Effect of Midazolam Premedication on Salivary Cortisol Levels in Pediatric Patients with Negative Frankl Behavior: A Pilot Study

Background/Objectives: This pilot study aimed to evaluate stress levels in pediatric patients classified as definitely negative according to the Frankl scale by measuring salivary cortisol concentrations. Additionally, the study assessed the impact of Midazolam premedication on stress reduction during dental procedures. Methods. Children and adolescents attending the Pediatric Dentistry Master’s program at the Catholic University of Valencia participated in the study. Salivary cortisol levels were measured before and after dental treatments, differentiating between invasive and non-invasive procedures. Patients were divided into two groups: those receiving Midazolam premedication and those who did not. Results. Findings showed a significant increase in cortisol levels following invasive dental treatments (0.991), whereas non-invasive treatments (0.992) did not lead to notable changes (p < 0.001). Patients premedicated with Midazolam exhibited significantly lower post-treatment cortisol levels compared to those who did not receive the medication (p < 0.05). Conclusion. These preliminary findings suggest that Midazolam-based management in children with definitely negative behavior may be associated with reduced physiological stress responses. As a pilot study with a limited sample and inherent group-allocation bias, the results should be interpreted with caution. The methodology proved feasible and supports the use of salivary cortisol in future, larger-scale studies designed to disentangle behavioral and pharmacological effects.