Comparative effectiveness and safety of dexmedetomidine and midazolam in pediatric dental sedation: a systematic review and meta-analysis

Dental fear and anxiety are prevalent challenges in pediatric dentistry. Sedation is crucial for managing these issues, ensuring a positive treatment experience, and enabling the safe and effective care of young patients who may otherwise be anxious or uncooperative. This systematic review and meta-analysis aimed to synthesize and compare existing evidence, offering a comprehensive evaluation of the performance of dexmedetomidine and midazolam in terms of sedation quality, onset of action, recovery time, and potential side effects in pediatric patients. The systematic review was registered with PROSPERO (registration number: CRD42024566935) and followed the PRISMA guidelines, including seven randomized controlled trials published between 2011 and 2024. The examined data focused on mask acceptance, parental separation, emergence delirium, satisfactory sedation, and the overall success of the sedation protocol. Risk of bias was assessed using the Cochrane Collaboration and ROBINS-I tools. Data were aggregated and weighted using Review Manager, followed by meta-analysis. To evaluate the pooled effect, heterogeneity, and potential publication bias, we used STATA 17.0, with statistical significance set at P < 0.05. Intranasal dexmedetomidine has demonstrated outcomes comparable or superior to those of midazolam in pediatric dental sedation. Midazolam exhibited a faster onset of action (10-57 min) than did dexmedetomidine (10-47 min), although the difference was not statistically significant. Parental separation outcomes favored dexmedetomidine with a statistically significant pooled effect, whereas mask acceptance and satisfactory sedation showed no significant differences. Dexmedetomidine significantly reduced emergence delirium compared with midazolam, suggesting a safer recovery profile. Both dexmedetomidine and midazolam have demonstrated effectiveness in managing pediatric dental patients, providing dependable sedation with similar results for parental separation and mask acceptance. Although midazolam exhibits a quicker onset of action and facilitates more rapid sedation, dexmedetomidine has the advantage of a lower incidence of emergent delirium, providing an additional layer of postoperative comfort. These results suggest that, although the choice of sedative may be influenced by the clinical need for faster onset or reduced postoperative complications, both agents effectively achieve satisfactory sedation, ensuring procedural comfort and promoting patient cooperation in pediatric dental settings.