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

Abstract

Highlights What are the main findings? In most included studies, intranasal sedation showed shorter recovery than oral routes; onset varied markedly across agents and studies, ranging from approximately 9 to 41 min. Thematic analysis developed six major themes covering drug efficacy, safety, onset, recovery, patient acceptance, and special need populations. What is the implication of the main findings? The non-invasive nature of intranasal delivery, with shorter recovery reported in most studies, makes it a practical option to improve cooperation in anxious or uncooperative children, although onset and sedation success vary by agent, and evidence for added benefit from multi-drug regimens remains mixed. Because recovery time, patient acceptance, and adverse event profiles vary widely across agents and routes, sedation should be individualized to the child’s age, behavior, and special healthcare with appropriate monitoring, underscoring the need for standardized, evidence-based protocols to guide safe drug and route selection. 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.