Comparative evaluation of efficacy and safety of nitrous oxide and midazolam for conscious sedation in pediatric dental patients: a systematic review and meta-analysis.

Children's fear of dental treatment can create challenges for dentists in managing their behavior, which may hinder the provision of proper dental care. The use of sedative agents can alleviate anxiety and control behaviors in pediatric dental patients. Nitrous oxide and midazolam are the two most commonly used pharmacological agents for behavioral management in pediatric dental care. However, evidence supporting their efficacy and safety is unclear. This systematic review and meta-analysis aimed to consolidate the most robust evidence on the efficacy and safety of nitrous oxide versus midazolam for conscious sedation in pediatric dental patients aged 3 to 16 years. As per the predefined protocol, a systematic review methodology was employed to search electronic databases. Titles and abstracts were screened, and the full text was reviewed by two authors. The included trials compared nitrous oxide and midazolam as single sedatives in children aged 3 to 16 undergoing dental treatment. These trials compared nitrous oxide with oral, intravenous, transmucosal, or intranasal midazolam. Data on the methods, participants, interventions, outcomes, and results were extracted, and each trial was assessed for risk bias. Of the seven articles, two had a moderate risk of bias and five had a high risk. The overall results showed no statistically significant differences between the two interventions (P = 0.64). Despite the limitations of this systematic review and meta-analysis, the present study provides important information regarding the efficacy of both sedatives. However, well-designed and well-documented clinical trials are still required. In addition, guidelines for the standardization of the criteria and definition of success in procedural sedation need to be developed.