Nitrous Oxide Sedation

Nitrous Oxide Sedation

Some individuals, adults and children alike, have typical anxiety with the average dental experience. If you have difficulty establishing the calm desired, nitrous oxide may be an option for you. 

What is Nitrous Oxide?

Nitrous Oxide is a safe and effective sedation agent used to calm anxiety induced by the dental visit as well as enhance effective communication.  It also works well for patients whose gag reflex interferes with dental treatment as the gag reflex is often heightened in an anxious state.
Nitrous Oxide sedation is a blend of two gases: Nitrous oxide and oxygen.  A fitted mask is placed over the nose and, as the patient breathes normally, uptake occurs through the lungs.  At the end of treatment, it is eliminated after a short period of breathing oxygen and has no lingering effects.

How does it work?

Nitrous Oxide is a vasodilator (increases the blood flow of the vessels to the heart by relaxing the endothelial (internal vessel) walls which in turn lowers your blood pressure.  The actual sedation mechanism of Nitrous Oxide is still unknown. However, it lowers the brain’s sensation to pain and anxiety and creates a calming sedation when dosed properly.

Upon administration, you may smell a faint sweet smell and experience a sense of well-being and relaxation.  Since it may produce a feeling of euphoria, it is often called, “Laughing Gas.”  You may experience tingling in your hands and feet or report a dreaming effect.  It raises the pain threshold and helps pass time more quickly.  The level of Nitrous Oxide is tapered to every patient depending on the effect.  Too much can make your stomach upset and induce lightheadedness, so it is important to communicate how you are feeling when dosing every patient.

How safe is it?

Very safe and it is well tolerated by most.  It has a rapid onset and is reversible, can be changed to many concentrations and is non-allergenic.  This is a completely conscious sedation therefore you keep all natural reflexes.  You will be able to communicate and function as normal.   It can be a nice adjunct to deliver safe dental care to those with cardiac concerns in conjunction with dental anxiety as it offers vasodilation of the vessels and more oxygen flow to the heart.

Is it for everyone?

Nitrous Oxide is not for everyone. 
The contraindications to its use include but may not be limited to: (please circle if any apply.)

  1. Hypertrophic Cardiomyopathy/ Hypertrophic Obstructed Cardiomyopathy
  2. Pulmonary Hypertension
  3. Home Oxygen use
  4. Tetrahydrafolate(THF) Deficiency
  5. Bleomycin  Therapy-Pulomonary Fibrosis within 1 year
  6. Severe COPD with Bolus- Chronic Bronchitis
  7. Pneumothorax
  8. Nasopharyngeal Obstruction
  9. Closed Tissue Spaces
  10. Claustrophobia 
  11. Multiple Sclerosis
  12. Pregnancy
  13. Use of the following drugs within a 48 hour period:
    • Nitroglycerin(patch or pill)/  Levitra/  Viagra/  Cialis.   
  14. Personality/Cognitive:
    An inability to tolerate sustained use of a nasal mask due to psychological or cognitive disturbances typically renders a patient intolerant and can intensify their anxiety.  These include: severely phobic patients, the cognitively impaired, uncooperative pediatric patients, and patients with personality or psychiatric problems in particular, Bipolar and Schizophrenia where use of Nitrous oxide may alter the disposition unpredictably and is not recommended. 

Are there any special instructions for nitrous Oxide/oxygen sedation ?

Before your appointment, refrain from eating 2 hours preceding the visit (this is to help prevent any nausea or vomiting.)  Second, be sure your medical history is complete to avoid complications or breathing problems during the sedation. Third, do not take any medications in conjunction with the nitrous delivery unless thoroughly discussed with your dentist.   Fourth, to ensure a successful sedation, you must breathe through the nasal mask during the procedure and refrain from breathing in through your mouth as the gas’ uptake is solely through breathing in.  This requires concentration and relaxation techniques.

After your dental treatment is completed, you will be placed on 100% oxygen for 5 minutes and the sedation is over. You will not have any lasting effects and may operate per usual. 

  1. I have read and understand the implications and contraindications of the use of Nitrous Oxide/ Oxygen sedation for my dental treatment.
  2. I have given an accurate medical history and disclosed all of my medications I currently take and have taken today.
  3. I have had all my questions answered to my satisfaction.