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Side Effects of Nitrous Oxide Sedation Dentistry

Nitrous oxide side effects during or after dental treatments are rare and in most cases not severe. The most serious and dangerous side effects of nitrous oxide are usually reported after its use for recreational reasons, but this type of use is not the subject of this article.

The normal effects of nitrous oxide include a tingling sensation in the arms and legs, light- headiness, a sense of warmth, a floating sensation, followed by a feeling of euphoria and an increased pain threshold.

Symptoms like sleepiness, difficulty to keep the eyes open or speak, or nausea are indications that the patient has been over-sedated and has reached a deeper level of sedation than it should be.

The following are some of the nitrous oxide side effects:

The following are some of the nitrous oxide side effects: Nausea - Nausea and dizziness is

Nausea - Nausea and dizziness is the most common side effect of nitrous oxide sedation. If a patient starts to feel nausea, he has received a higher concentration of N 2 O versus O 2 (usually over 50%) or for longer time than he can tolerate resulting in an overdose. The good news is that this effect is only temporary and the dentist can immediately be notified by the patient to reduce the nitrous oxide level until he feels comfortable again.

Each patient has a different level of tolerance in the gas. Some patients may also show signs of reverse tolerance to repeated use of nitrous oxide. Reverse tolerance means that the patient is getting more intense or prolonged feelings with the same or lower quantities of a drug at each subsequent use. N 2 O concentration should always be gradually increased (titration) at each visit, because even the same patient’s tolerance can vary from day to day.

Vomiting - Vomiting can occur as a side effect of nitrous oxide if the patient experience - Vomiting can occur as a side effect of nitrous oxide if the patient experience nausea during the administration of the gas. In this case the dentist must be ready to use the suction equipment to prevent the risk of the patient to inhale his own vomit and choke. The risk of vomiting is highly increased if the patient has a full stomach or has been drinking alcohol before the procedure.

stomach or has been drinking alcohol before the procedure. Reduced heart rate and reduced respiratory rate

Reduced heart rate and reduced respiratory rate - This is generally not a problem that healthy patients should worry about. However the dentist must take into account the possibility of these side effects before treating patients with specific heart or lung conditions who could be affected.

specific heart or lung conditions who could be affected. Ineffectiveness - Some people may not achieve

Ineffectiveness - Some people may not achieve adequate sedation even with the maximum allowed concentration of nitrous oxide at 70% (and 30% oxygen). They will inevitably have to use other types of deeper dental sedation such as intravenous sedation or general anesthesia. Nitrous oxide is given by a nose mask, so if patients are unable to breathe adequately through their noses, they will be unable to inhale sufficient nitrous oxide for effective sedation.

Hazy memory - Some patients report that after the dental treatment they do not have

Hazy memory - Some patients report that after the dental treatment they do not have clear memory of what exactly was happening when they were under nitrous oxide sedation. This is usually considered a benefit for most patients suffering from dental anxiety, but for some people who may feel that they lose control of their actions, hazy memory may be a non desired effect.

Laughing - Nitrous oxide is also called laughing gas because of its euphoric effect and the - Nitrous oxide is also called laughing gas because of its euphoric effect and the desire to laugh that it creates to those inhaling it. Some reserved patients may feel uncomfortable because they are afraid of getting embarrassed.

because they are afraid of getting embarrassed. Hallucinations - Dreams - Some patients report that during

Hallucinations - Dreams - Some patients report that during nitrous oxide sedation they felt like dreaming even though they were fully conscious, and had visual and auditory hallucinations. This can occur if the patient temporarily for some seconds moves to a deeper level of sedation. However it is generally a harmless side effect of nitrous oxide, except of the following cases:

Patients with some mental or psychiatric disorders, patients with drug addictions, and patients under the influence of drugs or alcohol may experience severe side effects (such as panic attacks) due to the mind-altering effects of nitrous oxide.

Patients suffering from severe phobias of any kind, or taking sleep-inducing medication, antidepressants, or psychotropic drugs are at high risk of having hallucinations when sedated with nitrous oxide.

