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The most recent pain and anxiety control techniques employed in patients with Down syndrome are described in relation to how cooperative the patient is and what assessment is made of his or her general condition. The growing deinstitutionalization of these patients and the growing social opportunities for them are matched by an increasing demand for dental treatment. Down syndrome is thus one of the disabilities with which the dentist is most likely to come into contact in his own surgery. Pain control is one of the keys to building the relationship between physician and patient and obtaining patient compliance in the conviction that only regular controls can maintain the oral health of these patients. A local anaesthetic, combined when possible with psychological techniques, remains the approach of choice and only a level of compliance that is really wanting or the need to carry out numerous operations in a single session should lead the dentist to choose conscious sedation or a general anaesthetic. The choice of technique, however, should take into account any systemic disease present, such as congenital heart and neurological diseases, bearing in mind that conscious or deep sedation and general anaesthesia should only be adopted in a hospital environment and require the presence of an anaesthesiologist.