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Abstract
Abstract: Pediatric dentistry plays a crucial role in managing children with special healthcare needs or dental anxiety. Successful treatment requires effective behavior management during dental procedures. This review examines the safety, efficacy, and appropriate applications of pharmacological methods used in pediatric dentistry, including nitrous oxide, oral sedatives, nasal sedation/intranasal mucosal sedation, intravenous (IV) sedation, and general anesthesia. Nitrous oxide is commonly used for moderate anxiety due to its rapid onset and minimal recovery time. Oral sedatives, such as benzodiazepines, achieve a deeper level of sedation but require a longer onset and recovery period. Nasal sedation provides a rapid and non-invasive alternative to traditional sedation methods, particularly in pediatric patients. General anesthesia is used when a child cannot cooperate due to extreme anxiety or medical conditions, while IV sedation is preferred for complex procedures or highly anxious children. Recent advances in sedation protocols have led to more personalized, safer, and effective treatment approaches. Background: Dental anxiety is prevalent in children, often leading to avoidance of essential dental care and poor oral health. Pharmacological sedation plays a critical role in alleviating anxiety and improving treatment outcomes. Nitrous oxide is ideal for brief treatments due to its rapid action and short duration. Oral sedatives, including benzodiazepines, provide deeper sedation but require longer preparation and recovery times. Nasal and intranasal mucosal sedation offer an effective, rapid alternative, especially in pediatric patients with difficult venous access or those who are needle-averse. General anesthesia is used for severe cases of anxiety or medical conditions, while IV sedation is preferred for more invasive treatments. Recent improvements in sedation safety protocols allow for customized approaches to meet individual child needs. Conclusion: Pharmacological sedation is necessary in pediatric dentistry, improving outcomes by reducing anxiety and personalizing treatments to ensure safety and effectiveness
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Copyright (c) 2025 Journal of Contemporary Dental Sciences

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References
- Inchingolo F, Inchingolo AM, Ferrante L, de Ruvo E, Di Noia A, Palermo A, et al. Pharmacological sedation in paediatric dentistry. Eur J Paediatr Dent 2024;25:230-7.
- Wilson S. Pharmacological management of the pediatric dental patient. Pediatr Dent 2004;26:131-6.
- Gao F, Wu Y. Procedural sedation in pediatric dentistry: A narrative review. Front Med (Lausanne) 2023;10:1186823.
- Gupta N, Gupta A, Narayanan MR. Current status of nitrous oxide use in pediatric patients. World J Clin Pediatr 2022;11:93-104.
- Arcari S, Moscati M. Nitrous oxide analgesic effect on children receiving restorative treatment on primary molars. Eur J Paediatr Dent 2018;19:205-12.
- Levering NJ, Welie JV. Current status of nitrous oxide as a behavior management practice routine in pediatric dentistry. J Dent Child (Chic) 2011;78:24-30.
- Sacchetti A, Turco T, Carraccio C, Hasher W, Cho D, Gerardi M. Procedural sedation for children with special health care needs. Pediatr Emerg Care 2003;19:231-9.
- Chi SI. Complications caused by nitrous oxide in dental sedation. J Dent Anesth Pain Med 2018;18:71-8.
- Yasny JS, Asgari A. Considerations for the use of enteral sedation in pediatric dentistry. J Clin Pediatr Dent 2008;32:85-93.
- Gallottini SG, Giammarini S, Amato A, Gallottini L. General anesthesia and dental sedation in patients with special needs: Why, when and how. A clinical guide for dental practitioners. J Osseointegration 2023;15:62-78.
- Ojha R, Gupta S, Panwar M. Oral sedation in pediatric dentistry. Eur J Dent Oral Health 2024;5:1-6.
- Jain SA, Rathi N, Thosar N, Baliga S. Midazolam use in pediatric dentistry: A review. J Dent Anesth Pain Med 2020;20:1-8.
- Lin CH, Desai S, Nicolas R, Gauvreau K, Foerster S, Sharma A, et al. Sedation and anesthesia in pediatric and congenital cardiac catheterization: A prospective multicenter experience. Pediatr Cardiol 2015;36:1363-75.