The hallucinations under nitrous oxide sedation may seem so real that there have been cases of dentists being falsely accused of sexual abuse because their patients had dreams of sexual nature when sedated.

their patients had dreams of sexual nature when sedated. Lack of co-ordination and balance - Nitrous

Lack of co-ordination and balance - Nitrous oxide may cause some disorientation and affect the control of body movements. A patient should not be allowed out of the dental chair unattended before fully recovered, to avoid potential injuries from falling.

fully recovered, to avoid potential injuries from falling. Headache - There is a small possibility of

Headache - There is a small possibility of experiencing a headache after nitrous oxide sedation.

of experiencing a headache after nitrous oxide sedation. Hyperthermia - A few cases of hyperthermia (high

Hyperthermia - A few cases of hyperthermia (high raise of body temperature) have been reported after inhaling nitrous oxide.

The side effects of nitrous oxide described above are the ones that are most possible to happen to the average patient having nitrous oxide sedation dentistry. However there are some potentially more serious risks but they can occur mainly (but not only) to specific patient groups who are not suitable candidates for nitrous oxide sedation.

Potential risks of nitrous oxide sedation dentistry

Most of the risks associated with the use of nitrous oxide by dental patients are caused either by

problems or errors in the proper administration of the gas (e.g. errors in the mixture of N 2 O/O 2 )

or by the inappropriate use of nitrous oxide to patients with conditions that contradict its usage.

Pressure increase due to nitrous oxide

A major cause of risks related to nitrous oxide is the change of pressure/volume of air-filled

cavities in the body. Nitrous oxide is 34 times more soluble in blood than the nitrogen that is replaced. It will thus diffuse from the blood into any closed air-containing space in the body faster than the nitrogen can diffuse out. This causes a temporary increase of the volume of the

gas filling the cavity, and subsequently an increase in the pressure to the walls of the cavity. Although the effect can be short lived, it can be enough to cause significant pain or/and damage

to the affected body tissues.

significant pain or/and damage to the affected body tissues. Eye damage - The increase on air

Eye damage - The increase on air pressure does not affect only physical body cavities, but also any enclosed air filled area in the body. Nitrous oxide should not be administered to patients who recently had ocular eye surgery. Opthalmologists frequently inject intraocular gases during eye surgeries related to retinal detachments (pneumatic retinopexy). These gas bubbles can remain in the eyeball up to 3 months before they are reabsorbed. Nitrous oxide inhalation can result in the immediate expansion of the gas bubble in the eye causing healing complications and possibly eye damage. Cases of total vision loss due to central retinal artery occlusion have been reported

in patients who had a recent pneumatic retinopexy eye surgery followed by dental treatment

using nitrous oxide sedation.

Ear problems - Nitrous oxide sedation can create an elevated pressure in the middle ear. This may - Nitrous oxide sedation can create an elevated pressure in the middle ear. This may result in ear problems like a sharp pain for a small percentage of patients, and in extreme cases bleeding in the ear, hearing impairment or rupture of typanic membrane. For this reason, patients who recently had any kind of middle ear surgery (e.g. tympanic membrane graft) or have blocked eustachian tubes should not be treated with inhalation sedation because the tympanic membrane can become distended and damaged following inhalation of the nitrous oxide.

and damaged following inhalation of the nitrous oxide. Gut pain - Nitrous oxide will dissolve out

Gut pain - Nitrous oxide will dissolve out of blood into air filled spaces such as the intestines, increasing the volume of air inside them, which can lead to severe gut pain.

In order to avoid possible side effects, nitrous oxide should not be used by patients who recently

had middle ear or ocular eye surgery, or have sinusitis, ear problems, bowel obstruction or pneumothorax. Patients with any of these conditions should inform their dentist, in order to suggest another more suitable method of sedation.

Hypoxia

Hypoxia is a very serious and dangerous condition that occurs when the body does not receive enough oxygen. Hypoxia can result in brain damage and eventually death due to asphyxiation. It

may happen either due to lack of oxygen in the breathing air or when someone stops breathing or breathes too shallowly or too slowly to meet their oxygen requirements.

