Background Pediatric dental sedation aims to have a cooperative child who is required to keep his mouth open during the procedure. Achieving the proper level of sedation might subject the child to circulatory and ventilatory troubles, which draws the attention toward performing researches for the proper sedative to be used in such circumstances. Aim of the work This study compares the effect of two sedatives (dexmedetomidine vs. midazolam) in children undergoing dental procedures. Patients and methods A total of 60 ASA I children aged 6–10 years who were scheduled for lower jaw dental procedure were enrolled in the current study. Children were randomized into two equal groups. In group D (dexmedetomidine group, n=30), 2-μg/kg dexmedetomidine was administered intravenously over 5 min as induction dose, followed by continuous infusion of 0.4 μg/kg/h as a maintenance. In group M (midazolam group, n=30), 0.05 mg/kg midazolam was administered intravenously followed by maintenance dose of 0.06–0.12 mg/kg/h titrated according to patient response. Local infiltration anesthesia was given by the dentist as 0.5 mg/kg mepivacaine 2%. Results In this study, mean arterial blood pressure, heart rate, respiratory rate, and oxygen saturation showed no significant differences between both groups. The time of onset of sedation was comparable between both groups (4.7±1.1 vs. 4.1±1.8 min in group D and group M, respectively). However, recovery time was highly significantly shorter in group D compared with group M (14.3±1.1 vs. 20.2±9.8 min, respectively). The duration of the procedures (24.7±3.1 vs. 22.2±7.5 min in group D and group M, respectively) and discharge times (14.1±2.2 vs. 13.5 ±5.9 min in group D and group M, respectively) were comparable between both groups. Number of patients requiring supplemental analgesia was significantly lower in group D compared with group M (6 vs. 16, respectively). Dentist satisfaction was equivalent in both groups of the study. Conclusion Dexmedetomidine and midazolam are safe and effective for consciously sedating pediatric patients undergoing dental procedures. Dexmedetomidine shows faster recovery and better postoperative analgesia compared with midazolam. Keywords: conscious sedation, dexmedetomidine, midazolam, pediatric dentistr