A systematic search was conducted in PubMed, Scopus, Web of Science, Embase, and CENTRAL, identifying randomized controlled trials (RCTs) comparing DK to D alone. Eligible studies were screened, and data were extracted following PRISMA guidelines. Meta-analyses were conducted using random effects models through RevMan software.

Five studies involving 308 pediatric patients were included. Meta-analysis showed no significant difference in onset of sedation time (MD = −0.02 minutes; 95% CI = [−3.27, 3.23]; P = .99; I² = 29%), duration of sedation (MD = −7.39 minutes; 95% CI = [−21.69, 6.91]; P = .31; I² = 95%), or recovery time (MD = 4.71 minutes; 95% CI = [−12.80, 22.23]; P = .60; I² = 92%). Analysis of Anxiety and pain scores favored DK (SMD = −0.67; 95% CI = [−1.20, −0.14]; P = .01; I² = 35%), (MD = −1.11; 95% CI = [−2.04, −0.19]; P = .02; I² = 20%), respectively. Adverse events, including bradycardia, hypotension, and agitation, vomiting, nausea showed no significant differences between groups.

The combination of DK does not offer significant advantages over dexmedetomidine alone for pediatric dental sedation. However, DK showed a moderate reduction in anxiety and pain with a favorable safety profile, suggesting it is a viable option in clinical practice.