Nitrous oxide is a gas that has been used in dentistry for its sedative/analgesic properties for more than a century. Among its desirable characteristics are its safety, effectiveness, and ease of use.
Nitrous oxide can support the induction of all levels of sedation. However, anxiolysis or minimal sedation (depending on which definitions your state uses) are the levels most commonly intended.
The anxious dental patient enjoys the most benefits from nitrous oxide sedation. Other indications include the patient who is in discomfort and the patient with a mild to moderate degree gag reflex.
There are no drug interactions with nitrous oxide.
Nitrous oxide is the safest of all inhalation anesthetics. There are occupational exposure concerns for the dental team, but proper equipment and administration techniques eliminate these.
The most common side effect is nausea and vomiting. These symptoms are mitigated by avoiding excessive concentrations and properly titrating to effect. Other side effects are much less common and avoided through proper technique and patient selection.
While nausea and vomiting are intraoperative side effects, there are no postoperative side effects to nitrous oxide.
The patient needs adequate evaluation, informed consent obtained, and proper armamentarium and protocol used.
No. Advanced armamentarium, such as the Safe Sedate®, eliminate the complication of the nasal mask and tubing getting in the way of the upper anterior teeth and preventing the mask from becoming unseated when a patient moves their head from side to side, as well as preventing the risk of infectious disease exposure from reused mask and tubing.
In most cases, yes.
Nitrous oxide comes in pre-filled tanks that can be attached to either a central or portable delivery system. This system also includes manifolds, regulators, fail-safe mechanisms, flowmeters, and evacuation equipment. Non-latex, flexible tubing connected to a nasal mask allows for the administration of the nitrous oxide/oxygen mixture to the patient.
Depending on the state or province in which you practice, your team can be qualified to provide and/or monitor the administration of nitrous oxide analgesia/sedation. At the very least, the clinical team involved in dental procedures involving nitrous oxide administration should have a basic understanding of its properties, side effects, armamentarium, monitoring, administration, technique, and dismissal criteria.
It depends on your role on the dental team and the state or province in which you practice. Check your governing regulations for your state on this site, and if you have questions, contact us.