The Efficacy of Dexmedetomidine Versus Ketamine for Sedation in Pediatric Dental Procedures: A Systematic Review and Meta-Analysis

Background: Effective and safe sedation is essential in pediatric dental practice to manage anxiety, pain, and cooperation during procedures. Objective: This exploratory systematic review and meta-analysis aimed to synthesize available RCT evidence comparing dexmedetomidine and ketamine across different sedation strategies (premedication and procedural sedation) in children undergoing dental procedures. Methods: This study was conducted and reported in accordance with the PRISMA 2020 statement. A comprehensive literature search was performed across PubMed, Web of Science, Scopus, and ScienceDirect for studies between 1990 and 2026. Randomized controlled trials (RCTs) were included. The primary outcomes assessed were intraoperative and postoperative analgesia, heart rate, systolic and diastolic blood pressure (SBP and DBP), oxygen saturation (SpO2), and recovery time. A meta-analysis of the extracted data was performed, and the risk of bias was assessed using the Cochrane risk of bias tool 2. Results: The review included four RCTs involving 178 children, with a mean age of 6.5–9.1 years. Intraoperative and postoperative analgesia did not differ significantly between groups (p = 0.09 and p = 0.08, respectively). Pooled analysis showed numerically lower heart rates with dexmedetomidine compared to ketamine, but the difference was not statistically significant (MD = −11.70; 95% CI: −29.27 to 5.86; p = 0.07). Systolic blood pressure was significantly lower with dexmedetomidine (MD = −6.69; 95% CI: −6.91 to −6.47; p = 0.002). Oxygen saturation did not differ significantly between groups (p = 0.35). Two studies were rated as having a low risk of bias. The remaining two had some concerns, related to unverified blinding and lack of outcome pre-specification. Conclusions: Based on limited and clinically heterogeneous evidence, both dexmedetomidine and ketamine appear to be viable options for sedation in pediatric dental settings, though no firm superiority conclusion can be drawn. Further randomized controlled trials with larger sample sizes and standardized sedation protocols are recommended to strengthen these findings and inform practice guidelines.