A Comparative Analysis of US State Pediatric Dental Moderate Sedation Regulations

Abstract

Background. Professional organizations have published guidelines for the administration of moderate enteral sedation. Despite the existence of these guidelines, the regulation of dental sedation practice is determined by individual state dental practice acts, leading to substantial variation in permitting, education, and safety requirements.

Purpose. The purpose of this study was to compare moderate enteral sedation laws and regulations across the 50 US states and evaluate their alignment with the American Academy of Pediatrics (AAP)/American Academy of Pediatric Dentistry (AAPD) Guidelines and the American Dental Association (ADA) Guidelines for Teaching Pediatric Pain Control and Sedation to Dentists and Dental Students.

Methods. An online review of all 50 state dental sedation laws was conducted from January 2025 to June 2025. Data on permit type, renewal interval, application fees, site visit requirements, emergency drills, and education requirements were extracted from the most current online-accessible dental state practice acts. Each state’s regulations were compared to the AAPD Guidelines for Monitoring and Management of Pediatric Patients Before, During, and After Sedation for Diagnostic and Therapeutic Procedures and the ADA Guidelines for Teaching Pain Control and Sedation to Dentists and Dental Students. Each state’s sedation regulations were assessed for alignment with those published guidelines.

Results. Forty-eight states (96%) require a permit to administer moderate enteral sedation, and two states (4%, IN and MI) do not require a permit. Most states (62%) issue a single combined moderate sedation permit that allows enteral and parenteral sedation, while 34% maintain separate moderate enteral and parenteral sedation permits. Intranasal (IN) sedation is rarely explicitly mentioned in state regulations, with only five states specifically addressing the IN route. The most common permit renewal interval is two years (58%), and application fees range from $8 to $1,000. Two-thirds of states require 1–5 annual continuing education hours for renewal. Twenty states (40%) require a pediatric endorsement, most frequently applying to patients ≤12 years old. Didactic requirements to obtain a pediatric endorsement range from 8–60 hours and 10–50 pediatric cases. Nearly all states (98%) mandate advanced life-support training for pediatric patients—most commonly Pediatric Advanced Life Support (PALS)—and 64% require an initial site visit, generally renewed every five years. Half of all states require that the permit holder regularly complete emergency drills. Educational standards for moderate enteral sedation permits vary widely, though 60 didactic hours and 20 cases are most common. Most states (86%) require Basic Life Support (BLS) for monitoring personnel, and 56% require two individuals during procedures (the licensed provider and a second team member with life-support training). Overall, alignment with ADA and AAPD safety and educational guidelines remains widely variable across states. Conclusions. Regulation of moderate enteral sedation has increased substantially in recent decades, yet significant variability persists among state permit definitions and requirements leading to misalignment with published national guidelines. These findings highlight the need for standardized, evidence-based state dental practice acts that clearly define sedation levels, routes, and training requirements to promote consistency and patient safety.