Evaluation of the Efficacy of Buccal Midazolam in Comparison With Intranasal Midazolam Sedation in Uncooperative Children During Dental Treatment

Aim: Behavioral management techniques are not always sufficient, and then it is necessary to use pharmacological management methods. The aim of this study is to compare the effectiveness of buccal midazolam sedation with intranasal midazolam in non-cooperative children during dental treatment. Materials and Methods: A randomized single blinded comparative clinical study consisted of 40 children aged 3–6 years who were divided randomly into two groups: Group A intranasal midazolam and Group B buccal midazolam. The onset time of action and recovery time from sedation were compared between the two groups, and the efficacy of sedation was evaluated by Houpt behavior scale. The independent student’s T test, Mann–Whitney U test, the Wilcoxon test and the Chi-square test were used. Results: There were no statistically significant differences in the onset time of action (p = 0.458) and recovery time from sedation (p = 0.148). There were no statically significant differences between the two groups in sleeping, crying, and movement categories (p = 0.747), (p = 0.183), (p = 0.732), respectively, or in the overall Houpt scale (p = 0.393), there were statistically significant differences in the sleep variable between the two studied phases in the intranasal group (p = 0.014) and in the movement variable in the buccal group (p = 0.039). Conclusion: Both buccal midazolam and intranasal sedation were effective in the management of uncooperative children during dental treatment at 85% and 80%, respectively. Trial Registration: Australian New Zealand Clinical Trials Registry: ACTRN12624000945527. © 2025 Elsevier B.V., All rights reserved.