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| Citation | Participants | Sedative regime | Dental procedure | Behavioral outcomes | Results/conclusions |
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| Malhotra et al., 2016 [3] | 36 children, 3–9 years old | MK: saline IN and midazolam (0.5 mg/kg) PO with ketamine (5 mg/kg) mixed in mango juice
DX: dexmedetomidine (1 μg/kg) IN and mango juice
C: saline IN and mango juice | Unclear | Sedation level and behavior score (modified observer assessment of alertness and sedation, MOAAS)
Ease of treatment completion (Houpt scale) | MK: 75.0% patients successfully sedated; DX, 53.9%; C, none
Houpt scores were higher in MK than DX |
|
| Flores-Castillo et al., 2015 [4] | 13 children,
17–46 months old | A: midazolam (0.4 mg/kg) SC
B: midazolam-ketamine (0.4 and 0.1 mg/kg) SC | Procedures with local anesthesia | Behavior (modified Houpt scale) | Group A: 53.85% (no cry and no movement)
Group B: 69.23% (cry and movement that not interfere with treatment) |
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| Salem et al., 2015 [5] | 88 children,
4–7 years old | Midazolam (0.2 or 0.5 mg/kg) PO
A: PO formulation
B: IV formulation | Pulp therapy in primary molars | Behavior (North Carolina and Houpt scale) | Acceptable behavior in 90.9% (A) and 79.5% (B) |
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| Mahmoud and Haggag, 2014 [6] | 30 children,
4–8 years old | A: dexmedetomidine (2.5 mcg/kg) PO
B: midazolam (0.5 mg/kg) PO | Procedures with local anesthesia | Behavior (modified Houpt scale) | Median Houpt scores were 4 (A) and 3 (B) |
|
| Ghajari et al., 2014 [7] | 16 children,
2–6 years old | A: midazolam (0.5 mg/kg) + hydroxyzine (1 mg/kg) PO
B: chloral hydrate (50 mg/kg) + hydroxyzine (1 mg/kg) PO | Not cited | Behavior (Houpt scale) | Groups differed in sedation success: A: 64.3%; B: 33.3% |
|
| Natarajan Surendar et al., 2014 [8] | 84 children,
4–14 years old | D1: dexmedetomidine (1 mcg/kg) IN
D2: dexmedetomidine (1.5 mcg/kg) IN
M1: midazolam (0.2 mg/kg) IN
K1: ketamine (5 mg/kg) IN | Teeth extractions | Behavior (author’s scale)
Pain (the FLACC Pain Assessment Tool) | Success: D2 (85.7%), D1 (81%), K1 (66.7%), M1 (61.9%) |
|
| Sheta et al., 2014 [9] | 72 children,
3–6 years old | A: midazolam (0.2 mg/kg) IN
B: dexmedetomidine (1 µg/kg) IN | Dental rehabilitation | Sedation status (no specific scale) | Children sedation:
A: 44.4%
B: 77.8% |
|
| Azevedo et al., 2013 [10] | 10 children,
2–4 years old | Midazolam in different doses (0.2 to 0.4 mg/kg) PO
placebo PO | Dental rehabilitation | Behavior (Frankl scale), Adequacy of sedation (Ramsay scale) | All midazolam doses allowed positive behavior and longer appointments
Midazolam: 58.1%
Placebo: 31.0% |
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| Chopra et al., 2013 [11] | 30 children,
2–8 years old | A: midazolam (0.25 mg/kg) MB spray
B: midazolam (0.25 mg/kg) IN | Procedure with local anesthesia | Behavior (Houpt scale)
Acceptability of administration route | The acceptance in A was better than in B. There was no difference in behavior scores |
|
| Mittal et al., 2013 [12] | 40 children,
2–6 years old | Premedication: midazolam (0.5 mg/kg) PO
Intervention:
A: propofol (1–1.5 mg/kg) IV
B: ketofol (1–1.5 mg/kg midazolam + 0.25 mg/kg ketamine) IV
Maintenance: propofol (25–75 mg/kg/min) IV (bolus if needed) | Pulpectomy in primary molars | Behavior: procedural success, operator satisfaction, quality of sedation
Also duration of treatment, recovery time, total dose of propofol | Other analysis showed no behavior differences between groups |
