Emerging trend of intranasal sedation in pediatric dentistry

Intranasal sedation is a minimally invasive drug-delivery technique used in dental practice to reduce anxiety, discomfort, and procedural distress, particularly in pediatric and special-needs patients. Best among submucosal methods. Intranasal administration is a painless, inexpensive and easy to apply method. It is used as an alternative to sedation by oral or injection, especially in pediatric patients. The duration of onset of action in intranasal administration is close to intravenous administration. There are two ways to administer IN medications: By dripping or atomization. This method involves administering sedative or anxiolytic medications through the nasal mucosa, allowing rapid absorption into the systemic circulation via the rich vascular plexus of the nasal cavity. Because it bypasses the gastrointestinal tract and first-pass hepatic metabolism, intranasal sedation offers a faster onset of action and more predictable clinical effects compared to oral administration.

One of the major advantages of intranasal sedation is its simplicity and non-invasiveness. It eliminates the need for intravenous access, which can itself be a source of fear and stress, especially in children and needle-phobic patients. The technique is generally well tolerated, easy to administer, and does not require advanced equipment, making it suitable for outpatient and office-based procedures. Commonly used drugs for intranasal sedation include midazolam, dexmedetomidine, ketamine, and fentanyl, either alone or in combination, depending on the desired depth of sedation and clinical context. Intranasal sedation is particularly valuable for short diagnostic or therapeutic procedures such as dental treatments, imaging studies, and minor surgical interventions. It provides effective anxiolysis, mild to moderate sedation, and in some cases analgesia, while preserving protective airway reflexes. With appropriate patient selection, dosing, and monitoring, intranasal sedation has demonstrated a high safety profile. Intranasal sedation is emerging as an important alternative to traditional sedation techniques in pediatric dental practise nowadays.