{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T23:36:12Z","timestamp":1792020972596,"version":"4.4.0"},"reference-count":41,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T00:00:00Z","timestamp":1761004800000},"content-version":"vor","delay-in-days":50,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Special Care in Dentistry"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>The aim of this systematic review was to analyze the efficacy, advantages and adverse effects of midazolam in outpatient pediatric dentistry.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This review was carried out in accordance with the PRISMA criteria. A systematic electronic search was conducted through MEDLINE\/PubMed, Scopus, and the Cochrane Library databases up to September 2024. An advanced and reproducible search strategy was used to identify relevant studies. Articles were excluded if they focused solely on midazolam as a premedication for general anesthesia or elective surgery, involving patients with special diseases. Inclusion criteria required participants aged 0\u201316 years, patients with behavioral and\/or cooperation disorders and undergoing simple dental restorative procedures under local anesthesia, such as fillings, pulp therapies, stainless steel crowns, or basic extractions. Patients with specific medical conditions, as well as those who were not monitored for vital signs during sedation, were excluded from the study. The risk of bias assessment was analyzed using the criteria set out in the Cochrane Handbook for Systematic Reviews of Interventions, version 5.1.0.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 28 studies were included in the analysis, which were conducted across 11 countries and involved a total of 4374 children aged between 2 and 14 years. Most studies demonstrated a low risk of bias. Many of the participants were ASA I or II status and were assessed using behavioral scales, primarily the Frankl scale. Twelve adjunct drugs were combined with midazolam, and various administration routes were explored, including oral, intranasal, and buccal. Dosing protocols varied, as did fasting guidelines prior to sedation. Outcome measures included vital sign monitoring and behavioral assessments, most commonly via the Houpt and MOAA\/S scales. Midazolam generally proved effective in reducing anxiety and improving cooperation, with reported benefits extending to future dental visits. Adverse effects were infrequently noted and typically mild, including nausea, vomiting, and paradoxical reactions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Midazolam has been shown to be an effective and safe agent for moderate sedation in pediatric dental procedures when administered orally at a dose range of 0.3\u20130.5\u00a0mg\/kg. The evidence suggests that it reliably reduces anxiety and improves cooperation. Supervision, preferably by an anesthesiologist, is recommended when combined with other drugs to ensure patient safety.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/scd.70107","type":"journal-article","created":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T05:30:23Z","timestamp":1761111023000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Efficacy of Midazolam in Outpatient Pediatric Dentistry: A Systematic Review"],"prefix":"10.1111","volume":"45","author":[{"given":"Judit","family":"Rabassa\u2010Blanco","sequence":"first","affiliation":[{"name":"Department of Dentistry Hospital Sant Joan de D\u00e9u University of Barcelona Barcelona Spain"},{"name":"Department of Odontostomatology Faculty of Medicine and Health Sciences University of Barcelona  Barcelona Spain"},{"name":"Hospital Dentistry and Periodontal Medicine Research Group Institut de Recerca Sant Joan de D\u00e9u (IRSJD)  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pau","family":"Cahuana\u2010Bartra","sequence":"additional","affiliation":[{"name":"Department of Dentistry Hospital Sant Joan de D\u00e9u University of Barcelona Barcelona Spain"},{"name":"Department of Odontostomatology Faculty of Medicine and Health Sciences University of Barcelona  Barcelona Spain"},{"name":"Hospital Dentistry and Periodontal Medicine Research Group Institut de Recerca Sant Joan de D\u00e9u (IRSJD)  