Theoretically hypoxia should not be considered a risk during nitrous oxide sedation dentistry, because even at the maximum allowed dosage of 70% nitrous oxide, the body gets 30% oxygen which is more than enough (actually more than the 21% of atmospheric air). A safety valve in the flow-meter equipment does not allow oxygen to be lower than 30%. Lack of enough oxygen causes nausea and unconsciousness, which is an immediate signal for the dentist to stop the administration of nitrous oxide and give 100% oxygen.

However there is always a remote risk involved in nitrous oxide sedation in case there is a malfunction of the equipment, prohibiting the flow of adequate oxygen, while at the same time the patient’s vital signs are not closely monitored and the dentist is not experienced enough to understand that the patient has lost consciousness.

Diffusion Hypoxia

Another side effect of nitrous oxide that may occur immediately after the end of nitrous oxide sedation is a related condition of post-inhalation hypoxia called ‘diffusion hypoxia’. After the N 2 O flow is stopped, the nitrous oxide is rapidly diffused from the blood back into the lungs which results in a displacement of oxygen and a subsequent drop in the partial pressure of oxygen in the lugs. The oxygen exchange into the lungs and circulation may become impaired, which can result in Diffusion Hypoxia.

Although diffusion hypoxia is not a major concern for healthy patients, it may be dangerous for patients with an airway obstruction or cardiopulmonary disease. Problems related with nitrous oxide diffusion hypoxia have been minimized after the dentists have adopted a new standard that suggests the administration of 100% oxygen for 3-5 minutes after discontinuation of nitrous oxide.

Oxygen Toxicity

This is a potential risk of nitrous oxide that affects patients under anti-neoplastic therapy with bleomycin sulfate which is known to cause pulmonary toxicity. Contrary to what happens in case of hypoxia, it is the high oxygen concentration (above 25% O 2 ) that can cause acute respiratory distress syndrome to this patient group. Since the use of 100% oxygen is part of the standard nitrous oxide sedation procedure (in both the initial and recovery phases) there is an increased risk of respiratory failure in these patients.

Pregnancy problems

Existing scientific research has linked several reproductive issues to persons with occupational connection to N 2 O, but not with dental patients who only occasionally get nitrous oxide. However dentists avoid the use of nitrous oxide sedation to pregnant patients, at least during the first semester of pregnancy to prevent any risks on the newborn.

Immune system risks

Nitrous oxide may affect the white blood cell production and function in patients with immune system deficiencies, and thus nitrous oxide sedation should be avoided.

B 12 Deficiency

Nitrous oxide is known to oxidise and inactivate the vitamin B 12 which is an essential component of certain enzymes. One such enzyme, methionine synthetase is essential for normal DNA production. Its interaction with vitamin B 12 may be a serious side effect of nitrous oxide for patients who already have a B 12 deficiency for any reason.

Although nitrous oxide affects the levels of B 12 for all users, healthy users have enough B 12 stored in physical body reservoirs (mostly in the liver) so that they are not affected by the occasional usage of N 2 O in the dental office. But B 12 deficiency is a potential nitrous oxide risk for people with already low levels of B 12 , or they are exposed to N 2 O for longer terms due to their occupation.

Several studies have demonstrated that the haematological, immune, neurological and reproductive systems can be affected. The symptoms of these effects may appear weeks or even months after the administration of the nitrous oxide. Patients who develop B 12 deficiency as a side effect of nitrous oxide dental sedation are at higher risk of suffering from other conditions such as:

hyperhomocysteinemia, an accumulation in the blood of the amino acid homocysteine that could cause vascular diseases

neurological disorders, such as mental confusion especially among the elderly

peripheral neuropathy, severe leg pains and numbness and

reproductive problems.

Despite the possible risks of nitrous oxide, it still remains a safe, effective way to eliminate dental anxiety. Following the safety protocols for administering the N 2 O/O 2 mixture, and proper patient selection rules are the key elements in minimizing the risk of nitrous oxide side effects.

