Objectives:To assess the safety and effectiveness of midazolam sedation administered transmucosally by the buccal route in paediatric dental patients. Methods:Children aged 10 to 16 (ASA I and II) ,referred for orthodontic extractions, where two appointments were required for equivalent but contralateral extractions, were recruited. Sedation with either nitrous oxide/oxygen titrated to 30%/70% or buccal midazolam (0.2mg/kg) was used at the first visit, the alternative being used at the second visit.The following parameters were recorded, vital signs every 2 minutes(arterial oxygen saturation, blood pressure, pulse rate and respiratory rate), sedation levels, behavioural scores and post operative satisfaction. Results:Forty children mean age 12.9 (10-15)years, were recruited.In the test group a mean dose of 10mg (6.8-18.2) of midazolam was administered. This allowed an adequate level of sedation to be achieved, with verbal communication being maintained throughout. Vital signs for both groups were comparable and within acceptable clinical limits. The mean time to the maximum level of sedation for the midazolam group was significantly longer compared to the nitrous oxide group, 14.4 and 7.05 minutes repectively (P=0.000). Of the 40 children recruited 36 (90%) successfully completed the trial. Sixty six percent were prepared to have buccal midazolam again, but only 27.7% preferred it to nitrous oxide/oxygen. Conclusion: Buccal midazolam (0.2mg/kg) appears to be a potentially useful and safe form of sedation for 10 to 16 year old dental patients, however, in its present form it is not as acceptable by patients as nitrous oxide/oxygen inhalation sedation.