- Attri JP, Sharan R, Makkar V, Gupta KK, Khetarpal R, Kataria AP. Conscious sedation: Emerging trends in pediatric dentistry. Anesth Essays Res 2017;11:277-81.
- Townsend JA, Wells MH. Behavior guidance of the pediatric dental patient. In: Pediatric Dentistry: Infancy through Adolescence. St. Louis: Elsevier; 2019. p. 352-70.
- Dowdy RA, Forgy S, Hefnawi O, Neimar TA. A review of current oral sedation agents for pediatric dentistry. Anesth Prog 2023;70:142-53.
- Parida S, Senthilnathan M. Administration of paediatric intranasal sedation: Need for appropriate formulation and equipment for dispensation. Indian J Med Res 2023;157:96-9.
- AlSarheed MA. Intranasal sedatives in pediatric dentistry. Saudi Med J 2016;37:948-56.
- Pansini V, Curatola A, Gatto A, Lazzareschi I, Ruggiero A, Chiaretti A. Intranasal drugs for analgesia and sedation in children admitted to pediatric emergency department: A narrative review. Ann Transl Med 2021;9:189.
- Fantacci C, Fabrizio GC, Ferrara P, Franceschi F, Chiaretti A. Intranasal drug administration for procedural sedation in children admitted to pediatric Emergency Room. Eur Rev Med Pharmacol Sci 2018;22:217-22.
- Coté CJ, Wilson S, American Academy of Pediatrics, American Academy of Pediatric Dentistry. Guidelines for monitoring and management of pediatric patients before, during, and after sedation for diagnostic and therapeutic procedures. Pediatrics 2019;143:e20191000.
- Gómez-Ríos I, Pérez-Silva A, Serna-Muñoz C, Ibáñez-López FJ, Periago-Bayonas PM, Ortiz-Ruiz AJ. Deep sedation for dental care management in healthy and special health care needs children: A retrospective study. Int J Environ Res Public Health 2023;20:3435.
- Lee D. Ensuring patient safety in pediatric dental care. J Korean Acad Pediatr Dent 2024;51:109-31.
- Garza MG, Najera RI, Ramírez EN, Quintero MT, Dominguez SL, Ramirez EL, et al. Sedation in pediatric dentistry, an overview and current update. Int J Appl Dent Sci 2022;8:176-80.
- Silegy T, Jacks ST. Pediatric oral conscious sedation. J Calif Dent Assoc 2003;31:413-8.
- Chen J, Deng K, Yu D, Fan C, Liu L, Gu H, et al. Recent developments in the non-pharmacological management of children’s behavior based on distraction techniques: A concise review. Healthcare (Basel) 2024;12:1940.
- Egelhoff JC, Ball WS Jr., Koch BL, Parks TD. Safety and efficacy of sedation in children using a structured sedation program. AJR Am J Roentgenol 1997;168:1259-62.
- Milnes AR, Maupomé G, Cannon J. Intravenous sedation in pediatric dentistry using midazolam, nalbuphine and droperidol. Pediatr Dent 2000;22:113-9.
- Meyer BD, Chen JW, Lee JY. Pharmacologic management for pediatric dental patients in the 21st century. Gen Dent 2018;66:19-22.
- Yang R, Zhao R, Chaudry F, Wang T, Brunton P, Khurshid Z, et al. Modern sedative agents and techniques used in dentistry for patients with special needs: A review. J Taibah Univ Med Sci 2024;19:153-63.
- Ashley PF, Chaudhary M, Lourenço‐Matharu L. Sedation of children undergoing dental treatment. Cochrane Database Syst Rev 2018;12:CD003877.
- Sharma A, Jayaprakash R, Babu NA, Masthan KM. General anaesthesia in pediatric dentistry. Biomed Pharmacol J 2015;8:189-94.
- Cravero JP, Agarwal R, Berde C, Birmingham P, Coté CJ, Galinkin J, et al. The society for pediatric anesthesia recommendations for the use of opioids in children during the perioperative period. Paediatr Anaesth 2019;29:547-71.