Contraindications of using Nitrous Oxide Sedation Dentistry

The currently known contraindications to the use of nitrous oxide sedation include the following:

Breathing problems Lung conditions

Inhalation sedation is not indicated for people with respiratory problems (asthma or emphysema) or difficulty breathing in through the nose. Patients with a cold are better to avoid inhalation sedation until they can breath normally. Nitrous oxide is given by a nose mask, so if patients are unable to breathe adequately through their noses, they will be unable to inhale sufficient nitrous oxide for sedation. Conditions relatively contraindicating the use of nitrous oxide include:

Sinus infections (sinusitis)

Nasal blocking conditions such as colds, influenza or allergies.

Cystic fibrosis or

Chronic obstructive pulmonary diseases (COPD) such as emphysema and bronchitis.

Mental conditions Drug abuse

Some patients report that during nitrous oxide sedation they had dreams even though they were fully conscious. These potentially mind-altering effects of nitrous oxide may be a contraindication in patients with some mental or psychiatric disorders, patients with drug addictions, and patients under the influence of drugs or alcohol.

Patients suffering from severe phobias of any kind, or taking sleep-inducing medication, antidepressants, or psychotropic drugs are at high risk of having hallucinations when sedated with nitrous oxide. Because of the fact that dreams or hallucinations some patients have may be of sexual nature, a dentist will not perform nitrous oxide sedation when there is no other person present in the room, in order to avoid false abuse claims.

Patients with conditions that do not allow proper understanding of the procedure and maintaining communication with the dentist are not suitable for inhalation sedation dentistry, which is based essentially in the patient’s responsiveness to dentist’s questions and instructions.

First trimester of pregnancy

The first trimester of pregnancy is the most difficult period of pregnancy when most of the complications occur. Several researches have linked chronic occupational exposure to nitrous oxide with an increased percentage of pregnancy complications including spontaneous abortion among pregnant women working in places where nitrous oxide is administered. No risk have been found for pregnant patients sedated with nitrous oxide, provided that the dentist monitors closely the N 2 O/O 2 mixture and does not allow oxygen levels fall below the safety level.

However dentists prefer not to use nitrous oxide sedation during the first trimester, and they will always request the patient’s physician or obstetrician consultation, to avoid any risk of their

treatment being linked with the possibility of a patient’s pregnancy complications. In general it is recommended that dental treatments should be avoided in the first semester, except if absolutely necessary.

Eye or ear surgery

Nitrous oxide should not be administered to patients who recently had eye surgery that involved introducing an intraocular gas. Nitrous oxide inhalation can result in the expansion of the gas bubble in the eye causing healing complications and possibly eye damage. Due to its physical properties, nitrous oxide moves into an air space faster than air moves out, thus it may cause a gas bubble in the body to expand by up to 10%.

Similarly, patients who recently had middle ear surgery (tympanic membrane graft) or have blocked eustachian tubes should not receive nitrous oxide sedation because the tympanic membrane can become distended and damaged following inhalation of the nitrous oxide.

Bleomycin therapy

Patients under anti-neoplastic therapy with bleomycin sulfate are contraindicated for the use of nitrous oxide sedation, due to the increased incidence of pulmonary fibrosis and other lung diseases. Patients undergoing bleomycin treatment for certain types of cancer are also predisposed to respiratory failure following exposure to high concentrations of oxygen over 25%. Since use of 100% oxygen is part of the standard sedation procedure (in both the initial and recovery phases) there is an increased risk of possible problems in these patients.

Other

Because of its euphoric effect (it is not called laughing gas for no reason) you may want to avoid nitrous oxide if you are too much afraid of getting embarrassed. The several videos in the web have proven that you may do or say some silly things when sedated.

Depending on the patient’s condition and the specific type of contraindication for the use of nitrous oxide sedation, the dentist may recommend the postponement of the treatment or propose a more suitable dental sedation method.

Chemistry of Nitrous Oxide

The chemical formula of nitrous oxide is N 2 O, also called Dinitrogen Monoxide. It is one of the several oxides of nitrogen; the others most known are nitric oxide (NO) and nitrogen dioxide NO 2 .

known are nitric oxide (NO) and nitrogen dioxide NO 2 . The nitrous oxide molecule’s structure

The nitrous oxide molecule’s structure is a linear chain of two nitrogen atoms, with the second one bound to an oxygen atom.

