Nitrous Oxide Inhalation Sedation Research Articles

The environmental impact of nitrous oxide inhalation sedation appointments and equipment used in dentistry.

This paper reports a life cycle impact assessment (LCIA) to calculate the environmental footprint of a dental appointment using N2O, comparing single-use equipment with reusable equipment. Nitrous oxide (N2O) is used successfully in dentistry to provide sedation and pain relief to anxious patients, most commonly in children. However, N2O is a powerful climate pollutant 298 times more damaging than carbon dioxide over a 100-year estimate. The functional unit chosen for this LCIA was 30min delivery of N2O to oxygen in a 50:50 ratio at 6L per minute flow rate as inhalation sedation to one patient. Two types of equipment were compared to deliver the anaesthetic gas: reusable and disposable items. The use of disposable equipment for N2O sedation produces a significantly larger environmental impact across nearly all of the environmental impact scores, but the overall global warming potential is comparable for both types of equipment due to the vast environmental pollution from N2O itself. N2O sedation is a reliable treatment adjunct but contributes to climate change. Single-use equipment has a further deleterious effect on the environment, though this is small compared to the overall impact of N2O. Dental priorities should be to deliver safe and effective care to patients that protects staff, minimises waste and mitigates impact on the environment alongside promoting research into alternatives.

Quality of obturation and the behavior of children treated under nitrous oxide conscious sedation: A double-blinded split-mouth randomized clinical trial

Abstract Aim: Our aim is to assess the quality of obturation and behavior of the children treated with and without nitrous oxide sedation and also to investigate the association between the quality of obturation and the behavior of children. Materials and Methods: A double-blinded split-mouth randomized clinical trial was conducted in 60 teeth. A total of 30 children aged 4–8 years in need of pulpectomy in bilateral mandibular molars were selected. On the first appointment, the children were assigned to protocol A, where the pulpectomy was performed without nitrous oxide inhalation sedation (NOIS). In the second visit, the children were allocated to protocol B, where pulpectomy was done in the contralateral molar under NOIS. The obturation quality and behavior of the children were graded according Coll and Sadrian criteria and Ohio State University Behavior Rating Scale, respectively. The data were assessed with descriptive statistics, Chi-square test, and Wilcoxin signed-rank test. Results: The quality of obturation and the behavior of the children were significantly better under conscious sedation (P = 0.000). Also, there was a significant association noted between the behavior of the children and quality of obturation (P = 0.0.012). Children exhibiting quiet behavior favored optimal fill, while in children showing cry alone or struggle , it was more of under-fill. In children showing both struggle and cry, more of over-fill pattern of obturation was noticed. Conclusion: Nitrous oxide sedation enhances the obturation quality and children’s behavior. Furthermore, there is a clear association between children’s behavior and obturation quality, regardless of whether nitrous oxide sedation is used or not.

Conscious Sedation: A Bridge between the Real and Ethereal

The most frequently encountered and unavoidable phenomenon in a dental practice is pain, often accompanied by fear and anxiety. Local anesthetic, which forms the foundation for pain-free dental treatment, does not serve the purpose in anxious patients and needs augmentation with “Conscious Sedation’’ techniques. Nitrous oxide is a frequently used inhalation anaesthetic in dentistry as it is known to provide anxiolysis, mild analgesia, and amnesia. It has proved to be safe in delivering conscious sedation for apprehensive dental patients. This review discusses the role of Nitrous oxide inhalation sedation (NOIS) in the field of endodontics highlighting its objectives, advantages and indications. It also brings to light the multidisciplinary applications of NOIS in dentistry.

The Effect of Anxiety and Stress on Acceptance of Dental Procedure before and after Inhalation Sedation in Pediatric Patients: An In Vivo Study.

