by Dr. Todd Fincher I’ve been practicing in the Mississippi Delta since 1987. My patients range from adolescents to the elderly, and I’ve employed the use of nitrous oxide with a single-dose sedative for many years with great success. As with any technique, case selection and medical history dictate your parameters, and a thorough medical history and screening should always be conducted at the outset. Nitrous oxide and single-dose sedative benefit both patient and dentist The nitrous oxide and single-dose sedative option offers patients an affordable alternative to more complicated sedation packages. The dentist benefits as well; the combination offers a cost-effective way to care for the anxious patient—assuming, of course, that this level of sedation is sufficient for the treatment being performed. It’s essential to invest in proper monitoring systems to ensure the safest care possible. I want to stress that proper monitoring systems don’t have to be costly and complex. For us the equipment can be as simple as a pulse oximeter hooked to the patient’s index finger. This produces an audible sound allowing you to monitor the patient while still concentrating on the procedure. The point is to take into account the degree of difficulty or stress to the patient and the length of time sedation will be necessary. I prefer techniques which afford me exact measurement concerning the level of sedation. ‘Less is more’—a concept that resonates with today’s savvy consumer The N20/single-dose option also carries the large advantage of simplicity. Today’s savvy consumer relates well to the principle that “less is more.†The option is easy for them to understand and grasp, and lessens their anxiety because it’s a concept they find familiar. We believe adults and late-teens make most appropriate candidates My practice considers adults and late-teens the appropriate candidates for this sedation combination. Again, the procedure to be performed dictates the parameters. As always this technique requires a thorough medical history and screening prior to administration. Pre-op visit on the day before treatment instills confidence in patients We find that a pre-op visit the day before the treatment is a very effective practice for us. At that time we give the patient the prescription for their sedative and introduce them to the area where they will be treated. We also take their pre-op vitals, including blood pressure, pulse, respiration, O2 saturation, and an EKG. Evaluate difficulties, and take note of certain physical effects As we’re all well aware, one size does not fit all, and the same is true in the case of N20 and single-dose sedatives. Always evaluate the relative difficulty of the procedure for you AND the patient. A careful assessment will guide you toward the right sedation package in each case. From the medical standpoint there are a number of areas which warrant very careful consideration by the dentist. Be aware of diffusion hypoxia, which causes myocardial depression, and its effects on the patient you’re treating. Also take note of shivering; this increases oxygen consumption five-fold in those patients suffering from cardiac disease. It also raises cardiac function—can your patient tolerate this? Because the possibility exists of a malfunctioning pacemaker be sure to inquire whether your patient has one of these devices. For some patient populations—for example, females with a history of motion sickness—there is a high likelihood of postoperative nausea and vomiting when using narcotics/benzodiazepines. As long as the proper monitoring devices are employed and case selection remains careful I am confident that N20 and single-dose sedative will continue to serve as a safe and useful technique benefiting both the patient and the dentist. 
Dr. Todd Fincher has been in dental practice since 1987. He graduated from Mississippi State University and subsequently earned a master’s in biology from Delta State University and a DDS from Louisiana State University. Dr. Fincher currently serves as clinical director of the School of Dental Hygiene at the Mississippi Delta Community College.
