Purpose: The purpose of the study was to assess and compare the changes in anxiety level and drug acceptance after intranasal and sublingual midazolam sedation. Methods: Forty three-to seven-year-olds were randomly assigned to Group A (n equals 20; 0.2 mg/kg intranasal midazolam sedation) or Group B (n equals 20; 0.2 mg/kg sublingual midazolam sedation) sedation. The anxiety levels at various time periods were assessed from recorded videos using the Venham clinical anxiety scale by two pediatric dentists. The acceptance of the drug administration was assessed using a four-point scale. The Wilcoxon signed rank test and Mann-Whitney U test were used for statistical analysis using SPSS 17.0 software. Results: There was a significant decrease in anxiety level from baseline to 20 minutes after drug administration in Group A (P>0.001) and Group B (P>0.001). However, there was no significant difference in the anxiety level between the two groups. The sublingual route of drug administration was better accepted (P=0.001) than the intranasal route of drug administration. Conclusions: Both intranasal and sublingual administrations of midazolam were equally effective in reducing the child's anxiety. The sublingual route of drug administration was better accepted than the intranasal route. © 2017 Elsevier B.V., All rights reserved.