# Single-Agent Sedation for Behavioral Management in Pediatric Dentistry: An Umbrella Review of Agents, Routes of Administration, Providers, and Clinical Settings

## TL;DR

This review summarizes 18 studies on using single-agent sedation to manage children's behavior during dental procedures, finding it effective but with limited data on satisfaction and acceptability.

## Contribution

The study provides a comprehensive umbrella review of single-agent sedation strategies for pediatric dental behavior management, highlighting variability in agent and route selection based on clinical context.

## Key findings

- Single-agent sedation is effective for managing children's behavior during dental treatment.
- Midazolam and nitrous oxide are the most studied sedative agents.
- Clinical setting and provider type influence agent and route selection.

## Abstract

What are the main findings?
The present umbrella review synthesized 18 systematic reviews (97 primary studies; 6877 children), identifying 14 single-agent sedation strategies (excluding deep sedation/general anesthesia) administered through eight different routes; sedation was consistently reported as an effective approach for behavioral management and completion of dental treatment in children.Agent selection and administration routes appeared to be influenced by the clinical setting (e.g., outpatient clinic or hospital) and provider type (e.g., dentist or anesthesiologist), while evidence concerning acceptability and satisfaction among children, caregivers, and providers remains notably limited.

The present umbrella review synthesized 18 systematic reviews (97 primary studies; 6877 children), identifying 14 single-agent sedation strategies (excluding deep sedation/general anesthesia) administered through eight different routes; sedation was consistently reported as an effective approach for behavioral management and completion of dental treatment in children.

Agent selection and administration routes appeared to be influenced by the clinical setting (e.g., outpatient clinic or hospital) and provider type (e.g., dentist or anesthesiologist), while evidence concerning acceptability and satisfaction among children, caregivers, and providers remains notably limited.

What are the implications of the main findings?
In appropriately monitored settings, selected single-agent sedation strategies may provide valuable means to support behavior management and dental treatment continuity in pediatric patients, when the chosen pharmacological approach is aligned with the provider’s expertise and available infrastructure.The influence of clinical setting and provider type on agent selection and sedation outcomes highlights the importance of focusing on patient-, caregiver-, and provider-related acceptability and satisfaction rates, to ensure high standards of quality in pediatric dental sedation.

In appropriately monitored settings, selected single-agent sedation strategies may provide valuable means to support behavior management and dental treatment continuity in pediatric patients, when the chosen pharmacological approach is aligned with the provider’s expertise and available infrastructure.

The influence of clinical setting and provider type on agent selection and sedation outcomes highlights the importance of focusing on patient-, caregiver-, and provider-related acceptability and satisfaction rates, to ensure high standards of quality in pediatric dental sedation.

Background: Dental fear and anxiety are highly prevalent in children, resulting in avoidance or incomplete dental treatment; sedation emerges as a possible behavioral management strategy. This umbrella review aimed to provide a structured and critical synthesis of the available knowledge on sedative single-agent efficacy and routes of administration employed for achieving sedation (excluding deep sedation/general anesthesia) during dental procedures in children for behavior management, as well as to evaluate acceptability and satisfaction for child, caregiver, and provider, and to assess the influence of clinical setting and provider. Methods: In line with the PRISMA statement, the protocol was registered on PROSPERO (CRD420251043738), and 18 systematic reviews were included and synthesized qualitatively. Results: Single-agent sedation was safe and effective for managing behavior in children during dental procedures, with midazolam and nitrous oxide being the most studied agents. Different routes of administration showed distinct characteristics in onset, recovery time, adverse effects and cooperation, while agent selection appeared influenced by clinical setting and provider type. However, data on acceptability and satisfaction from children, caregivers, and providers remains limited. Conclusions: Evidence suggests potential effectiveness of selected agents and routes in appropriately monitored settings, but data heterogeneity precludes strong comparative recommendations. Further studies are therefore needed to address the existing gaps in pediatric dental sedation.