At room temperature N 2 O is a colorless gas with a slightly sweet odor and taste. It can be produced by the reaction of diluted nitric acid with zinc, but the most common method is by heating carefully ammonium nitrate (NH4NO3) at 200o C which decomposes into N 2 O and water (H2O).

Nitrous oxide is considered an air-pollutant as it is one of the greenhouse gases. When N20 reacts with oxygen, it is oxidized to NO which reacts with ozone causing ozone depletion from the stratosphere zone of the atmosphere. It is estimated that nitrous oxide is by 6% responsible for the increase of temperature due to the greenhouse effect. The contribution of nitrous oxide used in dentistry to its overall emissions is extremely minimal, so you should not regret having nitrous oxide dental sedation even if you are environmentally sensitive.

Method of Action of N 2 O in dental sedation

Nitrous oxide has low solubility in blood, allowing it to diffuse rapidly across the alveolar- arterial membrane from the alveoli to the pulmonary circulation and reach the brain within a few seconds through the bloodstream. Although the exact ways that nitrous oxide gets its analgesic and anti-anxiety properties are not clear, several theories have been proposed.

It has been suggested that there are possibly multiple mechanisms of action that lead to the N 2 O effects. However, the most widely accepted theory is that the analgesic effect is linked to the interaction of nitrous oxide with the opioid receptors, which seems to alter the way that pain is processed by the brain, possibly similar to the way of action of morphine.

Nitrous oxide has been shown to interact with proteins in the nerve membrane, altering its structure, which leads to reduced flow of impulses through the Central Nervous System. The anxiolytic effect is achieved by its interaction with the GABA-A receptors which are inhibitory neurotransmitters, decreasing the activity of the nervous system. Nitrous oxide seems to depress almost all senses and sometimes memory.

As soon as the dentist interrupts the administration of the gas, nitrous oxide is excreted rapidly from the lungs and its effects are reversed, with full recovery achieved within a few minutes.

How Nitrous Oxide Sedation feels?

The symptoms you will feel when breathing the N 2 O/O 2 mixture depend on the depth of the sedation level which is mainly controlled by the relative concentration of the nitrous oxide in the mixture. This could start from 30% and reach up to 70% (but no more to avoid the risk of hypoxia).

The initial feeling of nitrous oxide sedation is a lightheadedness and a tingling sensation, especially in the arms and legs, which is followed by a feeling of warmth all over the body.

As the sedation reaches the desired levels, you will experience a pleasant feeling of euphoria and/or floating and you will become completely relaxed. At the same time, your threshold of pain continues to rise. A feeling of numbness develops especially in the soft tissues of the mouth. This can allow for many common dental procedures to be performed without the need of additional local anesthesia.

At the proper level for dental sedation you will be able to breath on your own, maintain your body’s functions and respond to your dentist, while you feel no pain and you are fully relaxed.

If you start to feel sleepy, like dreaming, or have difficulty to keep your eyes open or speak, you are at the edge of being over-sedated and you move at a deeper sedation level than you should. Nausea is a clear sign of over-sedation. Nitrous oxide can induce loss of consciousness at high concentrations, close to 70% or higher. If you feel any of these symptoms you should notify your dentist in order to adjust lower the concentration of nitrous oxide.

After the treatment you will return to a normal state in a few minutes without any ‘hangover’ effect, and you will be able to drive home on your own. A mild amnesia is reported in some cases, with the patient not remembering all of what happened when sedated.

Nitrous oxide offers patients the possibility of receiving dental care with a reduced level of fear and anxiety and reduced pain. It reduces barriers to care for fearful, phobic, and special needs patients; providing a safe and efficacious treatment method.

Nitrous Oxide Sedation Procedure

Because of the ease of use, excellent safety record, and the many advantages vs other sedation methods, the use of nitrous oxide for dental sedation continues to increase in the US and the rest of the world. However each country (and many states in US) have different regulations on who and how can use nitrous oxide for sedation purposes.

Nitrous oxide is a colorless gas with a slight sweet odor and taste, which has analgesic and anxiolytic properties. It is an inhalation sedative; sedation is achieved by inhaling a mixture of nitrous oxide and oxygen through a mask placed over the nose. It reduces anxiety, pain, and memory of the treatment experienced.

