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Laughing Gas (Nitrous Oxide) During Sedation Dentistry

The most commonly employed technique used in conscious sedation dentistry is inhalation sedation with nitrous oxide and oxygen (N₂0-0₂) or "laughing gas". It is estimated that approximately 35% of U.S. dentists use this technique to relieve dental anxiety.

The goal sought when laughing gas is used is to eliminate dental anxiety, making the patient more comfortable while the sedation dentist is able to more effectively complete the planned dental care procedure while the patient is sedated. Consult with your dentist to find out if this procedure right for you.

A small rubber inhaler will be placed over the patient's nose and adjusted so that the patient is comfortable. At this time, the patient will be breathing 100% oxygen.

Some patients at their first laughing gas visit will feel that they are not getting enough "air." The patient should tell the sedation dentist and he or she will provide them with even more oxygen to breathe.

Once the patient is comfortable breathing oxygen, the dentist gradually will introduce nitrous oxide. Over the next three to five minutes, the patient will be asked, "What are you feeling?" as the amount of nitrous oxide is slowly increased.

The signs and symptoms that most patients experience when receiving laughing gas include an initial feeling of lightheadedness, which gradually leads to an all-over feeling of warmth. Many persons mention a comfortable "vibrating" or "humming" sensation. It is common to feel one's fingertips and hands become "numb."

This same sensation may develop in the mouth - a benefit to the sedation dentist (and patient) during the dental care treatment. Some patients will mention that their arms and legs feel "very light." Interestingly, other patients will say that their arms and legs feel "so heavy I can't even move them."

If either of these occurs to the patient, it is perfectly normal. The individual might notice that they are perspiring a little, too. This is a normal effect of nitrous oxide and oxygen dentistry.

The sedation dentist will talk with the patient throughout the dental care procedure and the individual will be able to respond without any problem. This is a major advantage, and a safety feature, of conscious sedation using laughing gas.

If, at any time during the procedure, the patient feels that they are getting too much nitrous oxide or if they begin to feel uncomfortable, they should tell the dentist immediately and within seconds the dentist can adjust the flow of gases, and the patient will feel more comfortable again.

At the conclusion of the sedation dentistry treatment, the patient will once again receive 100% oxygen (for a minimum of three to five minutes). At the end of this time, the person should feel absolutely back to normal. If they still feel even a little bit sedated, the dentist should give the patient oxygen for a few more minutes.

Most dentists permit the fully-recovered laughing gas patient to leave the dental office unescorted and to resume their normal activities. In some situations where a patient recovers more slowly, they might be required to have an escort (friend or relative) drive them home.

Laughing gas inhalation sedation is highly effective in the management of mild to moderate levels of dental anxiety. It also is an excellent technique in persons who are extreme gaggers; laughing gas usually eliminates or minimizes gagging in most patients.

Finally, laughing gas is highly recommended for apprehensive patients who have medical problems such as angina pectoris, persons who have had a heart attack, or persons with high blood pressure, asthma or epilepsy.

Inhalation sedation dentistry should not be used with persons who are claustrophobic or with persons who are unable to breathe through their nose. Please discuss these with your dentist before treatment using laughing gas begins.

By Stanley F. Malamed, DDS

+Jim Du Molin is a leading Internet search expert helping individuals and families connect with the right dentist in their area. Visit his author page.

Anxiety Free Dentistry - Questions on Reducing Dental Anxiety

Q. Why do you need to have regular dental care check-ups?

A. Regular check-ups are needed to monitor your overall oral health. In addition to checking for cavities, your dentist examines the health of your entire mouth and surrounding soft tissues, checking for pre-cancerous or cancerous lesions, oral sores, and gum disease.

Your oral health is connected with your general health. Dental care check-ups can alert the dentist to other medical conditions that have symptoms in the mouth such as diabetes, nutritional deficiencies, and hormonal irregularities. Regular dental care visits are vital to prevent tooth decay, gum disease, and other conditions affecting your mouth.

Q. What can you do to feel more relaxed during a dental care appointment?

A. With the combination of modern anesthetics and new conscious sedation dentistry technology and techniques, many procedures only have minimal discomfort or are now entirely painless. Dental care providers want their patients to have maximum comfort and approach their treatments with a relaxed attitude and less dental anxiety.

There are a number of ways to decrease dental anxiety:

• Tell the dental care staff your concerns. Studies have shown that talking about your fears of possible discomfort actually reduces pain.
• Use visualization to picture yourself relaxed, or repeat messages that have a calming effect.
• Play your favorite music on a Walkman you bring with you (some dental offices are equipped with walkmans, too.)
• Arrange a signal with the dental care staff, such as raising your hand, if you need a break or feel discomfort.

Some dental care offices are now offering patients new options for stress-relief: hypnosis, self-hypnosis instructions, relaxation tapes, soft lighting, warm gel-filled eye masks, scented candles, and massaging pillows. These are helpful in reducing stress in patients that suffer from dental anxiety. Be sure to avoid the use of stimulants such as caffeine prior to your visit.

Q. Aromatherapy has a relaxing effect for many people. Is this effective for patients undergoing dental treatment?

A. Research studies conducted at Case Western Reserve University have noted that the use of aromatherapy has a significant positive effect on dental anxiety patients. Two-thirds of the patients receiving aromatherapy were more calm and relaxed than those patients without exposure to the scented fragrance oils.

Dentists are concerned about your comfort. Ask your dental provider if aromatherapy is available in the office to help reduce dental anxiety, or if you can bring your own for your dental care visit. Essential fragrance oils are available in health food stores, spas, and some grocery and drug store outlets.

Q. Are dental patients who are considered at risk for bacterial infections advised to take antibiotic medication prior to their appointments?

A. Certain medical conditions, such as heart valve problems or a recent total joint replacement, are considered at risk for infection at the site of the cardiac abnormality or joint replacement. This infection results from bacteria from the mouth entering the bloodstream and working its way to these vulnerable areas.

Consequently, dental care procedures likely to result in bleeding from the gums or mucous membranes will require patients to take antibiotics prior to that procedure. Such procedures could include, but are not limited to, extractions, implant surgery, incision and drainage for oral infection, and professional teeth cleaning.

Guidelines have been established by the American Heart Association and the American Dental Association to provide dentists and physicians with information regarding appropriate regimens for antibiotic therapy. It also outlines those situations when antibiotic therapy is or is not indicated.

There also are other medical conditions warranting antibiotic therapy prior to dental procedures. Be sure to update your dentist regarding your medical history. Your dentist and/or physician will advise you of any special needs.

Q. Where can you receive dental services if you do not have the money to cover the related expense?

A. If you do not have either dental insurance or the money to pay for a dental visit, you should inquire about financial aid from various sources within your community.

You may need to make several calls, but the local dental society, the local public health department, or social service agencies may be able to direct you to sources of assistance. Also, check local hospitals, dental schools, and outreach clinics that may be able to provide dental services at a reduced fee.

+Jim Du Molin is a leading Internet search expert helping individuals and families connect with the right dentist in their area. Visit his author page.