A comparison of two different dosages of oral midazolam in the same pediatric dental patients

Purpose: The purpose of this paper was to compare the efficacy and safety of two doses of oral midazolam (0.5 mg/kg and 0.75 mg/kg) on the same children when no cooperation could be achieved with the 0.5 mg/kg dose. Methods: Twenty-three healthy three-to eight-year-olds who were initially unable to tolerate dental treatment using nonpharmacologic behavioral management (sometimes in combination with nitrous oxide) participated in the study. Level of sedation, cooperation, parental satisfaction, parental prediction of child's future anxiety, and outcome of sedation with the two doses were evaluated. All treatments and behavioral evaluations were conducted by the same nonblinded dentist. Parental evaluations were nonblinded as well. Results: No respiratory events or other adverse effects were observed with either regimen. There was no gender difference in any parameter regarding the two doses of midazolam. No treatment was aborted with the 0.75 mg/kg dose. Sedation and cooperation were significantly higher at baseline and after 75, 30, and 45 minutes (P=.001) for the 0.75 mg/kg group. Parental satisfaction with the treatment was significantly greater with the higher dose. Conclusion: Midazolam at 0.75 mg/kg with 100 percent oxygen can enhance outcomes for pediatric dental patients who did not cooperate satisfactorily with a dose of 0.5 mg/kg.