Optimal oral dose of midazolam for the anxious child requiring dental treatment is 0.75 mg/kg

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Behavioural management is an essential approach for the dental treatment of the anxious child.  It is sometimes  necessary to supplement this with sedation.  The main aim of this study was to compare the effect of three doses of oral midazolam (0.5, 0.75, and 1 mg ⁄ kg) on the sedative state and cooperative behaviour of  children during dental treatment.

90 child patients unable to initially unable to tolerate dental treatment under behavioural management and local anaesthesia or in combination with nitrous oxide use were randomised to Groups A, B, and C and  received 0.5, 0.75, and 1 mg⁄ kg of oral midazolam, respectively.  The researchers measured prospectively, levels of sedation, cooperative behaviour, procedures completion rates, parent satisfaction, and adverse events .

They found:-

  • Sedation scores in B and C were higher than in A. (P < 0.001)
  • Cooperation scores (CS) in B and C were higher than in A (P < 0.001).
  • Significant increase in completion rates was observed between A and C (P = 0.025).
  • Parent satisfaction was greater in B and C compared to A (P < 0.001).
  • Adverse events were higher in C (P < 0.05) than in A or B.

The authors concluded

The amount  of 0.75 mg⁄ kg oral midazolam appears to be the optimal oral dose in terms of effectiveness, acceptability, and safety for dental treatments in paediatric patients, when administered by an experienced, paediatric anaesthetist.

Somri, M., Parisinos, C. A., Kharouba, J., Cherni, N., Smidt, A., Abu RAS, Z., Darawshi, G. and Gaitini, L. A. (2011), Optimising the dose of oral midazolam sedation for dental procedures in children: a prospective, randomised, and controlled study. International Journal of Paediatric Dentistry. doi: 10.1111/j.1365-263X.2011.01192.x


Related guidance

Sedation in children and young people   – NICE  December 2010

Conscious Sedation in Dentistry – Scottish Dental Clinical Effectivenes Programme (SDCEP 2006)

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Derek Richards

Derek Richards is a specialist in dental public health, Director of the Centre for Evidence-Based Dentistry and Specialist Advisor to the Scottish Dental Clinical Effectiveness Programme (SDCEP) Development Team. A former editor of the Evidence-Based Dentistry Journal and chief blogger for the Dental Elf website until December 2023. Derek has been involved with a wide range of evidence-based initiatives both nationally and internationally since 1994. Derek retired from the NHS in 2019 remaining as a part-time senior lecturer at Dundee Dental School until the end of 2023.

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