The study aimed to assess the anxiety and stress levels on acceptance of dental treatment in child patients approaching dental extraction procedures before and after nitrous oxide (N2O) inhalation sedation (IHS) by measuring serum amyloid A (SAA) and salivary cortisol (SC). A total of 32 children, ages ranging from 6 to 10 years, were randomly grouped as TI (before N2O IHS) and TII (after N2O IHS). Saliva samples were taken for biochemical evaluation of SAA before and after the procedure. Subjectively anxiety and stress levels were evaluated using modified child dental anxiety scale (MCDAS). Wilcoxon rank-sum test was used to compare the means of dental anxiety, SAA, and SC before and after N2O IHS. The Karl Pearson correlation coefficient was employed to determine the correlation between dental anxiety and SAA and SC before and after N2O IHS. There were significant differences in the dental anxiety level in child patients after administration of N2O IHS, and it also showed an increased rate of acceptance of dental treatment. This study showed that N2O is a safe and effective method in reducing dental anxiety and increasing acceptance of dental treatment in child patients with improved behavior and with no adverse effects. Anxiety and stress will always hinder the acceptance of dental treatment in child patients, especially during extraction procedures. N2O IHS is a safe and effective technique to overcome anxiety and stress in child patients and as well as allows them to undergo dental treatment with improved behavior. Kunta S, Arora RV, Jain R, et al. The Effect of Anxiety and Stress on Acceptance of Dental Procedure before and after Inhalation Sedation in Pediatric Patients: An In Vivo Study. Int J Clin Pediatr Dent 2023;16(2):302-307.

Nitrous Oxide Inhalation Sedation Rapid Analgesia in Dentistry: An Overview of Technique, Objectives, Indications, Advantages, Monitoring, and Safety Profile.

Khinda V, Rao D, Singh Sodhi SP. Nitrous Oxide Inhalation Sedation Rapid Analgesia in Dentistry: An Overview of Technique, Objectives, Indications, Advantages, Monitoring, and Safety Profile. Int J Clin Pediatr Dent 2023;16(1):131-138.

Efficacy and Safety of Nitrous Oxide Inhalation Sedation in Paediatric Dental Patients: A Comparison of Different Concentrations

Introduction: In order to effectively treat children, managing terrified and nervous paediatric dental patients is crucial. The choice of a specific behaviour control strategy is at the operator’s discretion, but it may be influenced by parental approval. Clinically beneficial pharmacological therapies, such as Nitrous Oxide-oxygen Inhalation Sedation (NOIS), have been demonstrated. However, prolonged exposure to specific amounts of these therapies could pose health hazards for medical personnel. Aim: To evaluate the clinical efficacy and safety of utilising N2 O inhalation sedation at a 70% concentration in a paediatric dental setting, compared to administering it at 50% and 60% concentrations. Materials and Methods: A non randomised clinical trial was conducted in the Department of Paediatric and Preventive Dentistry at Saveetha Dental College, Chennai, India. The duration of the study was three months, from June 2022 to August 2022. A total of 42 young patients between the ages of 4 and 10 who required mandibular pulpectomy and crown were selected. During the study, the researchers recorded each patient’s levels of sedation and cooperation at four specific time points while administering a fixed concentration of N2 O. The concentrations at these time points were 50% at the 10th minute, 60% at the 20th minute, 70% at the 30th minute, and 70% at the 40th minute. The study compared the primary outcomes of sedation and cooperation levels, along with the secondary outcome of adverse effects, between the different time intervals using the Kruskal-Wallis test followed by post-hoc tests for pairwise comparison. The level of significance was set at p<0.05. Results: The mean age of the children included in the present study was 7.4±1.324 years. At the end of 40 minutes at a 70% concentration, a deep sedation score of six was achieved by 7 (16.7%) of the patients, while none of the patients achieved this sedation level at concentrations of 50%, 60%, or 70% at the end of 30 minutes. The mean sedation score of patients at the end of 40 minutes at a 70% concentration (4.86±0.683) was higher than the sedation score of patients at the end of 30 minutes at a 70% concentration (4.36±0.656). Cooperation at a 70% concentration was better at the end of 40 minutes (5.83±0.377) than at the end of 30 minutes (5.40±0.497). At 50% and 60% concentrations, no adverse effects were observed. Conclusion: Sedation at a 60% concentration was more effective than 50% in achieving satisfactory cooperation to complete dental treatment without any adverse effects. Additionally, at a 70% concentration, sedation and cooperation were higher, but adverse effects were noted, warranting caution when considering its use for extended periods.

Nitrous Oxide Inhalation Sedation in Present Scenario: A Review Article

Nitrous Oxide Inhalation Sedation in Present Scenario: A Review Article

Evaluation of nitrous oxide inhalation sedation during inferior alveolar block administration in children aged 7-10 years

Background: To evaluate the nitrous oxide- oxygen inhalation sedation during inferior alveolar block administration in children. Materials & Methods: A total of 50 children of age 7-10 years, with a treatment plan of extraction of primary teeth were enrolled in the study. They were divided into 2 groups as N2O-O2 and oxygen. Those who presented with clinical conditions contraindicating the use of N2O–O2 or having known allergy to lignocaine were excluded from the study. Data was collected and result was analysed using SPSS software. The level of significance was at p≤0.05. Results: A total of 50 children were enrolled, 25 in each group. There was a significantly lower pain reaction to local anesthetic administration in the N2O-O 2 group (p

Nitrous oxide inhalation sedation: Is it just a child’s play?