- Apfelbaum JL, Hagberg CA, Connis RT, Abdelmalak BB, Agarkar M, Dutton RP, et al. 2022 American society of anesthesiologists practice guidelines for management of the difficult airway. Anesthesiology 2022;136:31-81.
- Almarzouq SS, Chua H, Yiu CK, Lam PP. Effectiveness of nonpharmacological behavioural interventions in managing dental fear and anxiety among children: A systematic review and meta-analysis. Healthcare (Basel) 2024;12:537.
- Barenie JT, Ripa LW. The use of behavior modification techniques to successfully manage the child dental patient. J Am Dent Assoc 1977;94:329-34.
- Kong X, Song N, Chen L, Li Y. Non-pharmacological interventions for reducing dental anxiety in pediatric dentistry: A network meta-analysis. BMC Oral Health 2024;24:1151.
- Anthonappa RP, Ashley PF, Bonetti DL, Lombardo G, Riley P. Non‐pharmacological interventions for managing dental anxiety in children. Cochrane Database Syst Rev 2017;2017:CD012676.
- Gizani S, Seremidi K, Katsouli K, Markouli A, Kloukos D. Basic behavioral management techniques in pediatric dentistry: A systematic review and meta-analysis. J Dent 2022;126:104303.
- Phan H, Nahata MC. Clinical uses of dexmedetomidine in pediatric patients. Paediatr Drugs 2008;10:49-69.
- Nelson TM, Xu Z. Pediatric dental sedation: Challenges and opportunities. Clin Cosmet Investig Dent 2015;7:97-106.
- Brickhouse TH, Unkel JH, Webb MD, Best AM, Hollowell RL. Articaine use in children among dental practitioners. Pediatr Dent 2008;30:516-21.
- Stein Duker LI, Grager M, Giffin W, Hikita N, Polido JC. The relationship between dental fear and anxiety, general anxiety/ fear, sensory over-responsivity, and oral health behaviors and outcomes: A conceptual model. Int J Environ Res Public Health 2022;19:2380.
- Hill JM, Vogel DY, Spek B, de Jong CJ, Krikken JB, Veerkamp JS. Pediatric sedation in dutch dental clinics: The influence of guideline modifications on adverse events. Dent J (Basel) 2024;12:66.
- Rai K, Hegde AM, Goel K. Sedation in uncooperative children undergoing dental procedures: A comparative evaluation of midazolam, propofol and ketamine. J Clin Pediatr Dent 2007;32:1-4.
- Camoni L, Santos A, Luporsi M, Grilo A, Pietrzak A, Gear J, et al. EANM procedural recommendations for managing the paediatric patient in diagnostic nuclear medicine. Eur J Nucl Med Mol Imaging 2023;50:3862-79.
- Deshpande A, Jain A, Shah Y, Jaiswal V, Wadhwa M. Effectiveness of self-designed dental storybook as behavior modification technique in 5 - 7 year-old children: A randomized controlled study. J Indian Soc Pedod Prev Dent 2022;40:253-9.
- Musselman RJ. Considerations in behavior management of the pediatric dental patient. Helping children cope with dental treatment. Pediatr Clin North Am 1991;38:1309-24.
- Webb MD, Moore PA. Sedation for pediatric dental patients. Dent Clin North Am 2002;46:803-14, xi.
- Urman RD, Kaye AD, editors. Moderate and Deep Sedation in Clinical Practice. United Kingdom: Cambridge University Press; 2017.
- Marques C, Dinis M, Machado V, Botelho J, Lopes LB. Evaluating the quality of systematic reviews on pediatric sedation in dentistry: An umbrella review. J Clin Med 2024;13:3544.
- Nasr VG, DiNardo JA. Sedation and analgesia in pediatric cardiac critical care. Pediatr Crit Care Med 2016;17:S225-31.
- Donnell CC, Flavell T, Wilson KE. LARAGA-Pharmacological behaviour management in paediatric dentistry in the UK. Pediatr Dent J 2022;32:100-9.
