Dentistry’s Blind Spot on Nitrous Oxide Emissions

By Genni Burkhart

Nitrous oxide has long been a trusted tool in dental sedation. It's safe, effective, and widely used across all types of practices. Yet increasingly, researchers and healthcare leaders are sounding the alarm about its overlooked environmental consequences. Nitrous oxide is a potent greenhouse gas, and even small, unmonitored leaks from dental operatories can contribute to a problem that's global in scale.

As hospitals and anesthesia providers begin making significant changes to reduce their environmental footprint, the dental community faces a question: What responsibility do they share? While the emissions from a single practice may seem minimal, their cumulative impact and the opportunity to improve cannot be ignored.

Why Nitrous Oxide Is a Climate Concern

For many dentists, worrying about emissions from nitrous oxide may feel unnecessary. It's proven to be reliable and essential to patient care. However, routine dental use contributes to unwanted emissions. In fact, those emissions contribute approximately 5% of global greenhouse gas emissions, and the United States produces more than any other country. (University of California, San Francisco, UCSF, 2023).

A 2024 life-cycle study found that nitrous oxide has approximately 298 times the warming impact of carbon dioxide over a 100-year period. The study also confirmed that most environmental damage originates from the gas itself, emphasizing the importance of limiting unnecessary flow and leakage during use (National Institutes of Health, 2024).

Nitrous oxide also contributes to the depletion of the ozone layer and remains in the atmosphere for more than 100 years. According to UCSF Health, wasteful or outdated delivery systems in medical facilities are responsible for significant emissions, with some estimates suggesting that unused gas accounts for more than half of what is dispensed in certain hospital settings (University of California, San Francisco, 2023).

Although dental practices use far lower quantities of nitrous oxide than hospitals, the issues are similar. Older equipment, inefficient flow rates, and poor staff training all contribute to avoidable emissions. This is especially true when nitrous oxide is delivered using continuous flow systems without appropriate scavenging or monitoring.

Hospitals Are Leading the Way

In response to these concerns, hospitals worldwide have taken steps to reduce emissions from inhaled anesthetics. A multi-country study published in Environmental Science & Technology found that global emissions from anesthetic gases decreased by 27% over the past decade, primarily due to the discontinuation of high-impact agents like desflurane (Talbot, 2025).

For example, UCSF has eliminated desflurane entirely and installed gas capture systems in operating rooms, resulting in measurable reductions without compromising patient care (University of California, San Francisco, 2023). In the United Kingdom and Germany, hospitals have implemented additional measures, including switching to lower-impact agents and enhancing monitoring, which have resulted in a reduction of more than 80% in emissions (Park, 2024).

These efforts reflect both public health priorities and environmental responsibility. As climate-related illness and disasters continue to rise, medical institutions are recognizing that promoting health also means limiting harm caused by the systems that deliver care.

While hospitals have focused more on halogenated agents like desflurane and sevoflurane, nitrous oxide remains part of the broader conversation because of its long atmospheric life and global warming potential. As a result, dentistry is not exempt from these concerns.

What This Means for Dentistry

In addition to concerns about climate impact, chronic exposure to nitrous oxide may pose health risks for dental teams. According to guidance from the Centers for Disease Control and Prevention (CDC), inadequate ventilation or poorly maintained scavenging systems can expose dental staff to levels of nitrous oxide that may lead to neurologic symptoms, vitamin B12 depletion, and possible reproductive health effects (Centers for Disease Control and Prevention, 2017).

Although the spotlight has mainly focused on hospitals, dental professionals are increasingly being asked to examine their role. Nitrous oxide remains a vital tool in sedation dentistry, particularly in treating pediatric, geriatric, and special-needs patients. It's effective, familiar, and has a strong safety profile.

However, as highlighted in a recent Incisor article, the landscape is shifting. In several states and institutions, piped nitrous oxide systems have been removed in favor of portable tanks, which reduce the risk of continuous leakage. In other settings, nitrous oxide is being phased out of general anesthesia use altogether due to concerns about occupational exposure and environmental considerations.

For dentists, the message is not to eliminate nitrous oxide, but to use it responsibly.

That includes reviewing how it is stored, how much is used, and how effectively teams are trained to minimize loss. Hospitals have reported savings from eliminating wasteful agents and systems. Likewise, dental practices, while smaller in scale, may also benefit from more efficient use and fewer refills.

How Dental Teams Can Reduce Emissions

There are practical steps dental practices can take to improve efficiency and reduce emissions without sacrificing the quality of care:

1. Evaluate your delivery system. If your practice uses a central nitrous oxide manifold system, assess whether leaks are occurring through outdated piping or unused outlets. Portable tanks may offer more control and reduce waste.

2. Maintain equipment regularly. Ensure that scavenging systems, valves, and flow meters are routinely checked and maintained. Even small leaks at connections can result in significant long-term loss.

3. Educate and train staff. Ongoing training helps teams utilize sedation equipment more efficiently, minimize over-administration, and understand the importance of preventing waste.

4. Track your use. Keep records of the amount of nitrous oxide ordered and the amount administered. This helps identify inconsistencies or inefficiencies.

5. Stay informed. Follow updates from medical literature, dental associations, and continuing education sources, such as DOCS Education, to stay current on best practices.

Lead by Example

The environmental consequences of nitrous oxide use in dentistry can be easily overlooked. Unlike visible waste, emissions often escape unnoticed, yet their impact is well-documented. Dentists have a significant influence on the health of their patients and the practices of their peers.

As medical institutions take steps to improve the delivery and management of gases, dentistry has an opportunity to lead by example. Patients and colleagues alike are watching. Practices that stay informed and proactive strengthen patient trust while meeting the moment with professionalism.

Environmental concerns may feel far removed from the dental operatory, but the path forward begins in familiar territory. It starts with taking responsibility, asking the right questions, and making improvements wherever possible.

References

1. Burkhart, G. (2025, June 24). Nitrous oxide in the news again? What dentists need to know. DOCS Education.
2. Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health. (2017, November). Evaluation of nitrous oxide exposures in dental operatories (Health Hazard Evaluation Report HHE–2016–0189–3296). U.S. Department of Health and Human Services.
3. González, L. L. (2023, June 26). How ‘Going Under’ is Getting Greener. UCSF News.
4. Park, M. (2024, March 25). How Hospitals Are Tackling Anesthesia’s Climate Impact. Time.
5. Talbot, A. (2025, April 3). Anesthetic gas emissions have dropped by 27% in the last decade. Phys.org.
6. National Institutes of Health. (2024). The environmental impact of nitrous oxide inhalation sedation. PubMed.

Author: With over 15 years as an award-winning journalist, editor, and writer, Genni Burkhart has covered everything from news, politics, and healthcare to finance, corporate leadership, and technology. As editor-in-chief of The Incisor newsletter and blog and features writer at DOCS Education, she brings a refreshing insight and a passion for storytelling to the world of sedation dentistry.