Nitrous oxide inhalation sedation: Is it just a child’s play? - JDS- Print ISSN No: - 2320-7302 Online ISSN No:- 2393-9834 Article DOI No:- 10.18231/j.jds.2022.011, Journal of Dental Specialities-J Dent Spec

Case Report: Applicability of sedation with nitrous oxide in the management of molar incisor hypomineralization in pediatric patients

Patients with molar-incisor hypomineralization (MIH) may manifest tooth hfypersensitivity and difficulties in undergoing dental treatment, including fear, anxiety, and behavior problems in the dental office. Then, the objective of this study was to report a clinical case series using inhalation sedation with nitrous oxide and oxygen as a clinical strategy in the management of MIH pediatric patients during dental treatment. Pediatric patients and their legal guardians were properly informed and data were extracted from clinical charts. Six clinical cases were included, whose patients were between 8 and 12 years old. Of these, 4 were female. The indication of moderate sedation took into account the clinical difficulties related to patients with MIH, such as obtaining anesthesia and cooperation, in addition to odontophobia and dental anxiety. All patients were carefully examined to undergo the sedation technique, including medical history and previous experiences with nitrous oxide inhalation sedation, as well as the vital signs were properly evaluated before, during and after the procedures. The nitrous oxide concentration ranged between 30% and 60%. The procedures were restorative, endodontic or surgical (extractions). In general, the use of sedation contributed to the performance of dental procedures. The use of inhaled sedation helped in behavioral management and during the treatment, increasing the effectiveness of local anesthesia. Patients were cooperative for treatment, while no adverse effects or complications related to sedation were observed. Thus, for the patients in this case series, the use of inhalation sedation with nitrous oxide and oxygen contributed to the clinical management of patients with MIH.

Nitrous Oxide Inhalation Sedation in Pediatric Dentistry: An overview of the available guidelines

Children with behavioral issues are usually inadequately treated using non-pharmacological behavior management techniques, making dental treatment a real clinical challenge for the practitioner. This leads to the indispensable need for advanced pharmacological techniques, such as inhalation sedation (IS). In pediatric dentistry, nitrous oxide sedation is considered the safest tool for a dental practitioner to use on uncooperative children, thus reducing the need for dental treatment under general anesthesia. To date, several sets of high-ranking evidence-based inhalation sedation guidelines are available,developed in the United States, United Kingdom, Europe, Australia, and New Zealand. This review summarizes the indications, contraindications, advantages, and disadvantages of using nitrous oxide sedation in children, and compares these in terms of inhalation sedation procedure and documentation. This review will assist the dental practitioner in developing appropriate practice regulations for safe and effective practice.

Use of pulse oximetry during nitrous oxide- oxygen inhalation sedation: mandatory or recommended?

There is skepticism amongst many dentists about the interference of nitrous oxide with the physiological parameters. This commentary attempts to make clear recommendations on the use of pulse oximeter during nitrous oxide inhalation sedation. Nitrous oxide is used commonly in dentistry as a tool to reduce fear/ anxiety and build a positive dental attitude. Dentists use pulse oximeter to monitor oxygen saturation during the period of administration of nitrous oxide. There is no consensus amongst various guidelines across the world on the necessity of using pulse oximeter during the period of administration of nitrous oxide CONCLUSION: Pulse oximetry may not be considered mandatory when nitrous oxide gas is being administered for minimal sedation to a healthy patient having no pre- existing diseases/illness.

Physiological Effects, Psychomotor Analysis, Cognition, and Recovery Pattern in Children Undergoing Primary Molar Extractions under Nitrous Oxide Sedation Using Two Different Induction Techniques: A Split-mouth Randomized Controlled Clinical Trial.

