ENDODONTIC TREATMENT PROTOCOLS FOR PATIENTS WITH SEVERE ANXIETY AND PANIC DISORDERS

Abstract

Introduction: Endodontics is a dental specialty dedicated to the diagnosis and treatment of pulpal and periapical diseases, often associated with high levels of anxiety. Dental anxiety serves as a significant public health barrier, as the fear of pain and clinical instruments leads to treatment procrastination or refusal, resulting in worsening infections. Patients with severe anxiety or panic disorders require specialized attention, as triggers such as needles and previous traumatic experiences can exacerbate phobic states. Modern practice seeks to integrate emotional support protocols and pharmacological interventions to break the cycle of avoidance and ensure safe care. Objective: This study reviews the literature on protocols and approaches used in the endodontic treatment of patients with severe anxiety and panic disorders, identifying best practices for clinical management. Methodology: An integrative literature review was conducted in the PubMed and VHL databases, focusing on publications between 2019 and 2025. The search strategy utilized descriptors such as "Endodontics," "Anxiety disorders," and "Panic disorder," applying the PICOS model to select experimental studies, case reports, and reviews in Portuguese and English. Results: Findings indicate that dental anxiety affects up to 58% of adults, being more prevalent in women and young adults. Non-pharmacological strategies, such as assertive communication, music therapy, and distraction techniques, reduce tension in over 60% of patients. Discussion: The discussion emphasizes that anxiety control is fundamental for clinical success, transforming the endodontist into an emotional manager. Conclusion: Effective management of anxious patients in endodontics requires an integrated approach that joins psychological sensitivity with technical rigor. Combining behavioral techniques with minimal sedation represents the gold standard for enabling treatment, preventing systemic complications, and improving quality of life.