Background: Intranasal sedation is commonly used in pediatric dentistry to manage dental anxiety and improve patient compliance. This systematic review and meta-analysis aimed to evaluate the recovery time, patient satisfaction, and adverse effects of the intranasal sedatives midazolam, dexmedetomidine, and ketamine in pediatric dental procedures. Methods: A systematic search of PubMed, Scopus, the Web of Science, the Cochrane Library, Embase, and Google Scholar was conducted following the PRISMA 2020 guidelines. Only randomized controlled trials (RCTs) involving intranasal sedation in pediatric patients (≤18 years) were included. The revised Cochrane risk of bias tool (RoB 2) was employed to assess study quality. A meta-analysis using a random-effects model was performed to evaluate the recovery time. Results: Twenty-one RCTs were included in this review. A meta-analysis of seven studies revealed that dexmedetomidine was associated with significantly longer recovery times compared to midazolam and ketamine. Specifically, midazolam demonstrated the shortest recovery time (mean difference: −19.1 min, p < 0.05), followed by ketamine (mean difference: −15.6 min, p < 0.05). A qualitative analysis of adverse effects showed mild to moderate complications, including nasal irritation (midazolam), prolonged sedation (dexmedetomidine), and hypersalivation (ketamine). Patient satisfaction was found to be highest with dexmedetomidine, although midazolam was preferred for its faster onset of sedation. Conclusions: Intranasal sedation in pediatric dentistry is a safe and effective approach, with each agent exhibiting distinct recovery profiles and safety considerations. The findings emphasize the importance of standardized sedation protocols and the need for further research into the long-term outcomes of these sedatives in pediatric populations.

Swaminathan K, et al. J Dent Anesth Pain Med. 2025 Feb;25(1):1-13. https://doi.org/10.17245/jdapm.2025.25.1.1

A healthy metabolic, cognitive, and physical wellness requires sleep. Children with neurodevelopmental disorders, such as autism spectrum disorder (ASD) and attention-deficit hyperactivity disorder (ADHD), are prone to sleep disturbances, which exacerbates the behavioral and cognitive issues. Likewise, the sleep problems co-occur with oral habits. This study aims to assess and compare the sleep habit and oral habits of children with ASD and ADHD with those of neurotypical children. A total of 96 children between the ages 4 and 10 were included. They were divided into two group: the case group, which included children with ASD and ADHD, and the control group, which included neurotypical children. Children's Sleep Habit Questionnaire- Abbreviated (CSHQ-A) was administered to parents to evaluate bedtime routine, sleep behavior, and morning habits. Demographic data, body mass index (BMI), and presence of oral habits were also recorded. A CSHQ-A total score greater than 41 was regarded as abnormal and suggestive of sleep problem. Statistical analysis includes unpaired t-test for continuous variables, Chi-square test for categorical data, and Pearson correlation was employed to correlate CSHQ-A total score and BMI. The CSHQ-A total score was significantly higher in cases (71.41 ± 9.3) than the controls (43.1 ± 16.9, p < 0.001). The mean difference in the CSHQ-A total score was 28.31 with a large effect size and 95% confidence interval. Children with ASD and ADHD were dependent on parents to fall asleep, needed special objects, and experienced frequent night awakenings. A higher CSHQ-A total score was related to oral habits particularly, bruxism. There was a negative correlation found between the CSHQ-A total score and BMI (r = −0.30, p = 0.002). Children with ASD and ADHD showed significant sleep disturbance than children in control group. This study highlights the relationship between the impact of sleep disturbance and the problems associated with neurodevelopmental disorders. These findings emphasize the importance of assessment of sleep habit along with routine oral examination into the pediatric dental practice. This study highlights the clinical importance of integrating sleep assessment into pediatric dentistry, especially for children with health needs. Early detection and intervention will help in cognitive development and promotes the overall health. Shan S, Vivek K, Haridoss S, et al. Assessment of Sleep Habit and Oral Habits in Children with Autism Spectrum Disorder and Attention-deficit Hyperactivity Disorder: A Cross-sectional Study. Int J Clin Pediatr Dent 2025;18(11):1327–1332.