How War is Creating a N2O Shortage

War and the pandemic are impacting the global supply of N2O, which is no laughing matter for dental patients.

By Susan Richards

Between COVID-19, the outbreak of war in Ukraine, and rising inflation, Americans are becoming painfully familiar with terms like international sanctions and supply chain disruptions. Toilet paper rationing has given way to baby formula shortages as the complexities of the market have combined with circumstances – some unforeseen, some predicted – to create a variety of crises in the U.S. and elsewhere.

While the current infant formula shortage is a result of ongoing supply chain issues compounded by a factory recall in February, it is mainly a domestic problem. However, the Russian invasion of Ukraine (also in February) is proving to be a catalyst for numerous product and resource deficits around the world – including one that is already causing problems for dentists.

War and Exports

Russia and Ukraine are responsible for providing approximately 29% of wheat and 80% of sunflower oil to the world. However, due to Ukrainian seaports being blocked by Russia, and international trade sanctions against Russia, the conflict has already begun to impact food supplies around the world. It’s expected to only get worse for poor countries relying on these resources.

The two countries are also accountable for exporting major commodities that are hitting the dental and medical community: ammonium nitrate and natural gas, which upon refinement can produce nitrous oxide (N2O) and helium.

Helium is used to diffuse heat, particularly in large MRIs and CTs. According to Kaiser Health News (KHN), the helium supply was already showing signs of trouble, and the war has only compounded the shortage. Experts in the medical supply chain field are seeing higher costs for MRI use and fear that the machines will be shut down in smaller community hospitals.

A full 40% of ammonium nitrate comes from Russia, and dentists are the primary consumer of its byproduct nitrous oxide. Also referred to as laughing gas, it is regularly used to treat anxious patients receiving dental procedures such as root canals.

N2O Supply and Demand

The U.S. Food and Drug Administration (FDA) has nitrous oxide listed as Currently in Shortage but even before the war broke out, there has been a precedent for N2O shortages.

• A fatal 2016 explosion at a nitrous oxide manufacturing facility resulted in warnings from both the FDA and the ADA that N2O was likely to be in short supply for dental professionals through 2017 – although based on many headlines that year, the impact on the whipped cream market was the real news.

• Due to the COVID-19 crisis, there was a high demand of liquid oxygen reported by hospitals last summer, which resulted in some dentists cutting back on nitrous use in their practices.

• Cumilla Medical College Hospital – a government-run hospital in Bangladesh – reported acute shortages of the gas last August due to the pandemic, prohibiting some surgeries from being performed.

In fact, according to a 2020 report, global demand for nitrous oxide was already projected to rise at a compound annual growth rate (CAGR) of 5.2% by 2026, reaching over $1 billion – up from $767.7 million in 2020.

Nitrous in Practice

Nitrous oxide is one of the oldest, safest, and most commonly used anesthetics used in dentistry. According to the Centers for Disease Control (CDC), it’s employed by 58% of all dentists and 89% of those treating pediatric patients. Its proven track record for safety and efficacy makes N2O an optimal tool for lightly sedating patients to minimize pain and anxiety in the dental chair.

Although COVID-19 hospitalizations and deaths have substantially declined, the pandemic continues to evolve as the war in Ukraine continues to rage. It remains to be seen if the nitrous oxide supply will be further impacted by these global concerns, but the dental community would be wise monitor the situation before it becomes a crisis at the practice level.

Meanwhile, DOCS Education is proud to offer potential solutions in these unpredictable times. Dentists can learn advanced N2O techniques as well as how to safely combine it with light oral sedatives. If the nitrous oxide supply reaches a critical stage, there are alternative methods for sedating anxious or patients or those with medical issues.

As the saying goes, hope for the best but plan for the worst. Just remember, we’re all in this together.


Author: Susan Richards is a staff writer at DOCS Education. With over 20 years of experience in local journalism and business marketing, Susan’s career includes award-winning feature writing, as well as creating content with context for a wide variety of industries.

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