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yndira","family":"Gonz\u00e1lez\u2010Ch\u00f3pite","sequence":"additional","affiliation":[{"name":"Department of Dentistry Hospital Sant Joan de D\u00e9u University of Barcelona Barcelona Spain"},{"name":"Hospital Dentistry and Periodontal Medicine Research Group Institut de Recerca Sant Joan de D\u00e9u (IRSJD)  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda Dolores","family":"Rocha\u2010Eiroa","sequence":"additional","affiliation":[{"name":"Department of Dentistry Hospital Sant Joan de D\u00e9u University of Barcelona Barcelona Spain"},{"name":"Hospital Dentistry and Periodontal Medicine Research Group Institut de Recerca Sant Joan de D\u00e9u (IRSJD)  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Albert","family":"Ram\u00edrez\u2010R\u00e1miz","sequence":"additional","affiliation":[{"name":"Department of Odontostomatology Faculty of Medicine and Health Sciences University of Barcelona  Barcelona Spain"},{"name":"Hospital Dentistry and Periodontal Medicine Research Group Institut de Recerca Sant Joan de D\u00e9u (IRSJD)  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elias Isaack","family":"Mashala","sequence":"additional","affiliation":[{"name":"Doctoral Programme in Medicine and Translational Research Faculty of Medicine and Health Sciences Hospital Sant Joan de D\u00e9u University of Barcelona Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Llu\u00eds","family":"Brunet\u2010Llobet","sequence":"additional","affiliation":[{"name":"Department of Dentistry Hospital Sant Joan de D\u00e9u University of Barcelona Barcelona Spain"},{"name":"Department of Odontostomatology Faculty of Medicine and Health Sciences University of Barcelona  Barcelona Spain"},{"name":"Hospital Dentistry and Periodontal Medicine Research Group Institut de Recerca Sant Joan de D\u00e9u (IRSJD)  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaume","family":"Miranda\u2010Rius","sequence":"additional","affiliation":[{"name":"Department of Dentistry Hospital Sant Joan de D\u00e9u University of Barcelona Barcelona Spain"},{"name":"Department of Odontostomatology Faculty of Medicine and Health Sciences University of Barcelona  Barcelona Spain"},{"name":"Hospital Dentistry and Periodontal Medicine Research Group Institut de Recerca Sant Joan de D\u00e9u (IRSJD)  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,10,21]]},"reference":[{"issue":"4","key":"e_1_2_12_2_1","first-page":"316","article-title":"Children's Fear and Behavior in Private Pediatric Dentistry Practices","volume":"26","author":"Baier K.","year":"2004","journal-title":"Pediatric Dentistry"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00784\u2010014\u20101380\u20105"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40368\u2010021\u201000660\u2010z"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.2344\/0003\u20103006\u201059.3.139"},{"key":"e_1_2_12_6_1","first-page":"E26","article-title":"American Academy of PediatriMS: Guidelines for Monitoring and Management of Pediatric Patients Before, During, and After Sedation for Diagnostic and Therapeutic Procedures","volume":"41","author":"Cot\u00e9 C. J.","year":"2019","journal-title":"Pediatric Dentistry"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.4103\/ccd.ccd_470_20"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.17245\/jdapm.2019.19.2.83"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/ipd.12017"},{"key":"e_1_2_12_10_1","article-title":"Sedation of Children Undergoing Dental Treatment","volume":"12","author":"Ashley P. F.","year":"2018","journal-title":"Cochrane Database of Systematic Reviews"},{"key":"e_1_2_12_11_1","unstructured":"Council of European Dentists.CED Resolution on the Use of Nitrous Oxide Inhalation Sedation\u2014Update Adopted by the CED General Meeting on 22 of November 2019 Revised CED Resolution on the review of Annex V.3\/5.3.1 of Directive 2005\/36\/EC https:\/\/www.omd.pt\/content\/uploads\/2019\/12\/CED\u2010DOC\u20102019\u2010055\u2010E.pdf."