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Nitrous Oxide


Sedation is the process of administering a drug to produce unconsciousness, or various states of calm, loss of sensation, awareness of the procedure, or loss of memory. There are many reasons to choose sedation. Different types of sedation produce different levels of sedation. If sedation is recommended, the goal of you and your dentist is to agree on the appropriate type. Whichever method you decide upon, the goal is to use the minimal amount needed to produce the necessary comfort and safety to complete your dental procedure.

Depending on the type of sedation, dentists require different levels of training or additional assistance in the process of administering sedation. Different types of sedation also require specific sedation safety protocols, medications, and equipment.

Nitrous oxide (laughing gas) has been used safely and effectively in dentistry since the 1840s. It is typically used if you have mild to moderate dental anxiety or a severe gag reflex. Under the effects of nitrous oxide, you breathe on your own and are conscious. You will feel relaxed and unconcerned about what is happening around you. You will typically have some memory of the procedure.

Nitrous oxide can be rapidly administered and easily reversed. No injections are required, but a local anesthetic will generally still be used for your comfort and safety.

  • How administered: Inhaled.
  • Level of sedation: Minimal to moderate.
  • Adjustable dosage during the procedure?: Yes. Your dentist can continuously measure and adjust the balance of nitrous oxide to pure oxygen delivered. This reduces the risk of under-sedation or over-sedation.
  • The patient is conscious: Yes.
  • Patient's respiration: Breathing on own.
  • A memory of the procedure afterward: Some, but this may vary.

Before you are sedated

  • You will share information to ensure that your dental staff can provide safe treatment and provide appropriate post-care guidance. Get important information here: Health history and current health status.
  • You should have a thorough understanding of the risks and complications that may occur. Ask about the steps that would be taken in the event of a complication.
  • You should discuss the treatment plan and review your options with your dentist. You may not be able to comprehend informed consent forms or questions describing your dental procedure while sedated.

During the procedure

  • A mask is applied over your nose and mouth to deliver a mixture of oxygen and nitrous oxide gas. Your dentist will slowly increase the amount of nitrous oxide mixed with the oxygen until you are visibly sedated.
  • Once you are visibly sedated, your dentist will typically provide a local anesthetic and perform the dental procedure(s).
  • Your dentist will then stop the nitrous oxide flow and increase the flow of pure oxygen for a few minutes. This process helps prevent the possibility of diffusion hypoxia.

