthetic alone or with adrenaline (control) | Heart rate (bpm) Intraoperative, 30 min · Dental surgery, mainly inferior alveolar and infraorbital nerve blocks (third molar and premolar extraction) | MD 0.10 [-1.02, 1.23] GRADE not reported 7 studies · 350 participants |
| Dexmedetomidine as an adjuvant to dental local anesthetic (any dose) | Local anesthetic alone or with adrenaline (control) | Duration of nerve block (minutes) Dental surgery, mainly inferior alveolar and infraorbital nerve blocks (third molar and premolar extraction) · Meta-regression, DEX dose 1 vs >1 ug/mL (univariable): coefficient | MD (meta-regression coefficient) -13.2 [-43.4, 16.9] GRADE not reported 12 studies |
| Dexmedetomidine as an adjuvant to dental local anesthetic (any dose) | Local anesthetic alone or with adrenaline (control) | Onset time of nerve block (seconds) Dental surgery, mainly inferior alveolar and infraorbital nerve blocks (third molar and premolar extraction) · Meta-regression, non-lidocaine vs lidocaine anesthetic (univariable): coefficient | MD (meta-regression coefficient) -0.75 [-44.54, 43.04] GRADE not reported Studies not reported |
| Dexmedetomidine as an adjuvant to dental local anesthetic (any dose) | Local anesthetic alone or with adrenaline (control) | Onset time of nerve block (seconds) Dental surgery, mainly inferior alveolar and infraorbital nerve blocks (third molar and premolar extraction) · Meta-regression, lidocaine (univariable): intercept Unresolved: the two extractors disagree on this row. | MD (meta-regression coefficient) -48.62 GRADE not reported Studies not reported |
| Dexmedetomidine as an adjuvant to dental local anesthetic (any dose) | Local anesthetic alone or with adrenaline (control) | Onset time of nerve block (seconds) From injection completion to effective sensory block · Dental surgery, mainly inferior alveolar and infraorbital nerve blocks (third molar and premolar extraction) · Mandibular anesthesia | MD -47.94 [-74.01, -21.86] GRADE not reported 5 studies · 270 participants |
| Dexmedetomidine as an adjuvant to dental local anesthetic (any dose) | Local anesthetic alone or with adrenaline (control) | Oxygen saturation (SpO2, %) Intra- and postoperative · Dental surgery, mainly inferior alveolar and infraorbital nerve blocks (third molar and premolar extraction) | MD 0.00 [-0.11, 0.10] High 5 studies · 250 participants |
| Dexmedetomidine as an adjuvant to dental local anesthetic (any dose) | Local anesthetic alone or with adrenaline (control) | Heart rate (bpm) All timepoints combined (30 min, 120 min, postoperative) · Dental surgery, mainly inferior alveolar and infraorbital nerve blocks (third molar and premolar extraction) | MD 0.24 [-0.53, 1.02] High 7 studies · 350 participants |
| Dexmedetomidine as an adjuvant to dental local anesthetic (any dose) | Local anesthetic alone or with adrenaline (control) | Diastolic blood pressure (mmHg) Intraoperative, 30 min · Dental surgery, mainly inferior alveolar and infraorbital nerve blocks (third molar and premolar extraction) | MD 0.04 [-1.37, 1.45] GRADE not reported 7 studies · 350 participants |
| Dexmedetomidine as an adjuvant to dental local anesthetic (any dose) | Local anesthetic alone or with adrenaline (control) | Duration of nerve block (minutes) From full sensory block to return of sensation · Dental surgery, mainly inferior alveolar and infraorbital nerve blocks (third molar and premolar extraction) | MD 31.10 [13.77, 48.43] Moderate Downgraded: inconsistency 7 studies · 534 participants |
| Dexmedetomidine as an adjuvant to dental local anesthetic (any dose) | Local anesthetic alone or with adrenaline (control) | Onset time of nerve block (seconds) From injection completion to effective sensory block · Dental surgery, mainly inferior alveolar and infraorbital nerve blocks (third molar and premolar extraction) · Site subgroup analysis, all maxillary and mandibular rows combined | MD -49.24 [-66.59, -31.88] GRADE not reported 6 studies · 490 participants |
| Dexmedetomidine as an adjuvant to dental local anesthetic (any dose) | Local anesthetic alone or with adrenaline (control) | Duration of nerve block (minutes) Dental surgery, mainly inferior alveolar and infraorbital nerve blocks (third molar and premolar extraction) · Multivariable meta-regression: lidocaine 2% vs 1% coefficient | MD (meta-regression coefficient) 19.5 [-32.3, 71.2] GRADE not reported 12 studies |
