Nitrous Oxide

Nitrous oxide is a gas that has been used in dentistry for more than a century for its sedative/analgesic properties. Among its desirable characteristics are its safety, effectiveness and ease of use.

All levels of sedation can be induced using nitrous oxide. However, anxiolysis or minimal sedation(depending on which definitions your state uses) is the level most commonly intended.

The anxious dental patient enjoys the most benefits from nitrous oxide sedation. Other indications include the patient who is in discomfort as well as 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 concerns for the dental team, but these are eliminated with proper equipment and administration technique.

While nausea and vomiting are intraoperative side effects, there are no postoperative side effects to nitrous oxide.

The patient needs to be properly evaluated, informed consent obtained, and proper armamentarium and protocol used.

No. Never and 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 patient from moving their head from side to side.

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 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 that will be 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 as well as the state or province in which you practice.

The most common side effect is nausea and vomiting. This can be largely avoided by avoiding excessive concentrations and properly titrating to effect. There are other side effects that are much less common that can often be avoided through proper technique and patient selection.

John P. Bitting, Esq. completed his undergraduate work at the University of California in History and earned his JD at the University of San Francisco School of Law. Originally from Pacific Palisades, California, he lives and practices law in Seattle, Washington. His legal practice is focused in the area of dental regulations with special emphasis on sedation. John travels to and works closely with the regulatory authorities of each state and province in North America to promote the making of sensible regulations for safe and effective sedation dentistry based upon science and the standard of care.

In his spare time, John enjoys watching baseball, playing softball and football, and hunting with his redbone coonhound, Hawkeye.