Pediatric Dental Sedation Guidelines

By Emma Yasinski


Earlier this summer, the American Academy of Pediatrics (AAP) published its latest update of the guidelines for using deep sedation with children. The recommendations were jointly authored with the American Academy of Pediatric Dentistry (AAPD).

Most of the rules remain unchanged since the last update, three years ago. Except one. The new guidelines instruct a second trained professional be present whenever a child is undergoing deep sedation.

This additional professional should be a physician anesthesiologist, a certified registered nurse anesthetist, a second oral surgeon, or a dentist anesthesiologist.

While one professional is responsible for conducting the child’s procedure, this second individual should be solely responsible for administering anesthesia and monitoring the child’s response to it. The American Society of Anesthesiologists, The Society for Pediatric Anesthesia, The American Society of Dentist Anesthesiologists, and The Society for Pediatric Sedation, endorsed the guidelines.

In an interview with Incisor, Kevin Donly, president of the AAPD, DDS, MS, explained that 30 years ago, “we didn’t really do general anesthesia in the office.” Anesthesia was more commonly done in a hospital setting. In recent years, however, due to difficulty scheduling operating rooms, outpatient care has become more common.


While one professional is responsible for conducting the child’s procedure, this second individual should be solely responsible for administering anesthesia and monitoring the child’s response to it.


Dr. Donly observes that while the AAP recommendation for a second professional is the most significant change in the new guidelines, it “isn’t that major” since most pediatric dentists using deep sedation already work with a second expert.

Dr. Kevin Donly
Dr. Kevin Donly
Dr. Roger Sanger
Dr. Roger Sanger

Still, he says, many children see general dentists instead of pediatric dentistry specialists, “and we want to make sure…if [the dentists use deep sedation or general anesthesia] that they have a person there really just to monitor and provide that anesthesia care.”

Although there have been some highly publicized pediatric sedation dentistry deaths over the past several years, Dr. Donly didn’t cite specific deaths as the impetus for the new guideline. “There's been some mortalities and some morbidities with children,” he said. “[But] it's not that there hadn't been before. It's very, very few. We just thought we should clarify that [two professionals should be present during procedures] because it just made sense.”

[Editor’s Note: Roger Sanger, DDS, MS is the lead instructor in pediatric sedation for DOCS Education. He is the author of two clinical textbooks, numerous scientific articles, and a textbook on pediatric dental practice management. He founded a multi-doctor, multi-office children’s dental group.

Dr. Sanger believes that there is a single best protocol for administering safe pediatric sedation. He will be leading the upcoming DOCS Education Pediatric Sedation Dentistry course in Seattle on November 8th and 9th.

To learn more about his philosophy of pediatric dental sedation, be sure to read Dr. Sanger’s Incisor essay, Given the News Reports, Why Would Any Caring Dentist Ever Use Sedation On a Child?]


Author: Contributing writer Emma Yasinski received her Master of Science (MS) in science and medical journalism from Boston University. Her articles have also appeared at, Kaiser Health News, NPR Shots, and Genetic Engineering and Biotechnology News.

Other Recent Incisor Articles by Emma Yasinski include:

The information contained in this, or any case study post in Incisor, should never be considered a proper replacement for necessary training and/or education regarding adult oral conscious sedation. Regulations regarding sedation vary by state. This is an educational and informational piece. DOCS Education accepts no liability whatsoever for any damages resulting from any direct or indirect recipient's use of or failure to use any of the information contained herein. DOCS Education would be happy to answer any questions or concerns mailed to us at 3250 Airport Way S, Suite 701 | Seattle, WA 98134. Please print a copy of this posting and include it with your question or request.
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