Oral Benzodiazepines in Pediatric Dental Sedation: Current Recommendations and Limitations - a review

Abstract Background: Oral benzodiazepines, particularly midazolam, represent a cornerstone of pharmacological behavior guidance in pediatric dentistry. However, evolving evidence regarding efficacy, safety, and clinical limitations has prompted a reassessment of current recommendations. Purpose: This review synthesizes current evidence on oral benzodiazepines for sedation in pediatric dental treatment, examining their efficacy, dosing recommendations, adverse effects, and clinical limitations. Methods: Systematic review of randomized controlled trials and meta-analyses examining oral midazolam and other benzodiazepines in pediatric dental sedation. Results: Oral midazolam demonstrates moderate-certainty evidence of efficacy at doses of 0.25–1.0 mg/kg. Recommended dosing for pediatric patients ranges from 0.5–0.75 mg/kg, with maximum effects achieved 20–30 minutes after administration. Success rates for behavior management range from 48% to 80%, with significant variability across studies. Adverse effects remain generally mild and infrequent, though respiratory depression and delayed recovery are documented at higher doses. Combined regimens with other sedatives demonstrate superior behavior management compared to monotherapy. Conclusions: Oral midazolam remains an effective and relatively safe sedative for pediatric dental treatment, but current limitations in dosage precision, variable absorption rates, and inability to titrate necessitate careful patient selection and close monitoring. Combination regimens may offer improved outcomes for anxious and uncooperative children. Keywords: benzodiazepines, midazolam, pediatric dentistry, sedation, conscious sedation, oral sedation, behavior management