Abstract
Background: Dental care for non-cooperative patients is a major clinical and organizational challenge, particularly in individuals with intellectual or neurodevelopmental disabilities and in patients with severe dental anxiety or phobia. When behavioral techniques are insufficient, conscious or deep sedation or general anesthesia may be required, but practical guidance on selection and care pathways remains fragmented. Methods: We combined a retrospective observational analysis from a single Italian academic center with a narrative review of the international literature. Forty-one sedation-assisted dental sessions were included. Demographics, indication for non-cooperation, sedation regimens, procedures, completion rates, and adverse events were descriptively analyzed. Results: The cohort included pediatric and adult patients; non-cooperation was mainly related to disability/neurodevelopmental conditions or severe dental phobia. Benzodiazepine-based oral or intravenous sedation, sometimes combined with low-dose propofol, enabled completion of all planned procedures without major adverse events or conversion to general anesthesia. The literature supports general anesthesia for profound non-cooperation or extensive treatment needs, but availability and waiting lists limit access; sedation is effective for selected cases with appropriate organizational support. Conclusions: An individualized stepped-care model integrating behavioral management, sedation, general anesthesia, and structured preventive recall may optimize access and outcomes within the Italian context and strengthen long-term post-treatment attendance.