Issues concerning the use of nitrous oxide (N2O) and sedative agents by pediatric dentists in relation to recent changes in sedation guidelines of the American Academy of Pediatric Dentistry (AAPD) and the American Academy of Pediatrics (AAP) are relatively unexplored. A 48-item questionnaire addressing demographics, N2O equipment, N2O use, safety, and personnel was mailed to 2,650 active AAPD members in the United States and Canada. The 1,758 (66.3%) responses were reviewed and descriptive statistics were obtained using SPSS/PC+ statistics package. Results suggest that respondents were representative of the demographics of the AAPD membership. The majority of respondents (89%) used N2O, with a central delivery system being most popular. The majority (74%) did not use any monitors when using N2O alone; 10% did not use monitors when N2O was used in combination with other sedative agents. A majority (59%) did not use a time-based recording of physiological parameters. In conclusion, a mixed impression was found about practitioners' use of N2O and sedative agents, suggesting wide variability in practitioner habits related to pharmacologic patient management.