Comparative evaluation of the sedative efficacy of oral midazolam (0.5 mg/kg vs. 0.75 mg/kg) with papoose board restraint for managing severe dental anxiety in paediatric patients: a retrospective cohort study.

BACKGROUND

Modern healthcare providers offer multiple anxiety management approaches; however, there is still no optimal strategy that balances efficacy and resource investment, particularly for children with severe dental anxiety and a limited number of affected teeth.

OBJECTIVE

To evaluate the sedative efficacy of oral midazolam at doses of 0.5 mg/kg and 0.75 mg/kg in combination with a papoose board when necessary in children with severe dental anxiety and to determine the most effective protocol.

METHODS

We retrospectively reviewed sedation cases in which 0.5 mg/kg or 0.75 mg/kg oral midazolam was used in our department between January 2020 and December 2024. Electronic health records were systematically reviewed to extract (1) demographic characteristics (age, weight, ASA status), (2) sedation parameters (dosage, time to onset, procedure duration), and (3) efficacy outcomes (Houpt behaviour rating scale, sedation success rate). The secondary safety outcomes included oxygen desaturation events and postoperative complications. Comparative analyses were performed using appropriate statistical methods.

RESULTS

A total of 51 patients in the 0.5 mg/kg group and 71 patients in the 0.75 mg/kg group were identified and included. No significant differences were observed between the two groups in terms of Houpt scores, onset times, operation times, recovery times, adverse effects or vital signs.

CONCLUSION

Oral midazolam at 0.5 mg/kg combined with a papoose board, when necessary, may serve as an effective alternative sedation protocol for children with severe dental anxiety and limited dental involvement.