|
| Moreira et al., 2013 [13] | 41 children,
<3 years old | A: midazolam (0.5 mg/kg) PO + ketamine (3 mg/kg) PO
B: midazolam (1.0 mg/kg) PO
C: placebo PO | Procedures under local anesthesia and protective stabilization | Behavior (OSUBRS) | Group A was associated with more cooperative behavior and a longer session |
|
| Toomarian et al., 2013 [1] | 30 children,
2–6 years old | Crossover design
hydroxyzine (1 mg/kg) PO associated with:
A: meperidine (2 mg/kg) PO
B: meperidine (1 mg/kg) SM
C: midazolam 0.5 mg/kg PO | Pulp therapy in primary teeth | Behavior (Houpt and modified Houpt) | Success rates:
A: 46.7%; B: 50%; C: 26.7%
Patients ≥ 4 years old had six times greater chance of success |
|
| Tyagi et al., 2013 [14] | 40 children,
2–6 years old | Parallel design
A: midazolam (0.5 mg) PO
B: diazepam (0.5 mg) PO
C: midazolam (0.06 mg/kg) IV
D: placebo PO | Restorations, pulp therapy, extractions, local anesthesia when necessary | Behavioral changes (Houpt scale) | Groups A and B: Similar sedative effects. Group C showed better scores in behavior. Group D: more negative behavior Midazolam was better than diazepam |
|
| Collado et al., 2013 [15] | 98 patients,
7–15 years old
| A: patients with intellectual disability (ID, 33)
B: Dentally anxious patients (DA, 44)
Midazolam (0.3 to 0.5 mg/kg) IV with or without inhalation sedation (50% N2O/O2) | Not cited | Success rate, level of cooperation (Venham), level of sedation (Ramsay scale) | In patients with DA and ID, more sessions were conducted with a totally relaxed patient (Venham score of 0)
Success rate:
A: 89.1%
B: 90.6% |
|
| Bhatnagar et al., 2012 [16] | 60 children,
3–9 years old | Parallel design
A: midazolam (0.5 mg/kg) PO
B: tramadol (2 mg/kg) PO
C: triclofos (70 mg/kg) PO
D: zolpidem (0.4 mg/kg) PO | Not cited | Level of sedation (no scale) and ease of handling | Groups A and B achieved better levels of sedation. D showed worse cooperation. Midazolam produced the best results, similar to tramadol |
|
| Guelmann et al., 2012 [17] | 17 children,
5–8 years old | A: discontinuation of nitrous oxide after local anesthesia (100% O2)
B: Constant nitrous oxide (50% de N2O/50% O2) | Restorative procedures, lower arch | Behavior (OSUBRS) | There were no differences between groups |
|
| Somri et al., 2012 [18] | 90 children,
3–10 years old | Midazolam PO administered in one of 3 doses:
A: 0.5 mg/kg
B: 0.75 mg/kg
C: 1 mg/kg | General procedures | Behavior (Houpt scale)
Sedation level (Wisconsin sedation scale)
Completion of procedures | Sedation scores, cooperation, completion of the procedure were higher in B and C than in A
|
|
| Bahetwar et al., 2011 [19] | 45 children,
2–6 years old
| A: midazolam (0.3 mg/kg) IN
B: ketamine (6 mg/kg) IN
C: midazolam + ketamine (0.2 mg/kg; 4 mg/kg) IN | Procedures under local anesthesia (infiltrative or block) | Success of treatment | Quicker sedation onset in B
Success rates:
A: 69.0%; B: 89.0%; C: 84.0% |
|
| Pandey et al., 2011 [2] | 34 children,
2–6 years old | Ketamine (6 mg/kg) IN administered with
atomizer (A) and
dropper (B) | Procedures under local anesthesia (infiltrative or block) | Success of sedation, behavior during administration and treatment, onset, sedation depth, recovery time | Sedation was successful in 84% (B) to 95% (A)
Group A had quicker onset and recovery time after sedation |
|
| Shabbir et al., 2011 [20] | 12 children,
3–9 years old | A: triclofos (70 mg/kg) PO
B: midazolam (0.5 mg/kg) PO | Procedures under local anesthesia | Behavior (Houpt scale) | Midazolam was more efficacious than triclofos |
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