Nitrous oxide inhalation sedation (NOIS) has been in use as a tool for pharmacological behavior modification and relative analgesia (RA) for well over 170 years now since its discovery in 1844 by the American Dentist Horace Wells. Advantages include raising of the pain reaction threshold, alteration of both pain sensitivity and pain reaction, reduction of fatigue, and time awareness that helps to handle stress and lengthy appointments. In addition, the most important clinical consequences of Nitrous Oxide (N2O) pharmacokinetics are rapid induction and recovery, reversibility, titrability, and adjustability. The goal of the current investigation was to analyze the safety aspects of nitrous oxide sedation. It was carried out on 25 patients within the age group 7-10 years requiring extractions of two primary molars in each patient. Split-mouth design was followed, with the first extraction done under traditional slow induction while the second extraction was done following the rapid induction technique of NOIS. N2O was studied for its physiological effects, psychomotor analysis was done, cognition and recovery patterns were analyzed utilizing the two different induction techniques. Based on the results obtained, it was found that N2O is a very safe and useful drug that delivers a comfortable patient for dental treatment.How to cite this articleKhinda V, Rao D, Sodhi SPS, et al. Physiological Effects, Psychomotor Analysis, Cognition, and Recovery Pattern in Children Undergoing Primary Molar Extractions under Nitrous Oxide Sedation Using Two Different Induction Techniques: A Split-mouth Randomized Controlled Clinical Trial. Int J Clin Pediatr Dent 2021;14(S-2):S131-S137.

Knowledge, Attitude, and Awareness about Nitrous Oxide Inhalation Sedation among Dental Practitioners of Gujarat, India

Introduction: Conscious sedation is a safe and effective method of anxiolysis. However, the use of conscious sedation in pediatric dental patients is a controversial topic as it involves the intersection of dentistry and medicine. Among the many questions that could be asked, it is necessary to find out what dental practitioners think about the use of sedatives in their routine pediatric dental practice. Therefore, the above survey was conducted aiming to evaluate the perceptions of dentists on the use of Conscious Sedation in pediatric dental practice in Vadodara city, Gujarat.
 Methods: Questionnaires were sent electronically to Indian Dental Association (IDA) members of Vadodara at the time of the study. The contact details of these dental practitioners were obtained from the IDA members list. Details on personal status, use of, and training in, conscious sedation techniques were sought via the questionnaires to find the knowledge, attitude, and awareness towards the use of Conscious Sedation in pediatric dental practice.
 Results: The questionnaire was sent to IDA members in Vadodara city, Gujarat. 64.37% (150 dentists) responded to the questionnaire. 48% were female practitioners and 52% were male practitioners. 78.5% were in favor of using conscious sedation as a behavior management technique in pediatric dental practice, irrespective of their qualification or years of experience. Maximum knowledge about conscious sedation was obtained through the curriculum.
 Conclusion: It can be concluded that the dentists of Vadodara city, Gujarat state developed a positive attitude towards the use of conscious sedation, however, complained of a lack of training to the subject.

Assessment of Nitrous Oxide Inhalation Sedation Module in Kuwait: A Survey on Undergraduate Dental Training Curriculum.

IntroductionThe use of nitrous oxide/oxygen (N2O/O2) inhalation sedation in dentistry has increased worldwide. This study aimed to evaluate the nitrous oxide/oxygen (N2O/O2) inhalation sedation undergraduate teaching curriculum at Kuwait University Faculty of Dentistry.MethodsA cross-sectional survey involving dental students in their clinical years (5th, 6th, and 7th years) at Kuwait University Faculty of Dentistry was conducted. Participation was voluntary and anonymous. The Likert scale-based survey comprised 17 statements that assessed various aspects of N2O/O2 inhalation sedation in dental procedures. Continuous data variables were compared among different groups using one-way analysis of variance (ANOVA). Categorical data variables were compared using either the Chi-squared test or Fisher’s exact test.ResultsFifty-six students participated in this survey-based study. All students attended an approximately equal number of practical hands-on-training sessions, with a mean of 1.7 (± 1.1) sessions (p = 0.813). Most students expressed confidence in administering N2O/O2 inhalation sedation with an insignificant difference between each group (p = 0.276). However, low confidence level was observed in certain intraoperative and postoperative management aspects of providing N2O/O2 to patients.ConclusionThis study indicated that the teaching curriculum regarding N2O/O2 inhalation sedation should be regularly evaluated. The quality of students’ educational pathways should also be assessed through surveys to improve and develop dental school curricula to the highest standard levels.

