Design Practitioners working in the General Dental Service in the area of the former North West Regional Health Authority were randomly sampled and sent a postal questionnaire.

Setting General Dental Service in the North Wrest of England.

Subjects 204 completed questionnaires were returned; a response rate of 71.1%,

Interventions Practitioners were asked about the patient management methods that they used for orthodontic extractions and what factors were important in choosing to use a general anaesthetic.

Outcome measures The mean percentages of patients treated with local anaesthetic alone, general anaesthesia and inhalation sedation with local anaesthesia were calculated for the sample. Factors influencing the choice of method used were scored by the practitioners on a ten point scale.

Results Local anaesthesia alone was used for two thirds of orthodontic extraction patients and general anaesthesia for one third. Inhalation sedation was rarely used. Poor patient cooperation and a nervous patient were the most important factors in choosing a general anaesthetic.

Conclusions Local anaesthesia is used for the majority of orthodontic extractions. However there remains an overuse of general anaesthesia and an underuse of inhalation sedation.