The main steps in the process of nitrous oxide administration are the following:

1. Patient evaluation and preparation for nitrous oxide sedation

Although N 2 O can be used for most of the patients, some nitrous oxide contraindications do exist for patients with certain conditions. The dentist must make sure that the patient is a suitable candidate for nitrous oxide sedation.

patient is a suitable candidate for nitrous oxide sedation. Medical history - An updated full medical

Medical history - An updated full medical and dental history of the patient must always be taken before any kind of sedation. If there is any concern or doubt, the patient’s physician must be consulted. The dentist will also ask if the patient had any problems or side effects in the past related to N 2 O usage.

Informed consent – In some countries the patient (or parent in case of children) must sign an In some countries the patient (or parent in case of children) must sign an informed consent form before receiving treatment (it is essential in countries like U.S. where malpractice lawsuits are common).

countries like U.S. where malpractice lawsuits are common). Patient instructions – The dentist must explain to

Patient instructions The dentist must explain to the patient all the details of the procedure (and possible N 2 O side effects) and discuss what the patient must do if he has a problem during the course of treatment. Written instructions must be given to the patient concerning proper behavior before, during and after the procedure.

proper behavior before, during and after the procedure. Final health assessment – Immediately before the

Final health assessment Immediately before the administration of the nitrous oxide the dentist will do a final health assessment of the patient, asking for any recent health issues or symptoms, and measuring the patient’s vital signs (blood pressure and heart rate). Normal breathing rate is also recorded so that the correct volume of mixture is applied for the sedation.

the correct volume of mixture is applied for the sedation. Airway evaluation – The patient must

Airway evaluation The patient must be able to breath freely from the nose without problems. Free nasal airways are very important for proper inhalation sedation. If the nose is temporarily blocked, either the treatment must be postponed or another form of sedation should be used.

Patient relaxation – The patient is placed on the dental chair and the dentist creates

Patient relaxation The patient is placed on the dental chair and the dentist creates a comfortable environment before administering the sedation. Relaxing music or television may be used to relax and also distract patients from their anxiety. A pillow or a blanket may also be provided to increase comfort.

2. Nitrous oxide administration

The sedation gas is actually a mixture of nitrous oxide and oxygen, which is provided either from a central unit piped into the operating room or by a mobile unit. A flowmeter is used to adjust and monitor the relative concentration of each gas in the mixture.

Starting the N 2 O sedation

A small rubber face mask is placed over the patient’s nose, through which the nitrous oxide and oxygen mixture is delivered. The patient is advised to breath normally through the nose and the sedation mask. The gas is administered through a valve in the mask, which releases gas only when the patient inhales through the nose. Since the sedative is received through inhalation, patients with needle-phobia can be more relaxed.

At the first phase of nitrous oxide sedation the patient breaths 100% oxygen for a few minutes until he gets used in breathing through the mask and feels comfortable with it.

Titration of N 2 O

As soon as the patient gets accustomed to breathing by the mask, the dentist will start to introduce the sedative gas. The percentage of nitrous oxide in the mixture is gradually increased (titration), while the dentist checks the patient’s response in order to understand when adequate sedation is achieved. Usually a mixture of at least 30% N 2 O (70% oxygen) is required for experiencing the analgesic and anxiolytic effects of nitrous oxide. Most patients will need a mixture of 50% N 2 O / 50% O 2 to feel comfortable.

The dentist will provide the minimum amount of nitrous oxide required to achieve the desired sedation level for each individual patient’s needs. The patient begins to feel a pleasant level of sedation anywhere from 30 seconds to three or four minutes. After an initial feeling of light- headedness, a patient may experience a sense of well-being, euphoria, or floating. The administration of nitrous oxide must be controlled by an appropriately trained and licensed dental professional.

Local Anesthesia

The analgesic effect of nitrous oxide can be adequate for certain treatments, eliminating the need for additional local anesthesia. Its numbing effect is stronger in the gingival tissues making nitrous oxide especially effective for treatments of gum disease. For some invasive procedures, after the patient is already sedated, the dentist will still have to provide local anesthesia to ensure that the patient will not experience any pain. However due to the numbing effect of the nitrous

oxide on the gums, the injections of the anesthetic can be done without discomfort. After that, the dentist can proceed to the dental treatments.

