Down syndrome (DS) is a congenital autosomal disorder characterized by generalized growth and mental deficiency. Patients with down syndrome may be anxious and uncooperative during dental treatment thus oral health professionals may need to use physical restraints, which causes further emotional trauma.

Intranasal sedation is a non-invasive, safe and well tolerated method by children. This paper presents a case report of a 12-year-old female patient with known diagnosis of Down syndrome, who was treated successfully under intranasal sedation using midazolam (0.5 mg/kg), in which multiple extractions were performed. Satisfactory levels of sedation were achieved with no adverse effects. Post-operative healing of socket was seen without any complications after 7 days of follow up.