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Review
. 2025 Feb 16;17(2):e79079.
doi: 10.7759/cureus.79079. eCollection 2025 Feb.

Comparison of Anesthetic Features in Diazepam and Midazolam for Sedation Dentistry: A Scoping Review

Takutoshi Inoue  1 , Toru Yamamoto  2 , Naotaka Kishimoto  2 , Kenji Seo  2
Affiliations
Review

Comparison of Anesthetic Features in Diazepam and Midazolam for Sedation Dentistry: A Scoping Review

Takutoshi Inoue et al. Cureus. .

Abstract

In recent years, there have been incidences of shortages of sedatives due to infectious diseases and supply issues. Dental anesthesiologists are required to have backup plans in case of supply shortages. Therefore, the aim of this study was to highlight the characteristics of diazepam and compare them with those of midazolam, and to explore the possibility of proposing useful situations for the use of diazepam in the modern intravenous sedation (IVS) scene. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. Literature research was performed using PubMed and Google Scholar. After a detailed scrutiny, 20 English-language studies comparing midazolam and diazepam met the eligibility criteria. The evaluation points were classified into four categories: onset of action, recovery from sedation, injection pain, and amnesic effects. The results of this analysis review highlight that diazepam tends to have (a) a slower onset of action and recovery, (b) more injection pain, and (c) a weaker amnesic effect compared with midazolam, and that diazepam has to be administered at higher doses compared with midazolam. The use of two drugs in combination (e.g., midazolam + propofol) is now a common practice due to the advances in anesthetic drugs. In addition, dentistry has become more advanced and involves lengthy procedures, such as implant surgeries. Therefore, it is necessary to focus on the optimal drug dosages in the combination of diazepam and propofol, the postoperative recovery time, and the presence or absence of injection pain and amnesic effects. Diazepam may be an alternative to midazolam for IVS during prolonged dental procedures in situations of shortage and requires further study.

Keywords: dental treatment; diazepam; intravenous sedation; midazolam; oral surgery; sedation dentistry.

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Conflict of interest statement

Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Identification of studies via databases with PRISMA flow diagram
PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses
Figure 2
Figure 2. Fields of articles that met the eligibility criteria
The 20 studies that met the eligibility criteria were subdivided into five areas.
Figure 3
Figure 3. Dosage and onset of action
From the results of seven studies [13,15,16,24,25,27,29], the dosage was examined. Because there was variation in the units (mg or mg/kg), they were converted to percentages. For example, 1 mg diazepam and 1 mg midazolam are 50% diazepam and 50% midazolam.
Figure 4
Figure 4. Age and onset of action
From the results of seven studies [13,15,16,24,25,27,29], the age was examined. The maximum, minimum, and average values for each study are shown in this figure. There was one report that did not state the average age. D: Diazepam; M: Midazolam
Figure 5
Figure 5. Dosage and recovery
From the results of 11 studies [10,11,13,15,16,22,25-29], the age was examined. Because there was variation in the units (mg, mg/kg, mg/30 sec), they were converted to percentages. For example, 1 mg diazepam and 1 mg midazolam are 50% diazepam and 50% midazolam.
Figure 6
Figure 6. Age and recovery
From the results of 11 studies [10,11,13,15,16,22,25-29], the age was examined. The maximum, minimum, and average values for each study are shown in this figure. There was one report that did not state the average, maximum, and minimum values, and three reports that did not state the average value. D: Diazepam; M: Midazolam
Figure 7
Figure 7. Dosage and injection pain (vascular pain)
From the results of 10 studies [10,11,15-17,19,23,27-29], the age was examined. Because there was variation in the units (mg, mg/kg, mg/30 sec, mg/min), they were converted to percentages. For example, 1 mg diazepam and 1 mg midazolam are 50% diazepam and 50% midazolam.
Figure 8
Figure 8. Age and injection pain (vascular pain)
From the results of 10 studies [10,11,15-17,19,23,27-29], the age was examined. The maximum, minimum, and average values for each study are shown in this figure. There were five reports that did not state the average value, and one report that did not state the maximum and minimum values. D: Diazepam; M: Midazolam
Figure 9
Figure 9. Dosage and amnesic effects
From the results of 16 studies [10-16,18,20-22,24-28], the age was examined. Because there was variation in the units (mg, mg/kg, mg/30 sec, mg/min), they were converted to percentages.
Figure 10
Figure 10. Age and amnesic effects
From the results of 15 studies [10-16,18,20-22,24,25,27,28], the age was examined. The maximum, minimum, and average values for each study are shown in this figure. There were three reports that did not state the average value. D: Diazepam; M: Midazolam
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