Maintenance of the sedation level

At any time during the procedure, the dentist can strengthen or weaken the mixture depending on the patient’s comfort and level of relaxation. If a patient begins to feel uncomfortable, he should tell the dentist immediately and within seconds the dentist can adjust the the mixture to instantly change the level of sedation, and the patient will feel more comfortable again (either increasing N 2 O if the patient starts to feel pain or anxiety, or reducing it if the patient feels nausea).

Monitoring the sedated patient

The patient must be monitored continuously when under nitrous oxide sedation. The concentration of oxygen should never be less than 30% to prevent ‘hypoxia’. While the dentist is focused in performing the dental treatment, another staff member should monitor the measurements of the flowmeter which controls the N 2 O/O 2 mixture, and the patient’s respiration by watching the inflation and deflation of the reservoir bag. A pulse oximeter to measure the concentration of oxygen in the blood is required when the administered N 2 O is over 50%. The dentist must maintain verbal contact with the patient, which must be able to respond without any problem. If there are signs that the patient feels sleepy or nauseous, the dentist must stop the administration of nitrous oxide.

3. Recovery after nitrous oxide dental sedation

The effects of nitrous oxide sedation are usually short lived, so full recovery is possible only some minutes after the sedative gas is discontinued. When the sedation dentistry treatment is completed, the patient will be given 100% oxygen (for about 3 to 5 minutes). After that time, almost 99% of the nitrous oxide has cleared the body, and the patient feels back to normal. Otherwise oxygen is provided for a few more minutes until full recovery. In most cases the dentist will allow nitrous oxide sedated patients to leave the office without escort and drive home by themselves, as soon as they feel fully alert and awake.

Advantages of Nitrous Oxide Sedation Dentistry

Because of its specific pharmacokinetic properties, nitrous oxide can offer significant benefits to the anxiety patient and it also has several advantages over other dental sedation methods. Advantages of nitrous oxide include:

Dental anxiety control

Nitrous oxide sedation is very effective for mild to moderate anxiety. The basic advantage of nitrous oxide sedation is that it can help transform patients with dental anxiety into relaxed and fully co-operative patients by relieving the stress, fear and anxiety associated with dental visits. The fact that many patients have little or no memory of their dental treatment under sedation reduces the fear for the next appointments.

Pain control

Nitrous oxide does not only reduces anxiety, but it also has analgesic properties by increasing the patient’s threshold of pain. Although it offers only mild pain control, this can be enough for simple not invasive procedures, reducing the need for additional local anesthesia. Its pain relieving action can help people who have difficulty getting numb.

Patient dentist communication

Nitrous oxide provides light sedation, meaning that the patient remains conscious being able to communicate with the dentist and respond to instructions, and the protective reflexes are maintained.

No preparation is needed

If during a regular dental visit, your dentist finds out that you need a treatment for which you will be more comfortable when sedated, you will need to schedule a next appointment if any other sedation method t han nitrous oxide is used. For oral sedation you must have taken a pill prior to the appointment and with iv sedation you have to be escorted by someone to drive you home after the treatment. With inhalation dentistry you do not need any prior arrangements; you can be sedated immediately.

Fast action

It is fast acting with its anti-anxiety and pain killing effect felt within 2-3 minutes. All the dentist has to do is to place a mask over your nose, administer the nitrous oxide and you will be relaxed in seconds.

No shots

Patients with fear of needles will appreciate the fact that no shots are required for inhalation sedation. For simple treatments you may not need shots for local anesthesia either. But even if you need, you will be so relaxed by the nitrous oxide that you will not care about getting a shot.

Adjustable sedation level

The depth of inhalation sedation can be adjusted easily and precisely at any time by regulating the nitrous oxide percentage in the N 2 O /oxygen mixture. The ability to adjust the sedation level to the exact amount needed to provide patient’s comfort and safety is the main advantage of nitrous oxide versus other types of conscious dental sedation. In oral sedation dentistry the sedative can only be provided in set dosages. With nitrous oxide the gas can be provided incrementally allowing the dentist to observe patient response and determine the appropriate sedation for achieving an optimal level of relaxation for the patient.