| Dexmedetomidine as an adjuvant to dental local anesthetic (any dose) | Local anesthetic alone or with adrenaline (control) | Duration of postoperative analgesia (minutes) From procedure end to first rescue analgesia or pain threshold (VAS 3 or more) · Dental surgery, mainly inferior alveolar and infraorbital nerve blocks (third molar and premolar extraction) · Sensitivity: fixed-effect model | MD 167.16 [161.80, 172.52] GRADE not reported 4 studies · 270 participants |
| Dexmedetomidine as an adjuvant to dental local anesthetic (any dose) | Local anesthetic alone or with adrenaline (control) | Duration of nerve block (minutes) Dental surgery, mainly inferior alveolar and infraorbital nerve blocks (third molar and premolar extraction) · Meta-regression, DEX dose >1 ug/mL (univariable): intercept | MD (meta-regression coefficient) 39.1 [16.6, 61.6] GRADE not reported 12 studies |
| Dexmedetomidine as an adjuvant to dental local anesthetic (any dose) | Local anesthetic alone or with adrenaline (control) | Duration of nerve block (minutes) Dental surgery, mainly inferior alveolar and infraorbital nerve blocks (third molar and premolar extraction) · Meta-regression, lidocaine 1% (univariable): intercept | MD (meta-regression coefficient) 33.5 [11.1, 56.0] GRADE not reported 12 studies |
| Dexmedetomidine as an adjuvant to dental local anesthetic (any dose) | Local anesthetic alone or with adrenaline (control) | Heart rate (bpm) Postoperative · Dental surgery, mainly inferior alveolar and infraorbital nerve blocks (third molar and premolar extraction) | MD 1.72 [-0.59, 4.02] GRADE not reported 4 studies · 200 participants |
| Dexmedetomidine as an adjuvant to dental local anesthetic (any dose) | Local anesthetic alone or with adrenaline (control) | Diastolic blood pressure (mmHg) At 120 min · Dental surgery, mainly inferior alveolar and infraorbital nerve blocks (third molar and premolar extraction) | MD -0.43 [-2.06, 1.21] GRADE not reported 3 studies · 150 participants |
| Dexmedetomidine as an adjuvant to dental local anesthetic (any dose) | Local anesthetic alone or with adrenaline (control) | Onset time of nerve block (seconds) Dental surgery, mainly inferior alveolar and infraorbital nerve blocks (third molar and premolar extraction) · Multivariable meta-regression: DEX concentration 1 ug/mL coefficient | MD (meta-regression coefficient) 22.47 [-10.55, 55.49] GRADE not reported Studies not reported |
| Dexmedetomidine as an adjuvant to dental local anesthetic (any dose) | Local anesthetic alone or with adrenaline (control) | Duration of postoperative analgesia (minutes) From procedure end to first rescue analgesia or pain threshold (VAS 3 or more) · Dental surgery, mainly inferior alveolar and infraorbital nerve blocks (third molar and premolar extraction) · Sensitivity: random-effects model in Comprehensive Meta-Analysis | MD 186.28 [108.95, 263.60] GRADE not reported 4 studies · 270 participants |
| Dexmedetomidine as an adjuvant to dental local anesthetic (any dose) | Local anesthetic alone or with adrenaline (control) | Onset time of nerve block (seconds) From injection completion to effective sensory block · Dental surgery, mainly inferior alveolar and infraorbital nerve blocks (third molar and premolar extraction) · Maxillary anesthesia | MD -49.88 [-63.76, -35.99] GRADE not reported 3 studies · 220 participants |
| Dexmedetomidine as an adjuvant to dental local anesthetic (any dose) | Local anesthetic alone or with adrenaline (control) | Duration of nerve block (minutes) Dental surgery, mainly inferior alveolar and infraorbital nerve blocks (third molar and premolar extraction) · Multivariable meta-regression: DEX dose 1 vs >1 ug/mL coefficient | MD (meta-regression coefficient) -29.1 [-81.2, 22.9] GRADE not reported 12 studies |
| Dexmedetomidine as an adjuvant to dental local anesthetic (any dose) | Local anesthetic alone or with adrenaline (control) | Onset time of nerve block (seconds) From injection completion to effective sensory block · Dental surgery, mainly inferior alveolar and infraorbital nerve blocks (third molar and premolar extraction) · Sensitivity: fixed-effect model | MD -50.58 [-53.72, -47.44] GRADE not reported 8 studies · 560 participants |
