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Nitrous Oxide: Effects and Administration in the Dental Office
Chelsea Leighton
Dental Hygiene, South College
RDH 1310: Pharmacology
Sarah McKinney, RDH, BSDH
November 22, 2022
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Nitrous Oxide: Effects and Administration in the Dental Office
If you have worked around pediatric dentistry or even have memories of your own
experiences from dental visits as a child, you might recall that dental visits are a common fear
around children. Your dental office may have used nitrous oxide to help calm your nerves. In
dentistry nitrous oxide is an effective tool to use when a patient may feel anxious about their
appointment; however it is very important to understand how to properly administer it and know
all the potential effects. In this paper I will discuss the effects of nitrous oxide on pediatric
patients and the importance of properly administering it.
A study done by Goyel et al. (2021) tested the effects on all five senses in pediatric
patients ages seven to twelve. They analyzed results at four different nitrous levels. The five
senses (i.e. hearing, touch, smell, taste, and vision) were evaluated at four different titration
levels to evaluate the effect of nitrous oxide on the five senses. The parameters were recorded
while giving 3 minutes of 100% oxygen, 3 minutes of 30% nitrous oxide, 3 minutes of 50% of
nitrous oxide and post operatively after giving 100% of oxygen for 5 minutes. (Goyel, Jain,
Sachdev & Singh, 2021) After gathering all the results they concluded there is a significant
change in all five senses and the patient should not be left unattended for atleast five to twenty
minutes after nitrous oxide is removed.
Baldwin et al. (2020) conducted a study to determine X. Their study included 52 pediatric
patients that were age 0-16 with an ASA grade of I or II. All children were given a titrated dose
of N2O, with a maximum dose of between 30 and 50%. All children were given 100% O2 during
recovery for at least 2 min. The total recovery period (time between N2O cessation and
discharge) was 4–26 min (Baldwin, Johnson, & Lyne, 2020). Twelve minutes was the average
time between haulting of the nitrous oxide and the patient’s discharge. The multi-operational
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apparatus for reaction time computer panel was used to measure the time taken in seconds to
respond to the unpredictable onset of one of eight small lights. Each participant was allowed 3
practice attempts which was followed up by 20 recorded attempts used in the study. The study
ultimately concluded there is a significant reaction time change before and after administration
and the patient needs to be attended prior to receiving nitrous oxide. Advising the guardian with
the child the effect on behavior is important.
Irfan et al. (2020) discuss the potential outcomes of improperly administering nitrous
oxide and facts that a dental professional should keep in mind when using nitrous oxide. It is
important to understand how to administer nitrous oxide for pediatric patients. Although it is
rare, death is a huge risk when prescribing nitrous oxide. When Irfan et al. (2020) reviewed death
cases related to general local anesthetic or accidents with administering nitrous oxide cases
involving death ultimately come down negligence. Factors leading to negligence can include not
advising your administrator of a mistake you may have made due to the fear of a lawsuit, lack of
training, or even giving the patient the wrong drug. Cardiovascular pulmonary and upper airway
complications are three major causes of morbidity and mortality in the dental office. The
American Society of Anesthesiologist (ASA) recommends the following sequence for pre-
operative evaluation: patient interview and review the health history, physical exam, assigning
the ASA score, and formulation and discussion of the anesthetic plan (Irfan et al, 2020).
When comparing all three articles they each support the same results in that
administering nitrous oxide properly will influence a patient’s mental competence, reaction time,
and ability to function normally while on nitrous oxide and up to 20 minutes after the nitrous
oxide is ceased. Baldwin et al. (2020) concluded patients were ready to be discharged between 4
to 26 minutes where Goyel et al. (2021) concluded patients should not be left unattended for at
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least 5 to 20 minutes prior to administration. Goyel, Jain, Sachdev & Singh also specified that
there was a difference in effects based off gender where Baldwin, Johnson, & Lyne did not
specify any gender related results. Although Irfan, Kumar, & Lund discuss the effects of nitrous
oxide, they discuss the effect that occur more negligent related.
It is safe to say that having the proper knowledge when administering nitrous oxide is
very vital to the patient’s health. When using nitrous oxide, dental hygienists need to advise the
guardian of the effects the patient might experience when leaving. It is also important for the
dental hygienist to know how to properly administer it and recognize the negative signs or side
effects when a patient is on nitrous oxide. Nitrous oxide is an effective resource to use when
working with anxious pediatric patients when administered and handled properly.
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Reference
Goyel, V., Jain, A., Mathur, S., Sachdev, V., & Singh, S. (2021). Exploring the effect on 5 senses
in children under nitrous oxide sedation. Journal of Evolution of Medical and Dental
Sciences, 10(38),3365+. https://link.gale.com/apps/doc/A677900953/AONE?
u=tel_a_scollege&sid=ebsco&xid=6d3e69b3
Baldwin, D., Johnson, J., & Lyne, A. (2020). Reaction times of children having nitrous oxide
inhalation sedation for dental procedures. Eur Arch Paediatr Dent 21, 25–30.
https://doi.org/10.1007/s40368-019-00433-9
Irfan M., Kumar S., & Lund R. (2020). Professional negligence during nitrous oxide sedation and
child fatality in dental office and suggested precautions: A short communications on
childcare and nitrous oxide sedation. Advances in Human Biology, 10(1), 3-5.
https://www.aihbonline.com/temp/AdvHumBiol1013-661863_182306.pdf
