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, lightheadiness, 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:
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 N2O versus O2 (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. N2O concentration should always be gradually increased (titration) at each visit,
because even the same patients tolerance can vary from day to day.
Vomiting - 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.
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.
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 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
desire to laugh that it creates to those inhaling it. Some reserved patients may feel uncomfortable
because they are afraid of getting embarrassed.
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.
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.
Headache - There is a small possibility of experiencing a headache after nitrous oxide
sedation.
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 N2O/O2)
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.
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 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.
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 patients 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
N2O 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% O2) 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 N2O, 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.

B12 Deficiency
Nitrous oxide is known to oxidise and inactivate the vitamin B12 which is an essential component
of certain enzymes. One such enzyme, methionine synthetase is essential for normal DNA
production. Its interaction with vitamin B12 may be a serious side effect of nitrous oxide for
patients who already have a B12 deficiency for any reason.
Although nitrous oxide affects the levels of B12 for all users, healthy users have enough B12
stored in physical body reservoirs (mostly in the liver) so that they are not affected by the
occasional usage of N2O in the dental office. But B12 deficiency is a potential nitrous oxide risk
for people with already low levels of B12, or they are exposed to N2O 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 B12 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 N2O/O2 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 patients responsiveness to dentists 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 N2O/O2 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 patients physician or obstetrician consultation, to avoid any risk of their

treatment being linked with the possibility of a patients 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 patients 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 N2O, also called Dinitrogen Monoxide. It is one of the
several oxides of nitrogen; the others most known are nitric oxide (NO) and nitrogen dioxide
NO2.
The nitrous oxide molecules structure is a linear chain of two
nitrogen atoms, with the second one bound to an oxygen atom.
At room temperature N2O 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 N2O 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 N2O in dental sedation

Nitrous oxide has low solubility in blood, allowing it to diffuse rapidly across the alveolararterial 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 N2O
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 N2O/O2 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
bodys 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 N2O 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.
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 patients physician must
be consulted. The dentist will also ask if the patient had any problems or side effects in the past
related to N2O usage.
Informed consent 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).
Patient instructions The dentist must explain to the patient all the details of the procedure
(and possible N2O 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.
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 patients 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.
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 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 N2O sedation

A small rubber face mask is placed over the patients 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 N2O
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 patients response in order to understand when adequate
sedation is achieved. Usually a mixture of at least 30% N2O (70% oxygen) is required for
experiencing the analgesic and anxiolytic effects of nitrous oxide. Most patients will need a
mixture of 50% N2O / 50% O2 to feel comfortable.
The dentist will provide the minimum amount of nitrous oxide required to achieve the desired
sedation level for each individual patients 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 lightheadedness, 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 patients 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
N2O 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 N2O/O2 mixture, and the patients 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 N2O 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
patients 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 N2O /oxygen mixture. The ability to adjust the sedation level
to the exact amount needed to provide patients 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 N2O.

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