Nitrous oxide (commonly called laughing gas) is a breathable gas that is used to mildly relieve pain and anxiety during dental procedures. Nitrous oxide is a non-addictive colorless gas with a slightly sweet taste and odor. It is mixed with pure oxygen and inhaled through a soft nosepiece or mask, which is attached by hoses to nitrous oxide and oxygen tanks. The gas begins to work in three to five minutes. When it is effective, nitrous oxide produces a sense of security, a feeling of warmth, and a pleasant, floating sensation.
Nitrous oxide is very safe. The patient keeps all natural reflexes when breathing nitrous oxide and there will always be a higher percentage of oxygen delivered than in ambient air. In general, your child will be relaxed and cooperative. However, a small percentage of children who receive nitrous oxide experience side effects, including headache, nausea, or vomiting.
After the procedure, the dentist will turn off the nitrous oxide and allow your child to breathe 100% oxygen until the child feels normal. The effects of nitrous oxide wear off as oxygen flushes the gas from your lungs. Your child won’t feel any after-effects once nitrous oxide completely leaves your system. While most children feel normal within minutes of turning off the gas, some may feel the effects up to 15 minutes after removal of the mask. Nitrous oxide can only mildly sedate a child and may not be effective for children who are very young, have severe dental fears, have extensive treatment needs, are natural mouth breathers, have nasal congestion, or resist wearing a mask on their nose. We generally recommend it on children who are five and older, need a minimal amount of treatment, and are not extremely fearful. Parents are allowed in the room for nitrous oxide sedation.
ORAL CONSCIOUS SEDATION
Oral conscious sedation (OCS) is a safe, effective, and non-invasive method to help increase cooperation and reduce anxiety and discomfort/pain associated with dental treatment. Various medications can be used to sedate a child. Drugs will be selected based on your child’s age, overall health, level of anxiety, and dental treatment recommendations.
Once the medications have been administered orally, it may take up to an hour or more before your child shows signs of sedation and is ready for dental treatment. In addition to the oral medication, nitrous oxide gas will be used in conjunction to help achieve an ideal level of sedation. Most children become relaxed and/or drowsy and may drift into a light sleep from which they can be aroused easily. Unlike general anesthesia, sedation is not intended to make a patient unconscious or unresponsive. Some children may not experiencerelaxation but an opposite reaction such as agitation or crying. This response to the medication may prevent us from completing the dental procedures.
OCS is only effective about 90% of the time with proper case selection. It is much more effective than using nitrous oxide alone. Parents are allowed in the room.
We reserve the use of general anesthesia for children who the above behavior guidance techniques are either ineffective or unsafe and whose treatment warrants immediate attention due to pain, infection, or extensive treatment needs. With general anesthesia, the child will be completely asleep and not feel or be aware of any discomfort during treatment.
I consider the usage of general anesthesia to be safe and critical for any pediatric dental office, but we do try and avoid it when possible. General anesthesia is administered by an anesthesiologist and I’ve been working with an anesthesia group for many years that I consider knowledgeable, competent, and most importantly, SAFE. Due to the complexities involving the administration of general anesthesia, this is the only time we do not allow parents in the room once we start.