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Posted on August 15, 2014
Spring in Fort Collins means we will soon welcome another class of Dental Assistants to our profession from Front Range Community College. As I prepare the Nitrous Oxide Certification course, I thought parents may be interested in gaining a good understanding of the drug and its use in children’s dentistry.

Nitrous Oxide was discovered in the late 1700’s but not used in a medical setting until a Dentist witnessed a demonstration of its effects at a roadside “show” in the early 1800’s. immediately recognizing its pain relieving effects, dentists used Nitrous Oxide until the first local anesthetic was discovered years later (cocaine!) In modern times, about 90% of pediatric dentists and about 55% of general dentists use Nitrous Oxide. The medical profession uses most of the Nitrous Oxide manufactured in the initial delivery of hospital anesthetic gases.

Alone, Nitrous Oxide cannot cause unconsciousness. It is classed as an inhalation sedative that has three therapeutic effects: pain relief, anesthesia, and anxiety control. Nitrous Oxide’s pain relieving ability is compared to morphine, but most dentists do not rely on it for blocking pain. It is amazing however, how pediatric dentists using Nitrous Oxide on a compliant younger child can prepare simple cavities and do fillings without resorting to local anesthesia or the dreaded numb lip. Nitrous Oxide produces anesthesia in that it alters the CNS (central nervous system) perception of time and the senses. Children under its influence simply aren’t as aware of what is going on around them when their senses are temporarily dulled, and time seems to fly by. Obviously, this allows the pediatric dentist to accomplish multiple fillings or extractions in the office on children as young as three years.

Anxiety control is the main reason dentists use Nitrous Oxide. For the child who can breathe through their nose while opening their mouth (read not crying), dental anxiety melts away. It is usually replaced by a relaxed body posture, the ability to be coached, and often a few giggles. What could have been a poor experience becomes a positive confidence builder! What boggles my mind is why our medical colleagues don’t employ it for ear tubes, wart removal or a host of other minor procedures.

Safety wise, Nitrous Oxide has a long track record of safety and effectiveness. All modern delivery systems assure that Nitrous Oxide is given WITH Oxygen. In fact the maximum dose is 70% Nitrous Oxide and 30% Oxygen; that means even at maximum dose, patients are getting more oxygen that present in room air. The one side effects children and adults must be careful of is vomiting with too much Nitrous Oxide. I teach in my class that this side effect can be almost entirely prevented with careful monitoring and is a late symptom of too much for too long. If you think about the physiology that makes sense. If Nitrous Oxide uses the same receptors as do narcotics, and too much narcotic makes your stomach nauseous, you just have to be careful on the right dose. Any pediatric dentist or staff is going to be well trained to maximize comfort when using Nitrous Oxide and eliminate side effects. Nobody has a magic wand for treating children with dental anxiety, but Nitrous Oxide is close!

For more questions on any aspect of Nitrous Oxide, don’t hesitate to email me, Greg Evans, at greg@biggrinswithdrgreg.com. Let’s work together to raise healthy children!