Dental fear and anxiety management in children is considered one of the biggest challenges in pediatric dentistry.Intranasal sedation is a promising technique for managing unco-operative pediatric patients with rapid onset, ease of administration, and minimal invasiveness. We aimed to review the efficacy, onset time, duration, and behavioral success of intranasal sedation agents in pediatric dental procedures and identify the most effective regimens for clinical practice.This systematic review followed the PRISMA 2020 guidelines and included randomized controlled trials (RCTs) assessing intranasal sedation in children undergoing dental procedures. Primary outcomes were onset time, duration of sedation, and sedation success rates. The inclusion criteria were applied through search in six databases.Risk of bias was evaluated using the Cochrane RoB 2 tool. Meta-analyses were carried out using RevMan software, where pooled odds ratios and weighted mean differences were calculated on efficacy outcomes.Eighteen RCTs fulfilled the inclusion criteria, where intranasal agents such as midazolam, ketamine, dexmedetomidine, and their combinations were used. Meta analyses demonstrated intranasal sedation generally has a faster onset (moderate heterogeneity, I² = 40%) and is associated with greater success rates for achieving sedation than other methods. A combination of midazolam with ketamine or dexmedetomidine provided better results for both onset and behavioral success. The duration of sedation appears equivalent to oral or intravenous routes. Overall risk of bias was moderate due to blinding and selective reporting concerns.Midazolam, especially when combined with ketamine or dexmedetomidine, yielded promising results in relation to rapid onset and success of sedation. However, further large-scale RCTs are necessary to standardize dosing protocols and ensure that these findings are validated and optimized for clinical applications.

Dental fear and anxiety management in children is considered one of the biggest challenges in pediatric dentistry.Intranasal sedation is a promising technique for managing unco-operative pediatric patients with rapid onset, ease of administration, and minimal invasiveness. We aimed to review the efficacy, onset time, duration, and behavioral success of intranasal sedation agents in pediatric dental procedures and identify the most effective regimens for clinical practice.This systematic review followed the PRISMA 2020 guidelines and included randomized controlled trials (RCTs) assessing intranasal sedation in children undergoing dental procedures. Primary outcomes were onset time, duration of sedation, and sedation success rates. The inclusion criteria were applied through search in six databases.Risk of bias was evaluated using the Cochrane RoB 2 tool. Meta-analyses were carried out using RevMan software, where pooled odds ratios and weighted mean differences were calculated on efficacy outcomes.Eighteen RCTs fulfilled the inclusion criteria, where intranasal agents such as midazolam, ketamine, dexmedetomidine, and their combinations were used. Meta analyses demonstrated intranasal sedation generally has a faster onset (moderate heterogeneity, I² = 40%) and is associated with greater success rates for achieving sedation than other methods. A combination of midazolam with ketamine or dexmedetomidine provided better results for both onset and behavioral success. The duration of sedation appears equivalent to oral or intravenous routes. Overall risk of bias was moderate due to blinding and selective reporting concerns.Midazolam, especially when combined with ketamine or dexmedetomidine, yielded promising results in relation to rapid onset and success of sedation. However, further large-scale RCTs are necessary to standardize dosing protocols and ensure that these findings are validated and optimized for clinical applications.

Dental fear and anxiety management in children is considered one of the biggest challenges in pediatric dentistry.Intranasal sedation is a promising technique for managing unco-operative pediatric patients with rapid onset, ease of administration, and minimal invasiveness. We aimed to review the efficacy, onset time, duration, and behavioral success of intranasal sedation agents in pediatric dental procedures and identify the most effective regimens for clinical practice.This systematic review followed the PRISMA 2020 guidelines and included randomized controlled trials (RCTs) assessing intranasal sedation in children undergoing dental procedures. Primary outcomes were onset time, duration of sedation, and sedation success rates. The inclusion criteria were applied through search in six databases.Risk of bias was evaluated using the Cochrane RoB 2 tool. Meta-analyses were carried out using RevMan software, where pooled odds ratios and weighted mean differences were calculated on efficacy outcomes.Eighteen RCTs fulfilled the inclusion criteria, where intranasal agents such as midazolam, ketamine, dexmedetomidine, and their combinations were used. Meta analyses demonstrated intranasal sedation generally has a faster onset (moderate heterogeneity, I² = 40%) and is associated with greater success rates for achieving sedation than other methods. A combination of midazolam with ketamine or dexmedetomidine provided better results for both onset and behavioral success. The duration of sedation appears equivalent to oral or intravenous routes. Overall risk of bias was moderate due to blinding and selective reporting concerns.Midazolam, especially when combined with ketamine or dexmedetomidine, yielded promising results in relation to rapid onset and success of sedation. However, further large-scale RCTs are necessary to standardize dosing protocols and ensure that these findings are validated and optimized for clinical applications.

Recent studies have investigated the use of dexmedetomidine (DEX) as an adjuvant to local anesthetic solutions.Building on this emerging evidence, this study aimed to assess the efficacy of adding DEX to local anesthetics in patients undergoing impacted third molar surgery. A systematic search was conducted across four electronic databases, PubMed, ScienceDirect, Web of Science, and the Cochrane Library, using a combination of Medical Subject Headings terms and free-text keywords related to impacted third molar surgery. Six studies comprising 266 patients were included in the qualitative systematic review, and only four of them, involving 200 patients, were included in the quantitative meta-analysis. The random-effects model demonstrated statistically significant reductions in anesthetic onset time (mean difference [MD] = –0.96 min; 95% confidence interval [CI]: –1.52 to –0.39; P = 0.0009), systolic blood pressure (MD = –3.58 mmHg; 95% CI: –6.58 to –0.58; P = 0.020), and pain at 6 and 12 h postoperatively (MD = –2.32, 95% CI: –2.85 to –1.78; P = 0.0001) in the local anesthesia + DEX group compared with local anesthesia alone. The findings indicated that incorporating DEX into local anesthesia for impacted third molar surgery resulted in statistically significant improvements in the onset of anesthetic effects and postoperative pain scores.