- American Academy of Pediatric Dentistry, Clinical Affairs Committee - Sedation and General Anesthesia Subcommittee. Guideline on use of anesthesia personnel in the administration of office-based deep sedation/general anesthesia to the pediatric dental patient. Pediatr Dent 2012;34:170-2.
- Bean T, Aruede G. Conscious sedation in dentistry. In: StatPearls. Treasure Island, FL: StatPearls Publishing; 2023.
- St Clair T. Informed consent in pediatric dentistry: A comprehensive overview. Pediatr Dent 1995;17:90-7.
- Kakti A, Abumelha RK, Alajmi AM, Dagriri LK, Alkodari LA, Fares MJ, et al. Postoperative pain of pediatric patients undergoing dental treatment under general anesthesia visiting a general hospital: A cross-sectional study. Children (Basel) 2023;10:671.
- Khinda V, Rao D, Sodhi SP. Nitrous oxide inhalation sedation rapid analgesia in dentistry: An overview of technique, objectives, indications, advantages, monitoring, and safety profile. Int J Clin Pediatr Dent 2023;16:131-8.
References
Inchingolo F, Inchingolo AM, Ferrante L, de Ruvo E, Di Noia A, Palermo A, et al. Pharmacological sedation in paediatric dentistry. Eur J Paediatr Dent 2024;25:230-7.
Wilson S. Pharmacological management of the pediatric dental patient. Pediatr Dent 2004;26:131-6.
Gao F, Wu Y. Procedural sedation in pediatric dentistry: A narrative review. Front Med (Lausanne) 2023;10:1186823.
Gupta N, Gupta A, Narayanan MR. Current status of nitrous oxide use in pediatric patients. World J Clin Pediatr 2022;11:93-104.
Arcari S, Moscati M. Nitrous oxide analgesic effect on children receiving restorative treatment on primary molars. Eur J Paediatr Dent 2018;19:205-12.
Levering NJ, Welie JV. Current status of nitrous oxide as a behavior management practice routine in pediatric dentistry. J Dent Child (Chic) 2011;78:24-30.
Sacchetti A, Turco T, Carraccio C, Hasher W, Cho D, Gerardi M. Procedural sedation for children with special health care needs. Pediatr Emerg Care 2003;19:231-9.
Chi SI. Complications caused by nitrous oxide in dental sedation. J Dent Anesth Pain Med 2018;18:71-8.
Yasny JS, Asgari A. Considerations for the use of enteral sedation in pediatric dentistry. J Clin Pediatr Dent 2008;32:85-93.
Gallottini SG, Giammarini S, Amato A, Gallottini L. General anesthesia and dental sedation in patients with special needs: Why, when and how. A clinical guide for dental practitioners. J Osseointegration 2023;15:62-78.
Ojha R, Gupta S, Panwar M. Oral sedation in pediatric dentistry. Eur J Dent Oral Health 2024;5:1-6.
Jain SA, Rathi N, Thosar N, Baliga S. Midazolam use in pediatric dentistry: A review. J Dent Anesth Pain Med 2020;20:1-8.
Lin CH, Desai S, Nicolas R, Gauvreau K, Foerster S, Sharma A, et al. Sedation and anesthesia in pediatric and congenital cardiac catheterization: A prospective multicenter experience. Pediatr Cardiol 2015;36:1363-75.
Attri JP, Sharan R, Makkar V, Gupta KK, Khetarpal R, Kataria AP. Conscious sedation: Emerging trends in pediatric dentistry. Anesth Essays Res 2017;11:277-81.
Townsend JA, Wells MH. Behavior guidance of the pediatric dental patient. In: Pediatric Dentistry: Infancy through Adolescence. St. Louis: Elsevier; 2019. p. 352-70.
Dowdy RA, Forgy S, Hefnawi O, Neimar TA. A review of current oral sedation agents for pediatric dentistry. Anesth Prog 2023;70:142-53.
Parida S, Senthilnathan M. Administration of paediatric intranasal sedation: Need for appropriate formulation and equipment for dispensation. Indian J Med Res 2023;157:96-9.
AlSarheed MA. Intranasal sedatives in pediatric dentistry. Saudi Med J 2016;37:948-56.
