International Guidelines on Conscious Sedation in Pediatric Dentistry: A Comparative Analysis and Evidence Mapping Study

Conscious sedation is widely used in pediatric dentistry to manage dental anxiety, behavioral difficulties, and systemic diseases that compromise patient compliance with dental care. Despite its clinical importance, international recommendations vary considerably. OBJECTIVE: To conduct a comparative analysis and evidence mapping of international clinical practice guidelines on conscious sedation in pediatric dentistry. METHODS: A comparative guideline analysis and evidence mapping study was performed. Electronic searches were conducted in PubMed (MEDLINE), Scopus, EMBASE, Cochrane Database of Systematic Reviews, Web of Science, LILACS, SciELO, TRIP, and OpenGrey up to December 2023. Guidelines issued by recognized professional or governmental organization addressing conscious sedation in pediatric dentistry were included. Predefined domains were analyzed, including indications, contraindications, pharmacological agents, dosages, routes of administration, monitoring, discharge criteria, and professional training. Data were synthesized descriptively and graphically mapped to illustrate coverage patterns. RESULTS: Twelve international guidelines were included. Complete convergence (100%) was observed in core safety domains, such as patient assessment, monitoring, and professional training. A high agreement was found for discharge criteria (91.67%) and contraindications (83.33%). However, substantial variability emerged in pharmacological protocols, with only 16.67% of guidelines providing comprehensive drug and dosage descriptions. Routes of administration and emergency equipment recommendations were inconsistently reported, appearing in 66.67% and 50% of guidelines, respectively. CONCLUSIONS: Although foundational safety principles are consistently addressed, significant heterogeneity persists in pharmacological and procedural recommendations. This variability may contribute to differences in practice and uncertainty among practitioners. Greater international harmonization of guidelines may improve consistency, enhance clinical decision-making, and strengthen patient safety in pediatric dental care. CLINICAL RELEVANCE: Identifying areas of convergence and variability across international guidelines may support the development of more standardized sedation protocols and promote safer evidence-based clinical practice in pediatric dentistry.