Evaluation of Dexmedetomidine Intranasal Spray on Patient's Anxiety and Pain in Minor Oral Surgery: A Prospective Clinical Study

Dental anxiety is a common psychological barrier encountered during minor oral surgical procedures and is often associated with increased pain perception, sympathetic stimulation, poor patient cooperation, and reduced treatment acceptance. Conscious sedation plays an important role in alleviating anxiety while maintaining protective airway reflexes and patient responsiveness. Dexmedetomidine, a highly selective α₂-adrenergic receptor agonist, has gained increasing attention because of its sedative, anxiolytic, analgesic, and sympatholytic properties with minimal respiratory depression. The intranasal route offers a non-invasive, needle-free method of drug delivery with rapid systemic absorption and improved patient acceptance. Although intranasal dexmedetomidine has been evaluated in various medical settings, limited evidence exists regarding its effectiveness in outpatient minor oral surgical procedures. Aim To evaluate the efficacy of intranasal dexmedetomidine spray in reducing anxiety and pain during minor oral surgical procedures and to assess its effects on sedation level, hemodynamic parameters, and oxygen saturation. Materials and Methods A prospective clinical study was conducted in the Department of Oral and Maxillofacial Surgery, SIBAR Institute of Dental Sciences, Guntur, Andhra Pradesh. Thirty patients requiring minor oral surgical procedures under local anesthesia were enrolled after obtaining written informed consent and institutional ethical clearance. Patients satisfying the inclusion criteria received intranasal dexmedetomidine before surgery using a mucosal atomization device according to the study protocol. Anxiety was evaluated using the Visual Anxiety Facial Scale (VAFS), while pain perception was assessed using the Visual Analogue Scale (VAS). Sedation was assessed with the Ramsay Sedation Scale (RSS). Hemodynamic parameters, including heart rate, systolic blood pressure, diastolic blood pressure, and peripheral oxygen saturation (SpO₂), were recorded at predetermined intervals before and after drug administration and throughout the surgical procedure. The collected data were statistically analyzed using appropriate descriptive and inferential statistical tests. A p-value of <0.05 was considered statistically significant. Results Thirty patients successfully completed the study. Intranasal dexmedetomidine produced a significant reduction in preoperative anxiety scores and achieved satisfactory conscious sedation without compromising patient cooperation. Pain scores remained low during the surgical procedure, indicating effective perioperative analgesia. A significant reduction in heart rate and blood pressure was observed following drug administration, reflecting attenuation of sympathetic activity while remaining within clinically acceptable limits. Oxygen saturation remained stable throughout the procedure, with no evidence of respiratory depression. No major adverse events requiring medical intervention were encountered, and all procedures were completed successfully under local anesthesia with satisfactory operating conditions and good patient acceptance. Conclusion Intranasal dexmedetomidine is a safe, effective, and well-tolerated sedative adjunct for minor oral surgical procedures performed under local anesthesia. It significantly reduces patient anxiety, provides satisfactory conscious sedation and analgesia, maintains stable respiratory function, and contributes to favorable hemodynamic control without serious complications. Its non-invasive route of administration and high patient acceptability make it a promising alternative to conventional sedation techniques in outpatient oral and maxillofacial surgery. Larger randomized controlled trials with longer follow-up periods are recommended to further validate its efficacy and establish standardized clinical protocols. Keywords: Dexmedetomidine; Intranasal administration; Conscious sedation; Dental anxiety; Minor oral surgery; Oral and maxillofacial surgery; Visual analogue scale; Ramsay sedation scale.