Pansini V, Curatola A, Gatto A, Lazzareschi I, Ruggiero A, Chiaretti A. Intranasal drugs for analgesia and sedation in children admitted to pediatric emergency department: A narrative review. Ann Transl Med 2021;9:189.
Fantacci C, Fabrizio GC, Ferrara P, Franceschi F, Chiaretti A. Intranasal drug administration for procedural sedation in children admitted to pediatric Emergency Room. Eur Rev Med Pharmacol Sci 2018;22:217-22.
Coté CJ, Wilson S, American Academy of Pediatrics, American Academy of Pediatric Dentistry. Guidelines for monitoring and management of pediatric patients before, during, and after sedation for diagnostic and therapeutic procedures. Pediatrics 2019;143:e20191000.
Gómez-Ríos I, Pérez-Silva A, Serna-Muñoz C, Ibáñez-López FJ, Periago-Bayonas PM, Ortiz-Ruiz AJ. Deep sedation for dental care management in healthy and special health care needs children: A retrospective study. Int J Environ Res Public Health 2023;20:3435.
Lee D. Ensuring patient safety in pediatric dental care. J Korean Acad Pediatr Dent 2024;51:109-31.
Garza MG, Najera RI, Ramírez EN, Quintero MT, Dominguez SL, Ramirez EL, et al. Sedation in pediatric dentistry, an overview and current update. Int J Appl Dent Sci 2022;8:176-80.
Silegy T, Jacks ST. Pediatric oral conscious sedation. J Calif Dent Assoc 2003;31:413-8.
Chen J, Deng K, Yu D, Fan C, Liu L, Gu H, et al. Recent developments in the non-pharmacological management of children’s behavior based on distraction techniques: A concise review. Healthcare (Basel) 2024;12:1940.
Egelhoff JC, Ball WS Jr., Koch BL, Parks TD. Safety and efficacy of sedation in children using a structured sedation program. AJR Am J Roentgenol 1997;168:1259-62.
Milnes AR, Maupomé G, Cannon J. Intravenous sedation in pediatric dentistry using midazolam, nalbuphine and droperidol. Pediatr Dent 2000;22:113-9.
Meyer BD, Chen JW, Lee JY. Pharmacologic management for pediatric dental patients in the 21st century. Gen Dent 2018;66:19-22.
Yang R, Zhao R, Chaudry F, Wang T, Brunton P, Khurshid Z, et al. Modern sedative agents and techniques used in dentistry for patients with special needs: A review. J Taibah Univ Med Sci 2024;19:153-63.
Ashley PF, Chaudhary M, Lourenço‐Matharu L. Sedation of children undergoing dental treatment. Cochrane Database Syst Rev 2018;12:CD003877.
Sharma A, Jayaprakash R, Babu NA, Masthan KM. General anaesthesia in pediatric dentistry. Biomed Pharmacol J 2015;8:189-94.
Cravero JP, Agarwal R, Berde C, Birmingham P, Coté CJ, Galinkin J, et al. The society for pediatric anesthesia recommendations for the use of opioids in children during the perioperative period. Paediatr Anaesth 2019;29:547-71.
Apfelbaum JL, Hagberg CA, Connis RT, Abdelmalak BB, Agarkar M, Dutton RP, et al. 2022 American society of anesthesiologists practice guidelines for management of the difficult airway. Anesthesiology 2022;136:31-81.
Almarzouq SS, Chua H, Yiu CK, Lam PP. Effectiveness of nonpharmacological behavioural interventions in managing dental fear and anxiety among children: A systematic review and meta-analysis. Healthcare (Basel) 2024;12:537.
Barenie JT, Ripa LW. The use of behavior modification techniques to successfully manage the child dental patient. J Am Dent Assoc 1977;94:329-34.
Kong X, Song N, Chen L, Li Y. Non-pharmacological interventions for reducing dental anxiety in pediatric dentistry: A network meta-analysis. BMC Oral Health 2024;24:1151.