After the procedure

  • Your dentist may recommend or prescribe medication to help with pain management.
  • If you have not arranged for a ride home, your dentist will ensure that the nitrous oxide is entirely out of your system before allowing you to drive. The effects of nitrous oxide are generally gone within ten minutes after delivering the gas.
  • Medication control: Every person reacts slightly differently to nitrous oxide. Your dentist cannot accurately predict how you will respond to the nitrous oxide/oxygen mixture and experience the desired effect.
  • Administration: The effectiveness of nitrous oxide will depend on your willingness to wear a nasal mask and inhale the nitrous oxide/oxygen mixture through your nose. People with claustrophobia may be uncomfortable wearing a nasal mask.
  • Individuals with special needs: People with special needs may not have the ability to cooperate during dental procedures. Even with a capable dental staff and a relaxed setting, special needs patients may require some form of sedation. If you have concerns, be sure to share your questions and concerns with your dentist.
  • Sleep apnea and obesity: If you are obese or have obstructive sleep apnea, you may be more likely to develop complications.
  • Drug interactions: When combined with sedatives or opioids, nitrous oxide can depress breathing and present a life-threatening situation. Sedation can also have a life-threatening effect when combined with other central nervous system depressants such as narcotic pain relievers, insomnia medications, or alcohol.
  • Respiratory issues: Patients with chronic respiratory problems such as COPD, emphysema, chronic bronchitis, pneumothorax, or cystic fibrosis may not be able to undergo sedation with nitrous oxide. Nitrous oxide may cause hypoxia (low oxygen in your tissues) due to increased airway resistance. Patients with asthma can generally be safely sedated with nitrous oxide.
  • Bowel obstructions: If you have a bowel obstruction, you may be at higher risk for complications from nitrous oxide sedation. Nitrous oxide can cause pockets within your intestinal tract to rupture. Your dentist may consult with your physician prior to using nitrous oxide if you have this condition.
  • Diminished capacity: Nitrous oxide can impair your ability to safely drive, operate machinery, or perform other motor functions. The effects of nitrous oxide are generally gone within ten minutes after delivering the gas. Your dentist will monitor you until you are able to resume normal activities.
  • Pregnancy: If you are pregnant (especially in the first trimester), nitrous oxide may not be recommended since it can inactivate methionine synthase. This is an enzyme related to DNA production.
  • Over-sedation: Sometimes, more than one sedative may be administered at the same time (for example, nitrous oxide and IV sedation). This may cause a risk of over-sedation. Be sure you understand the purpose of all medications your dentist plans to use.
  • Immune system disorders: If you have an immune system disorder, your dentist may not recommend nitrous oxide to the effect it has on the production and function of specific white blood cells. Your dentist may want to discuss your condition with your physician before administering nitrous oxide.
  • Vitamin B12 or folate deficiency: Nitrous oxide may not be recommended as a sedation option if you have a vitamin B12 or folate deficiency. Nitrous oxide exposes you to high oxygen concentrations, which may increase your risk of developing respiratory toxicity and failure.
  • Bleomycin chemotherapy: If you are undergoing bleomycin chemotherapy, nitrous oxide may not be recommended as a sedation option. Nitrous oxide exposes you to high oxygen concentrations, which may increase your risk of developing respiratory toxicity and failure.
  • Hypoxia: Diffusion hypoxia can occur if the dentist does not provide pure oxygen for a few minutes following the procedure. If you vomit, it is possible that some may be inhaled, potentially causing aspiration pneumonia and, in very rare cases, death.
  • Insurance coverage and cost: Ask your dentist about the cost of nitrous oxide sedation. Many insurance plans do not cover this expense.

While not direct alternatives to sedation, there are some things you can do to help you relax for your dental procedure.

  • Get a massage or other treatment before the procedure to provide a relaxed feeling.
  • Bring something that comforts you to the dental office.
    • Many people like to listen to music.
    • Some dentists have videos you can watch during a procedure.
    • You may want to bring a comfortable pillow, a warm blanket, or a stuffed animal.
    • A dentist's chair-side manner can make a big difference. A dentist with a soothing voice, sincere compassion for your dental needs, and a gentle, unhurried pace can go a long way toward making you comfortable and less anxious. This is worth considering when choosing a dentist.

If you delay or avoid necessary dental care due to anxiety or fear, it can have significant consequences. Delaying care can result in pain, periodontal disease, abscesses, tooth decay, tooth loss, and jaw problems. In rare cases, life-threatening infections can result from untreated dental issues.

Delayed treatment and poor oral health can also lead to complications in other parts of your body. For example, periodontal disease can lead to the development of cardiovascular disease, strokes, or other conditions.

  • What are the effects of nitrous oxide sedation?
  • Will nitrous oxide counteract any of my medications or complicate my medical conditions?
  • If a complication from the procedure occurs will the sedation make it more difficult to address?
  • How soon after the sedation will it be safe to return to work, drive or use machinery?
  • Will you administer pure oxygen at the end of the procedure to avoid any nausea associated with diffusion hypoxia?

Plan Coverage Disclaimer

Services described in this resource may not be covered by your dental plan. Your dental plan administrator may also place limits on services, or some of the services may be eligible medical plan expenses. Other services may be subject to review for dental necessity. This may affect the services your plan will cover and the amount your plan considers to be an eligible dental plan expense. Consider submitting a pre-treatment estimate before services are rendered. Please refer to your certificate for coverage details.

Author: Symbyos staff, Fluent staff
Last updated: 3/5/2021Medical review: Thomas J. Greany DDS, 2/28/2021
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