Fear of pain and of the unknown have long been recognized as major reasons for dental therapy avoidance. Add to this possible parental interjections of fear and avoidance of unfamiliar environments and the young patient is prepared for a difficult experience. Enter the dentist, whose trepidation for the ensuing encounter and whose possible negative feelings may lead to a breakdown of mutual confidence. Patient management is a major reason for the specialty of pediatric dentistry. The dentists that deal with pediatric and special patient populations have had increasing difficulty in providing sedative services for the individuals that need this management modality. The purpose of this article is to review the reasons for the utilization of chloral hydrate hydroxyzine as the predominant oral premedication regimen and review factors relating to the safety of its use.