Pharmacological Sedation for Dental Treatment in People with Intellectual or Neurological Disabilities: Treatment Completion, Cardiorespiratory Adverse Events and Recovery. A Systematic Review and Meta-analysis.

Objective: To evaluate the effectiveness of treatment and the cardiopulmonary safety of pharmacological sedation in patients with intellectual or neurological disabilities. Methods: The study was registered in PROSPERO (CRD420261542414) and conducted following the recommendations of the Cochrane Handbook and PRISMA guidelines. The PubMed, Google Scholar, Dimensions, Scopus and Cochrane Library databases were searched till 1 October 2026 without any language restrictions. Studies included into the review were eligible human clinical studies that contained information on treatment completion, adverse effects and/or recovery after sedation for dental care in patients with intellectual or neurological disabilities. Tools that evaluated risk of bias according to each study design were employed and outcome-level certainty of evidence assessment using GRADE was performed. Meta-analysis was conducted by pooling of treatment completion, cardiorespiratory adverse effects and recovery indicators under random-effects model. The rate of serious adverse events was examined in terms of frequency with exact confidence interval. Results: Twenty-two papers have been selected. Treatment completion or success was reported in 18 studies (93.8%, 95% CI 90.0–96.8%; I² = 89.8%). The incidence of desaturation was 6.0% (95% CI 1.8 – 12.2%), and the one of airway intervention 7.3% (1.3 – 16.8%). Serious adverse effects occurred in 1/2,245 patients/sedations (0.04%; exact 95% CI 0.00 – 0.25%). Other adverse effects and vomiting in 5.8% (95% CI 2.1 – 10.9%) and 3.0% (1.1 – 5.7%), respectively. The average length of early recovery and readiness for discharge was 13.9 minutes (95% CI 8.3 – 19.6) and 59.7 minutes (44.1 – 75.4), respectively. Prolonged recovery was observed in 7.5% (95% CI 0.8 – 19.3%). Low evidence certainty was identified in 3 outcomes and very low in 9 outcomes. Conclusions: Sedation has proved its ability of frequent treatment completion, but cardiorespiratory adverse events and heterogeneous recovery remained problems. Clinical and statistical heterogeneity, along with methodological limitations, prevented conclusions about safety or effectiveness.