Intranasal and Oral Pharmacological Sedation in Pediatric Dentistry: A Thematic Scoping Review of Efficacy, Recovery, and Safety Outcomes

Abstract

Introduction: Conscious sedation (CS) is commonly recommended in pediatric dental clinics to manage uncooperative and anxious patients. Various routes of drug administration have been introduced to achieve effective CS. Among these, the intranasal (IN) route has gained popularity in dentistry due to its non-invasive nature. However, there is currently no comprehensive thematic review analyzing the efficacy and safety of drug regimens delivered via the intranasal route alone or in combination with other administration routes. Therefore, the aim of the present review is to thematically analyze the efficacy and safety of different drug regimens used for conscious sedation delivered through the intranasal route and/or in combination with other routes. Material and Method: This scoping review was conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. The protocol was prospectively registered on the Open Science Framework (OSF) prior to data extraction. Predefined inclusion criteria were developed, and five electronic databases were searched. The search identified a total of 239 articles from different databases. After evaluation and removal of duplicates, a total of 54 articles were assessed for full-text eligibility. Finally, 18 articles were included, and data extraction was performed. To develop themes the included articles were imported to the N-vivo software package. Results: Six themes and sixteen subthemes were developed. The major themes were route efficacy and behavioral outcomes, onset of action, patients’ acceptance and tolerance, special needs population, recovery and duration, safety profile and adverse events. Conclusion: Combined intranasal and oral conscious sedation is a generally safe and well-accepted approach in pediatric dentistry, but variations in recovery time, patient acceptance, and adverse events necessitate individualized sedation strategies.