Authors describe most recent techniques in anxiety and pain control in Down Syndrome patients. Physical and psychological considerations are factors that determine the choice of methods. Down Syndrome represents one of the most frequent genetic diseases causing mental and physical impairment and because of crescent deinstitutionalisation and social opportunities these patients often require dental treatment. Pain control represents one of the most important aspects in therapeutical approach to obtain patient compliance, considering that oral health is the result of continuing relationship between dentist and patient. Congenital heart and neurological diseases are to be carefully considered in choosing a pain control technique. Local anaesthesia together with psychological approach is always the first choice and other techniques are reserved to non collaborative patients and to cases needing one step therapy. However conscious and deep sedation and general anaesthesia required hospital environment and the presence of an anaesthesiologist to monitorize vital parameters