Anthonappa RP, Ashley PF, Bonetti DL, Lombardo G, Riley P. Non‐pharmacological interventions for managing dental anxiety in children. Cochrane Database Syst Rev 2017;2017:CD012676.
Gizani S, Seremidi K, Katsouli K, Markouli A, Kloukos D. Basic behavioral management techniques in pediatric dentistry: A systematic review and meta-analysis. J Dent 2022;126:104303.
Phan H, Nahata MC. Clinical uses of dexmedetomidine in pediatric patients. Paediatr Drugs 2008;10:49-69.
Nelson TM, Xu Z. Pediatric dental sedation: Challenges and opportunities. Clin Cosmet Investig Dent 2015;7:97-106.
Brickhouse TH, Unkel JH, Webb MD, Best AM, Hollowell RL. Articaine use in children among dental practitioners. Pediatr Dent 2008;30:516-21.
Stein Duker LI, Grager M, Giffin W, Hikita N, Polido JC. The relationship between dental fear and anxiety, general anxiety/ fear, sensory over-responsivity, and oral health behaviors and outcomes: A conceptual model. Int J Environ Res Public Health 2022;19:2380.
Hill JM, Vogel DY, Spek B, de Jong CJ, Krikken JB, Veerkamp JS. Pediatric sedation in dutch dental clinics: The influence of guideline modifications on adverse events. Dent J (Basel) 2024;12:66.
Rai K, Hegde AM, Goel K. Sedation in uncooperative children undergoing dental procedures: A comparative evaluation of midazolam, propofol and ketamine. J Clin Pediatr Dent 2007;32:1-4.
Camoni L, Santos A, Luporsi M, Grilo A, Pietrzak A, Gear J, et al. EANM procedural recommendations for managing the paediatric patient in diagnostic nuclear medicine. Eur J Nucl Med Mol Imaging 2023;50:3862-79.
Deshpande A, Jain A, Shah Y, Jaiswal V, Wadhwa M. Effectiveness of self-designed dental storybook as behavior modification technique in 5 - 7 year-old children: A randomized controlled study. J Indian Soc Pedod Prev Dent 2022;40:253-9.
Musselman RJ. Considerations in behavior management of the pediatric dental patient. Helping children cope with dental treatment. Pediatr Clin North Am 1991;38:1309-24.
Webb MD, Moore PA. Sedation for pediatric dental patients. Dent Clin North Am 2002;46:803-14, xi.
Urman RD, Kaye AD, editors. Moderate and Deep Sedation in Clinical Practice. United Kingdom: Cambridge University Press; 2017.
Marques C, Dinis M, Machado V, Botelho J, Lopes LB. Evaluating the quality of systematic reviews on pediatric sedation in dentistry: An umbrella review. J Clin Med 2024;13:3544.
Nasr VG, DiNardo JA. Sedation and analgesia in pediatric cardiac critical care. Pediatr Crit Care Med 2016;17:S225-31.
Donnell CC, Flavell T, Wilson KE. LARAGA-Pharmacological behaviour management in paediatric dentistry in the UK. Pediatr Dent J 2022;32:100-9.
American Academy of Pediatric Dentistry, Clinical Affairs Committee - Sedation and General Anesthesia Subcommittee. Guideline on use of anesthesia personnel in the administration of office-based deep sedation/general anesthesia to the pediatric dental patient. Pediatr Dent 2012;34:170-2.
Bean T, Aruede G. Conscious sedation in dentistry. In: StatPearls. Treasure Island, FL: StatPearls Publishing; 2023.
St Clair T. Informed consent in pediatric dentistry: A comprehensive overview. Pediatr Dent 1995;17:90-7.
Kakti A, Abumelha RK, Alajmi AM, Dagriri LK, Alkodari LA, Fares MJ, et al. Postoperative pain of pediatric patients undergoing dental treatment under general anesthesia visiting a general hospital: A cross-sectional study. Children (Basel) 2023;10:671.
Khinda V, Rao D, Sodhi SP. Nitrous oxide inhalation sedation rapid analgesia in dentistry: An overview of technique, objectives, indications, advantages, monitoring, and safety profile. Int J Clin Pediatr Dent 2023;16:131-8.