Intranasal versus sublingual sedation in pediatric dentistry: a systematic review

Effective and well-tolerated sedation is critical for managing anxiety and uncooperative behaviors in pediatric dental patients. The intranasal and sublingual routes offer needle-free alternatives to oral or intravenous sedation; however, their comparative performance in dental settings remains underexplored.

To systematically compare the efficacy, onset time, and child cooperation outcomes of intranasal and sublingual sedative agents in pediatric dental patients.

A systematic review was conducted following the PRISMA 2020 guidelines. The databases searched included PubMed, Embase, Scopus, Web of Science, and Cochrane Library for English language studies published between 2000 and 2025. Both randomized controlled trials and non-randomized comparative studies evaluating intranasal versus sublingual sedation in children undergoing dental procedures were included in this review. The primary outcomes were successful sedation and child cooperation during the procedure. Secondary outcomes included onset time, route acceptance, and adverse events. Data were synthesized narratively, and meta-analysis was conducted where feasible. Risk of bias was assessed with the Cochrane RoB 2 tool for randomized trials and the Newcastle-Ottawa Scale for non-randomized studies.

28 studies involving more than 1500 children were included in this review. Sedation success rates were high for both routes (~ 94% intranasal and ~ 93% sublingual), with no statistically significant differences between them. Behavioral scores and anxiety reduction were equivalent across routes. Intranasal sedation produced a significantly faster onset (mean difference: ~ 4.5 min; p < 0.001), whereas sublingual administration was significantly better accepted by children (p = 0.001-0.01).

Intranasal and sublingual sedation routes are equally effective and safe for pediatric dental care. Intranasal delivery offers a faster onset, whereas sublingual administration is more acceptable in children. Clinicians may individualize route selection based on child temperament, procedural urgency, and environmental considerations without compromising sedation efficacy or safety.

INPLASY 202550016.