Treating an uncooperative, uncontrollable child can be unpleasant for all parties involved. Despite the dentist's best efforts to employ traditional techniques, the behavioral management of challenging pediatric dental patients often requires more than "tell, show, do". Consequently, pre-operative pharmacological intervention may be necessary. Enteral sedation may be the optimal adjunct for the dental treatment of such a challenging patient population. However it must be utilized with caution and is not an appropriate treatment modality for all. This paper will present various considerations for the safe, appropriate and effective use of enteral sedation in contemporary pediatric dentistry. With the strong demand for this service, properly trained practitioners can broaden their practice and provide a win-win scenario for themselves and their patients.