Flexible duration

With oral sedation, which can also be used for light conscious sedation, the length of treatment is predetermined by the amount of sedative given to the patient before the procedure (because the effects of pills or intravenous drugs last for a specific time span). Nitrous oxide has the advantage that the patient can remain sedated for exactly as long the dentist needs to complete the procedure just by maintaining the flow of N 2 O.

Safety

Nitrous oxide usage in sedation dentistry has a proven safety record with very limited side effects. The fact that sedation is quickly reversible by just stopping the administration of the gas reduces significantly the risks in combination with proper equipment, patient monitoring and a properly trained dentist.

Fast recovery

Recovery time after the flow of nitrous oxide is discontinued is short. You will be given 100% oxygen for 3-5 minutes which is usually enough for full recovery. Within this period 99% of nitrous oxide is expelled from the lungs and its action disappears without after effects such as a ‘hangover’ effect that is common after taking oral sedatives. You can return to normal activities immediately after.

No escort is needed

Another benefit of nitrous oxide sedation is that you do not need someone to escort you to and from the dental office. In a few minutes after the procedure, as soon as the dentist has confirmed that you have fully recovered from the inhalation sedation, you can drive home at your own.

Suitable for most adults and children

Nitrous oxide can cover the sedation needs of most patients with dental anxiety either adults or children. It provides an alternative for medically compromised patients suffering from conditions such as cardiovascular disease, bleeding disorders , liver and kidney disorders who are not suitable candidates for iv sedation and general anesthesia.

Lower cost of sedation dentistry

The cost of inhalation sedation is slightly lower than oral sedation, and significantly lower compared to iv sedation and dental general anesthesia. Due to its low cost, nitrous oxide is the most accessible type of dental sedation, preferred by patients who need help to fight their dental anxiety but they can not afford intravenous sedation or general anesthesia.

Better time efficiency

Having a relaxed patient helps the dentist to make more efficient use of time. Complex treatments can be completed in a smaller number of appointments or even in a single dental visit.

Positive user experience

A patient who does not have to worry about anxiety and pain during the dental visit can build a more positive view about the dentist and dental treatments. For this reason nitrous oxide sedation can lead to a much better dental health for the patient.

Disadvantages Limitations & Risks of Nitrous Oxide Sedation

– Limitations & Risks of Nitrous Oxide Sedation Nitrous oxide can provide only mild pain control.

Nitrous oxide can provide only mild pain control. It is not a substitute for local dental anesthesia during invasive dental surgery.

Increased dosage of nitrous oxide may cause nausea or vomiting if you have a full stomach.for local dental anesthesia during invasive dental surgery. It can only offer light to moderate sedation.

may cause nausea or vomiting if you have a full stomach. It can only offer light

It can only offer light to moderate sedation. This may not be enough for extremely phobic patients who need a deeper level of sedation. It is also not suitable for claustrophobic patients who may not feel comfortably with the mask covering their nose. Nitrous oxide can provide adequate comfort for most of the patients, but it can not be compared with the level of comfort of deep sedation.

not be compared with the level of comfort of deep sedation. Some people will not achieve

Some people will not achieve adequate sedation with permissible levels of oxygen.

achieve adequate sedation with permissible levels of oxygen. Nitrous oxide can not help for post-treatment pain

Nitrous oxide can not help for post-treatment pain control. Its pain relieving action is lost just a few minutes after the administration of the gas is stopped.

Because of its euphoric effect (it is not called laughing gas for no reason) you may want to avoid nitrous oxide if you are too much afraid of getting embarrassed. The several videos in the web have proven that you may do or say some silly things when sedated.Inhalation sedation is not indicated for people with respiratory problems (asthma or emphysema) or difficulty

Inhalation sedation is not indicated for people with respiratory problems (asthma or emphysema) or difficulty breathing in through the nose. Patients with a cold are better to avoid inhalation sedation until they can breath normally. Learn more about nitrous oxide sedation contraindications.of getting embarrassed. The several videos in the web have proven that you may do or