| Dexmedetomidine as an adjuvant to dental local anesthetic (any dose) | Local anesthetic alone or with adrenaline (control) | Duration of nerve block (minutes) Dental surgery, mainly inferior alveolar and infraorbital nerve blocks (third molar and premolar extraction) · Multivariable meta-regression: intercept Unresolved: the two extractors disagree on this row. | MD (meta-regression coefficient) 37.7 [14.9, 60.6] GRADE not reported 12 studies |
| Dexmedetomidine as an adjuvant to dental local anesthetic (any dose) | Local anesthetic alone or with adrenaline (control) | Onset time of nerve block (seconds) Dental surgery, mainly inferior alveolar and infraorbital nerve blocks (third molar and premolar extraction) · Meta-regression, DEX concentration 1 vs >1 ug/mL (univariable): coefficient | MD (meta-regression coefficient) 20.80 [-12.27, 53.87] GRADE not reported Studies not reported |
| Dexmedetomidine as an adjuvant to dental local anesthetic (any dose) | Local anesthetic alone or with adrenaline (control) | Systolic blood pressure (mmHg) All timepoints combined (30 min, 120 min, postoperative) · Dental surgery, mainly inferior alveolar and infraorbital nerve blocks (third molar and premolar extraction) | MD 0.01 [-1.18, 1.20] High 7 studies · 350 participants |
| Dexmedetomidine 1 ug/mL as an adjuvant to dental local anesthetic | Local anesthetic alone or with adrenaline (control) | Onset time of nerve block (seconds) From injection completion to effective sensory block · Dental surgery, mainly inferior alveolar and infraorbital nerve blocks (third molar and premolar extraction) · Dexmedetomidine 1 ug/mL | MD -43.72 [-59.69, -27.76] GRADE not reported 6 studies · 390 participants |
| Dexmedetomidine as an adjuvant to 2% lidocaine for dental nerve block | 2% lidocaine alone or with adrenaline (control) | Onset time of nerve block (seconds) From injection completion to effective sensory block · Dental surgery, mainly inferior alveolar and infraorbital nerve blocks (third molar and premolar extraction) · Lidocaine 2% only | MD -49.09 [-60.11, -38.08] GRADE not reported 6 studies · 450 participants |
Included primary studies 18
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Alizargar 2021 Injection of Lidocaine Alone versus Lidocaine plus Dexmedetomidine in Impacted Third Molar Extraction Surgery, a Double-Blind Randomized… PMID:33574974 | 2021 | this review only | not stated | not extracted yet |
| Bhardwaj 2024 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Doshi 2024 Comparing the efficacy of adrenaline, clonidine, and dexmedetomidine in enhancing local anesthesia for impacted third molar extraction: a… PMID:39118811 | 2024 | this review only | not stated | not extracted yet |
| Elsawy 2021 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Etemadi 2022 Effect of Dexmedetomidine Added to Lidocaine Cartridge on the Level of Patient Sedation, Cooperation, and Patient and Surgeon Satisfaction… DOI:10.1155/2022/4722674 | 2022 | this review only | not stated | not extracted yet |
| Etemadi 2022 Effect of Dexmedetomidine Added to Lidocaine Cartridge on the Level of Patient Sedation, Cooperation, and Patient and Surgeon Satisfaction… PMID:36193181 | 2022 | this review only | not stated | not extracted yet |
| Khandaitkar 2016 A clinical study to determine the efficacy of 7ppm dexmedetomidine as an adjuvant to 2% lignocaine in infraorbital nerve block. PMID:27522312 | 2016 | this review only | not stated | not extracted yet |
| Kosar 2021 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Kumar 2016 The newer aspect of dexmedetomidine use in dentistry: As an additive to local anesthesia, initial experience, and review of literature. PMID:28163484 | 2016 | this review only | not stated | not extracted yet |
| Nalawade 2021 A clinical comparative study of dexmedetomidine as an adjuvant to 2% plain lignocaine and 2% lignocaine with 1:200,000 adrenaline as local… PMID:34483586 | 2021 | this review only | not stated | not extracted yet |