},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40368\u2010015\u20100187\u20107"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.33549\/physiolres.934511"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12903\u2010023\u201002965\u20105"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1592\/phco.24.13.1177.38089"},{"issue":"2","key":"e_1_2_12_16_1","first-page":"101","article-title":"Conscious Sedation Efficacy of 0.3 and 0.5 mg\/kg Oral Midazolam for Three to Six Year\u2010Old Uncooperative Children Undergoing Dental Treatment: A Clinical Trial","volume":"13","author":"Fallahinejad Ghajari M.","year":"2016","journal-title":"Journal of Dentistry"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.15171\/joddd.2015.013"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.17245\/jdapm.2023.23.2.69"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.17796\/1053\u20104625\u201046.2.11"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.31041"},{"issue":"4","key":"e_1_2_12_21_1","first-page":"255","article-title":"Intranasal Fentanyl Combined With Oral Midazolam for Pediatric Dental Sedation: A Controlled Randomized Blinded Crossover Clinical Trial","volume":"44","author":"Alhaidari R. I.","year":"2022","journal-title":"Pediatric Dentistry"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.4103\/ccd.ccd_818_17"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.4103\/0976\u2010237X.183058"},{"key":"e_1_2_12_24_1","doi-asserted-by":"publisher","DOI":"10.3290\/j.qi.b1702197"},{"key":"e_1_2_12_25_1","doi-asserted-by":"publisher","DOI":"10.4103\/1735-3327.245235"},{"key":"e_1_2_12_26_1","doi-asserted-by":"publisher","DOI":"10.5005\/jp\u2010journals\u201010005\u20102092"},{"key":"e_1_2_12_27_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12871-023-02289-5"},{"key":"e_1_2_12_28_1","doi-asserted-by":"publisher","DOI":"10.2344\/15\u201000016.1"},{"key":"e_1_2_12_29_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0213074"},{"key":"e_1_2_12_30_1","doi-asserted-by":"publisher","DOI":"10.5812\/ijp.25(3)2015.494"},{"key":"e_1_2_12_31_1","doi-asserted-by":"publisher","DOI":"10.1155\/2015\/349795"},{"key":"e_1_2_12_32_1","doi-asserted-by":"publisher","DOI":"10.30476\/DENTJODS.2021.89323.1406"},{"issue":"2","key":"e_1_2_12_33_1","first-page":"106","article-title":"Comparison of Drug Acceptance and Anxiety Between Intranasal and Sublingual Midazolam Sedation","volume":"38","author":"Shanmugaavel A. K.","year":"2016","journal-title":"Pediatric Dentistry"},{"key":"e_1_2_12_34_1","doi-asserted-by":"publisher","DOI":"10.5005\/jp\u2010journals\u201010005\u20102085"},{"key":"e_1_2_12_35_1","doi-asserted-by":"publisher","DOI":"10.5005\/jp\u2010journals\u201010005\u20102096"},{"key":"e_1_2_12_36_1","doi-asserted-by":"publisher","DOI":"10.1590\/1807\u20103107BOR\u20102016.vol30.0107"},{"key":"e_1_2_12_37_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12903\u2010021\u201001594\u20100"},{"key":"e_1_2_12_38_1","doi-asserted-by":"publisher","DOI":"10.7860\/JCDR\/2016\/16760.7592"},{"issue":"3","key":"e_1_2_12_39_1","first-page":"139","article-title":"Retrospective Evaluation of Moderate Sedation Visits That Used Oral Meperidine and Hydroxyzine With Oral or Intranasal Midazolam","volume":"90","author":"Jain G.","year":"2023","journal-title":"Journal of Dentistry for Children (Chicago Ill)"},{"key":"e_1_2_12_40_1","doi-asserted-by":"publisher","DOI":"10.3390\/children9050611"},{"key":"e_1_2_12_41_1","doi-asserted-by":"publisher","DOI":"10.1097\/JS9.0000000000000340"},{"key":"e_1_2_12_42_1","first-page":"13","volume-title":"Farmacolog\u00eda B\u00e1sica y Cl\u00ednica","author":"Lorenzo P.","year":"2009"}],"container-title":["Special Care in Dentistry"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/scd.70107","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,13]],"date-time":"2025-11-13T15:23:08Z","timestamp":1763047388000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/scd.70107"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9]]},"references-count":41,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2025,9]]}},"alternative-id":["10.1111\/scd.70107"],"URL":"https:\/\/doi.org\/10.1111\/scd.70107","archive":["Portico"],"relation":{},"ISSN":["0275-1879","1754-4505"],"issn-type":[{"value":"0275-1879","type":"print"},{"value":"1754-4505","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9]]},"assertion":[{"value":"2025-05-02","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-09-22","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-10-21","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70107"}}