English

BACKGROUND Sensation and perception are two separate processes that are very closely related. Sensation is the input about the outside world obtained by our sensory receptors while perception is the difficult system by which the brain selects, organizes and interprets these sensations. Effects of nitrous oxide on the sensation and perception has not been unturned although role in physiological, anxiolytic, behavioural, psychomotor and analgesic parameters have been examined in both children and adults. The human senses have long been unnoticed, despite their responsiveness being of great importance. The purpose of this study was to evaluate the effectiveness of nitrous oxide inhalation sedation on 5 senses i.e. sight, hearing, touch, smell and taste at different titrations of nitrous oxide and oxygen. METHODS 7 to 12 years old children with Frankl’s behaviour rating score of 2, 3 and 4 with no prior dental experience and requiring dental treatment under nitrous oxide sedation who were systemically healthy were included in the study. The 5 senses (i.e. hearing, touch, smell, taste and vision) were evaluated with different materials at 4 different titration levels to evaluate the effect of nitrous oxide on the 5 senses T0: 100 % oxygen, T1: 30 % nitrous oxide, T2: 50 % nitrous oxide, T3: 100 % oxygen. RESULTS The results of the present study depicted that there is significant difference in the perception of various senses at different concentrations of nitrous oxide and also when compared to baseline values. It was observed that the patient regained the normal perception in 5 minutes after 100 % oxygen post-operatively. CONCLUSIONS Nitrous oxide is found to depress/relax one’s senses too. KEY WORDS Vision, Smell, Taste, Touch, Sound, Perception, Consciousness, Nitrous Oxide Sedation, Oxygen, Behaviour

Trends in Dental Sedation of Korean Children and Adolescents

The purpose of this study was to investigate trends in dental sedation of Korean children and adolescents. A retrospective study was conducted on patients under 20 years of age who received dental treatment under sedation using National Health Insurance Service-National Sample Cohort Database from 2002 to 2015. Based on the 1 million standard data, there were 436 cases of dental treatment under sedation in 2002, but 4002 cases in 2015, showing a trend increasing every year. The 3 - 5 year old group accounted for the largest portion (54.2%), while the 6 - 8 year old group increased recently. Nitrous oxide inhalation sedation is the most commonly used, accounting for 45.9% in 2002, but increased to 89.5% in 2015. Combination of nitrous oxide inhalation sedation, chloralhydrate and hydroxyzine was the most common, accounting for 5.7% in 2002, but decreased to 2.9% in 2015. There is a trend to use the sedation method more safely and in a way that reduces side effects.

Comparison of patient and parental preference between nitrous oxide sedation and conventional behavior management technique for dental treatment: A randomized crossover study

Aim: To Compare patient and parental preference between nitrous oxide sedation and conventional behaviour management technique for dental treatment.Material and Methods: This cross-over split mouth study design was performed on 30 children (6-12 years old) who require a bilateral treatment involving inferior alveolar nerve block. 15 children were enrolled in a group A & 15 children in a group B. Thereafter, the outcome of preference of technique was assessed by parent and child after both techniques were performed. Results: The collected data was statistically analysed. The majority of children and parents preferred nitrous oxide inhalation sedation to conventional behaviour management techniques. Conclusion: Study concludes that nitrous oxide was preferred by both children and their parents over conventional behavior management techniques.

Clinical Use of Nitrous Oxide Inhalation Sedation in Patients with a History of Epilepsy

Clinical Use of Nitrous Oxide Inhalation Sedation in Patients with a History of Epilepsy

Dental Management in a Patient with Glanzmann’s Thrombasthenia : A Case Report

Glanzmann’s thrombasthenia (GT) is a rare, autosomal recessive inherited congenital disorder, characterized by impaired blood coagulation due to platelet dysfunction. It was first reported by the pediatrician Glanzmann in 1918.GT affects both males and females, and it is more common in regions of the Middle East, India, and France, where intermarriage is common. It has an incidence of about 1 in 1,000,000 people. In South Korea, according to the Division of Rare Diseases, Korea Centers for Disease Control and Prevention, around 200 cases have been reported in 2018.Clinical symptoms include petechia, ecchymosis, epistaxis, and gingival bleeding. The spontaneous loss of deciduous teeth can result in excessive bleeding with that blood transfusion should be considered. Preventing hemorrhages and hemostasis are most important factors in dental treatment. Local bleeding can be controlled by compression, but platelet transfusion can be required by prolonged bleeding.Pediatric dentists can minimize the gingival bleeding by control of the oral hygiene to prevent gingivitis and dental caries. The importance of oral hygiene and periodic recall check-up should be emphasized. During dental treatment, the examination and the treatment plan of patient should be modified to prevention of hemorrhages carefully.A 6-year-old girl with GT was referred for the treatment of dental caries, and resin restoration was performed under nitrous oxide inhalation sedation. After treatment, compression was required for the bleeding control.