The Council on Dental Accreditation has the formidable task of determining what minimally needs to be included in the curricula of advanced training programs. Concerns have emerged regarding curriculum requirements for advanced training programs in pediatric dentistry in the area of pediatric sedation. Conceptually, among the obligatory demands to provide well rounded experience in all aspects of pediatric dentistry, wide variation in curriculum didactics and clinical experience with sedation techniques presents a dilemma for accreditation bodies. Wide variation appears to exist amongst programs with respect to what constitutes adequate exposure making use of both a limited and extensive spectrum of available agents and combinations to manage the childhood manifestations of varying levels of anxiety and behavioral resistance. This dilemma is not limited to training in sedation, but several other vital areas of instruction might also be included. Demands to provide broad experience across all areas of instruction within the framework of 24 month programs is alone at the very least challenging. Added to the complexity of securing adequate exposure to all clinical arenas is the additional component that exposes the postgraduate student to research requirements. As such, concerns have been raised with respect to potential benefit of lengthening training programs from two to three years, particularly where research components and advanced degrees are selected. At present, adequate experience and proficiency in the area of pediatric sedation is considered minimal and query is underway to determine what constitutes sufficient exposure to ensure safe and effective training experience. Catastrophic events continue to appear in the literature documenting sedation mishaps and examples of poor clinician judgment. Focus of this manuscript falls on the area of sedation since it poses the greatest risk and most timely concern for high risk and life threatening outcomes.