Buccal versus intranasal midazolam sedation for pediatric dental patients

OBJECTIVES: The purpose of this randomized controlled crossover clinical trial was to evaluate and compare the behavioral differences resulting from the sedative effects of atomized transmucosal (buccal) and atomized parenteral (intranasal) midazolam (0.3 mg/kg) as a method for sedation of pediatric dental patients. METHODS: Twenty‐five patients aged between 36‐72 months were randomly selected and divided into two groups that were sedated with either atomized buccal or intranasal midazolam (0.3 mg/kg) in the first visit and the other method in the second visit. Patient behavior was rated and drug acceptance by method of administration was determined. Procedures were videotaped. Kappa statistics showed that the inter‐examiner reliability for assessment of sedation between the operator and examiner who reviewed the video tapes was 100 percent agreement for sleep rating scale, 94 percent for movement rating scale, 91 percent for crying rating scale, and 94 percent for overall behavior rating scale. RESULTS: There were no statistically significant differences between both groups in physiological parameters during sedation except at 15 minutes. There were significant differences between both groups in drug acceptance (p=0.008) and onset time (p=0.00). The statistical differences between the two groups were not significant in all behavior rating scales except in crying rating scale, since the buccal group showed more crying. In both groups, all children had a glazed look and delayed eye movement. Most of the children had lack of muscle coordination and slurred speech. CONCLUSIONS: Atomized buccal and intranasal midazolam are both effective for sedation of pediatric dental patients and have the same maximum working time. However, atomized intranasal is more acceptable by children, has faster onset time, and children demonstrate less crying behavior than buccal midazolam.