Comparison of the Onset of Action and Behavioral Responses to Intranasal and Sublingual Routes of Midazolam Sedation in Children - A Randomized Controlled Trial

Young children with serious oral illnesses and non complianceoften test the patience and skills of the Pediatric dentists.Children aged 3 to 7 years with severe pain and pathology aremore anxious and have difficulty in communicating properlyto the dentist . Pain and the treatment procedures assuch influencethe behavior of the children in the dental office.These children require local anesthetic drug administration to alleviate the pain. 
The reaction of the child to local anesthetic drug administration can be a sign of emerging perception which further affects the behavior of the children in the dental office. Pharmacologic behavior management might be needed to manage them. Moderate sedation as described by American Academy of Pediatric Dentistry (AAPD) refers to drug induced depression of consciousness during which patients respond purposefully to verbal commands.
Transmucosal sedation has gained a lot of importance in pediatric dentistry in the last decade. The term transmucosal means “through, or across a mucous membrane”. Transmucosal drug delivery system includes drugs administration through rectal, intranasal and sublingual routes. These routes offer a rapid onset and bypass  first pass metabolism. Being non invasive, these routes can be child friendly. Among the medications available, midazolam has gained a lot of attention as a good pediatric sedative

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