Sedation Dentistry

Sedation (nitrous oxide) for dental procedures

Nitrous oxide is a gas, and is commonly known as happy gas or laughing gas. Giving nitrous oxide is a way to help reduce a child's pain and anxiety during dental treatment. The gas is given through a small nosepiece, and your child will be awake throughout the procedure. Children usually recover quickly from the effects of the gas after their dental treatment has been completed.

Before the procedure

As the parent or carer, you must give your consent to use sedation and consent for the dental procedure. You need to understand the reasons for sedation and the following risks:

• In some cases, your child's oxygen levels may drop. If this happens, they will be given oxygen through an oxygen mask. Nurses will carefully check your child's breathing throughout the procedure.
• Some children may vomit. Very rarely, they may breathe the vomit into their lungs, which may require some specific treatment.

Fasting

Your child can have a light meal, such as jelly, soup or toast, and a drink two hours before the procedure. After that, they should have nothing to eat or drink until after the procedure.

During the procedure

Nitrous oxide sedation is given in the dental chair. Your child will breathe the sedation gas through a small nosepiece that sits on their nose. It does not cover their mouth.

• The nitrous oxide makes children feel sleepy and relaxed. Your child will still be aware of what is happening around them, but will feel dreamy and floaty, warm, and have tingling in their hands and feet. They may be a little forgetful, and might not be able to remember the procedure afterwards.
• While giving the nitrous oxide, staff will monitor your child's level of sedation to ensure that they can still cooperate and follow verbal instructions.
• The dental treatment will be carried out. Local anaesthesia injections may also be given so that your child doesn't feel pain. These can be given while your child is sedated.

After the procedure

Your child will recover from the effects of the nitrous oxide very quickly once their dental treatment has been completed. They will be observed for a brief period following the sedation.

Some children may feel a little sick or nauseated. If they feel sick or vomit, give your child some water to drink. If they refuse water, try clear liquids, such as diluted fruit juice, or icy poles, jelly or clear soup to help keep your child hydrated.

If your child has had a local anaesthetic as well, they need to be careful not to bite their lip or cheek while it is numb.

Key points to remember

• Nitrous oxide gas helps reduce a child's pain and anxiety during dental procedures.
• You need to give consent before your child has sedation.
• Children usually recover quickly from the effects of nitrous oxide gas sedation.
  The American Academy of Pediatric Dentistry (AAPD) recommends the use of nitrous oxide for these indications:
• Patients who are fearful, anxious, or uncooperative
• Patients with special health care needs
• Patients with gag reflexes that interfere with dental care
• Patients who do not respond adequately to local anesthesia
• Younger patients who must undergo lengthy dental procedures

Nitrous Oxide for Children

Is nitrous oxide equally safe for children? The AAPD states that laughing gas is considered generally acceptable to children and tan be titrated easily. Many children show enthusiasm for using the gas and report feeling a tingling or warming sensation. The laughing gas can help expedite procedures that are not particularly uncomfortable but require the child not to move for extended periods. However, some children may experience nausea or have difficulty wearing the mask. Discuss options for sedation with your child's dentist when planning dental treatment.

Who Shouldn't Use Laughing Gas?

While nitrous oxide is considered a safe and effective sedative, it might not be the right choice for you. The AAPD lists several risk factors for using laughing gas. Tell your dentist if you have any of the following conditions:

• currently in the first trimester of pregnancy
• a history of respiratory illnesses like chronic obstructive pulmonary disease (COPD)
• a vitamin B-12 deficiency
• a history of substance abuse
• an enzyme condition methylenetetrahydrofolate reductase deficiency
• a history of mental health conditions

Laughing gas can be a useful tool for easing anxiety and pain during dental procedures. If you think you might benefit from using nitrous oxide for your next appointment or operation, talk to your dentist about available options.