6.24.20 Correction: The article was corrected to identify Dr. John Moenning as one of the investigators involved in the Purdue study. It was omitted in the previous version. Sincere thanks to Dr. Anthony Carroccia for pointing out the omission.
The COVID-19 pandemic has forever changed the way dentistry keeps patients safe—and making patients feel safer is critical to inspiring their confidence to return for treatment.
Now more than ever, it is critical to eliminate all sources of cross-contamination in ways patients can see. One of the main potential sources is reusable nitrous oxide hose-and-mask delivery systems.
In addition to the viral and bacterial risks, repeated chemical or steam sterilization of hose delivery systems breaks down the integrity of the materials, resulting in leaks of nitrous oxide gases into the operatory, exposing dentists and their teams to unnecessary health risks.
Adding the numerous COVID protocols to the routine of cleaning, disinfecting, and sterilizing equipment after each use begs for a safe, less labor-intensive solution. Many practices spend considerable time between patients disinfecting nitrous oxide equipment, disassembling multiple pieces, washing them in soapy water, autoclaving, then reassembling for the next patient.
Despite best efforts to sanitize equipment, pathogens can and do survive in reusable systems. Particularly, multiple connectors in the hose system tend to gather pathogens and are very difficult to disinfect.
In April of 2020, the American Academy of Pediatric Dentistry published Re-emergence Pediatric Dentistry Practice Checklist: “A guide for re-entry into practice for pediatric dentists during the COVID-19 pandemic.” Among the recommendations was switching to Single-Use Equipment as part of your point-of-care operatory environment:
- Identify one-time disposable armamentarium that has sterilizable and multi-use counterparts and solutions such as nitrous oxide circuits/masks and laundered gowns.
A 2009 Study from Purdue University evaluated two nitrous oxide scavenging systems using infrared thermography to visualize and control emissions. Of the two, only the Safe Sedate® single-use nitrous oxide delivery system “met the American Conference of Governmental Industrial Hygienists threshold limit value of less than 50 ppm during an eight-hour day and performed significantly better” than the other system.
The Safe Sedate® single-use nitrous oxide delivery system acts as superior Patient Protective Equipment and makes traditional N2O hose and mask delivery systems obsolete. The system delivers nitrous oxide and evacuates residual gas with precision. No sterilization is required. It does take a little practice—3-5 patients on average—to get used to using the single-use masks efficiently, per Dr. John Moenning, the founder of Safe Sedate® and one of the investigators in the Purdue study. However, the benefits of switching over far outweigh the minor transitional adjustments.
“Although there is a benefit to administering N2O to patient, healthcare professionals incidentally exposed to excess and exhaled N2O may experience adverse health effects,” according to the Purdue study. “In a large retrospective review, Cohen and colleagues reported on the health problems experienced by dentists and chairside assistants who had been exposed to N2O in their jobs.”
Cited epidemiologic studies indicate deleterious health effects at nitrous oxide air concentration levels as low as 50 parts-per-million, including:
- Increased incidences of spontaneous abortion
- Premature births
- Bone marrow depression
- Impaired visual effects
- Alterations in Vitamin B12 and plasma homocysteine concentrations
Single-use Safe Sedates® significantly reduce leakage with a patented mask design that has multiple vents, creating negative pressure surrounding the patient’s face. Therefore, even gasses exhaled through the mouth are sucked back into the advanced mask system and safely evacuated from the office.
Nitrous oxide with Safe Sedate® enables dentists and teams to sedate their patients safely, easily perform necessary dental procedures, and accomplish more per patient visit.
Considering the time and labor involved in cleaning reusable hose systems, the risk of cross-contamination, and the danger of exposing staff to N2O leaks, every dentist who offers nitrous oxide should seriously consider switching over to a single-use system.
Rademake, April M., et al. Journal of the American Dental Association. “Evaluation of two nitrous oxide scavenging systems using infrared thermography to visualize and control emissions.” Vol. 140, February, 2009.