| Ouchi 2016 Dexmedetomidine Dose Dependently Enhances the Local Anesthetic Action of Lidocaine in Inferior Alveolar Nerve Block: A Randomized… PMID:27015544 | 2016 | this review only | not stated | not extracted yet |
| Ouchi 2020 Dexmedetomidine 2 ppm Is Appropriate for the Enhancement Effect of Local Anesthetic Action of Lidocaine in Inferior Alveolar Nerve Block:… PMID:32398441 | 2020 | this review only | not stated | not extracted yet |
| Patil 2022 Does dexmedetomidine combined with levobupivacaine in inferior alveolar nerve blocks among patients undergoing impacted third molar… PMID:35449786 | 2022 | this review only | not stated | not extracted yet |
| Priyaranjan 2020 A Comparative Study Evaluating the Efficacy of Lignocaine and Dexmedetomidine with Lignocaine and Adrenaline in Third Molar Surgery DOI:10.1007/s12663-020-01477-x | 2020 | this review only | not stated | not extracted yet |
| Priyaranjan 2020 A Comparative Study Evaluating the Efficacy of Lignocaine and Dexmedetomidine with Lignocaine and Adrenaline in Third Molar Surgery. PMID:35712398 | 2022 | this review only | not stated | not extracted yet |
| Singh 2018 Dexmedetomidine as an Additive to Local Anesthesia: A Step to Development in Dentistry. PMID:29964002 | 2018 | this review only | not stated | not extracted yet |
| Suryawanshi 2022 Comparative Analysis of Anaesthetic Efficacy of 2% Lignocaine With Dexmedetomidine as an Adjunct in Nerve Blocks for Dental Extractions: A… PMID:36225489 | 2022 | this review only | not stated | not extracted yet |
| Yamane 2014 Effect of dexmedetomidine injected into the oral mucosa in combination with lidocaine on local anesthetic potency in humans: a crossover… PMID:25544294 | 2015 | this review only | not stated | not extracted yet |
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Participants aged 10 years or older undergoing dental procedures (pulpal anesthesia studies and under 10 years excluded) | 658 participants (877 arch-level injections); India 10, Japan 3, Iran 2, Egypt 1 studies |
| Intervention | Dexmedetomidine as an adjuvant to dental local anesthetic | Dexmedetomidine 0.24 to 15 ug as adjuvant to lidocaine, levobupivacaine or ropivacaine; inferior alveolar nerve block (11), IANB plus infraorbital (4), submucosal (1) |
| Comparison | Local anesthesia alone or with alternative adjuvants | Local anesthetic alone or with adrenaline |
| Outcomes | Onset time, anesthesia duration, postoperative analgesia duration, pain scores, sedation, adverse events (heart rate, blood pressure, oxygen saturation) | Onset time (8 studies, n=560), anesthesia duration (7, n=534), analgesia duration (4, n=270), heart rate, systolic and diastolic blood pressure, oxygen saturation; postoperative pain and sedation narrative only |
| Study designs | Clinical trials published in English | 14 RCTs and 2 non-randomized studies (16 trials) |
| Timing | Not specified | 30 min, 120 min and postoperative hemodynamics |
AMSTAR 2 items
Two independent extractors rated each item. Their ratings are shown side by side because they have not been reconciled yet. The overall rating follows Shea et al. 2017: one critical flaw gives Low, more than one gives Critically Low.
| Item | Extractor A | Extractor B | Agree |
|---|---|---|---|
| 1Research question includes PICO components | Yes | Yes | yes |
| 2Protocol established before the reviewcritical | Partial Yes | Partial Yes | yes |
| 3Choice of study designs explained | No | No | yes |
| 4Comprehensive literature searchcritical | Partial Yes | No | no |
| 5Study selection in duplicate | Yes | Yes | yes |
| 6Data extraction in duplicate | Yes | Yes | yes |
| 7List of excluded studies with reasonscritical | No | Yes | no |
| 8Included studies described in detail | Partial Yes | Partial Yes | yes |
| 9Risk of bias assessed satisfactorilycritical | RCT: Yes · NRSI: Yes | NRSI: Yes · RCT: Yes | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | RCT: Yes · NRSI: No | NRSI: No · RCT: No | no |
| 12Impact of risk of bias on the pooled results | No | No | yes |
| 13Risk of bias accounted for in interpretationcritical | Yes | No | no |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | Yes | Yes | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Critically Low | Critically Low | yes |