Aim We compared the efficacy of sedation with oral Midazolam and a combination of oral Midazolam and Ketamine, used as alternatives to general anaesthesia during tooth extraction. Study Design: Retrospective study Materials and methods A total of 30 patients aged between 3 and 9 years, who had elective tooth extraction were included in the study Subjects in Group A (n. 15) were given 0.75 mg/kg Midazolam orally while those in Group B (n. 15) were given 0.75 mg/kg Midazolam orally + 5 mg/kg ketamine. Acceptance of orally administered drugs, sedation and anxiety scores and reactions to local anaesthetic injection and tooth extraction were assessed. Results Sedation and anxiety scores in Group B were better than in Group A (p<0.05). Reactions to local anaesthetic injection and tooth extraction were very significantly less common in Group B (p<0.0001). Requirement for an additional medication was more common in Group A (p<0.05). Side effects were not observed in either group. Statistics: Patient demographics and time to discharge were analysed by Mann-Whitney U test, whereas Chi-square test was used to analyse compliance to sedation, anxiety and sedation scores, reaction to tooth extraction, side effects and additional drug requirement. Condusion Compared to oral Midazolam only a combination of oral Midazolam+Ketamine resulted in better sedation and surgical comfort in children during a painful procedure such as tooth extraction.