Sedation Dentistry (Nitrous Oxide/Oxygen)

Many children come to the dentist fearful, anxious, or unable to sit still during a dental procedure. Sedation dentistry is designed to:

• Decrease anxiety about the dental appointment in children.
• Allow dentists to safely carry out treatment procedures.
• Avoid trauma or negative associations with the dentist.
• Allow treatment for children with special healthcare needs or limited pain tolerance.
• Assist children with gag reflexes or who have difficulty staying still for long periods of time.

Nitrous oxide sedation is recommended for:

• Anxious or fearful children who avoid or resist dental appointments.
• Children with extensive treatment needs.
• Children with special healthcare needs, such as those with autism or ADHD.
• Children who have a gag reflex or have difficulty staying still in the chair.
• Children who need multiple procedures in a single appointment.

Nitrous oxide sedation is especially useful for children ages 3 or older who can understand and comply with simple instructions.

Sedation in pediatric dentistry can be categorized into various levels of sedation, also referred to as depth:

• Minimal sedation (Anxiolysis): Achieved with nitrous oxide/oxygen, the child is awake and relaxed.
• Moderate sedation: Involves oral medications with nitrous oxide in some cases.
• Deep sedation and general anaesthesia: Used for more complicated treatments, the child may be asleep and would be monitored by an anaesthesiologist.

Nitrous oxide/oxygen sedation is the most frequently used method of minimal sedation for dental treatment because of its safety, ease of use, and the rapid effect and recovery that occurs.

This is a straightforward, child-friendly process that typically involves the following steps:

• Pre-visit instructions: The dentist will instruct that the child eat a light meal and explain the visit to both parent and child.
• Nasal mask application: A small flavored mask will be placed on the child's nose under gentle restraint.
• Gas administration: The necessary mixture of nitrous oxide and oxygen will be delivered. Within a few minutes the child will begin to feel relaxed.
• Monitoring: The dentist will monitor the child's vital signs during the procedure.
• Dental procedure: Once the child is appropriately sedated the dentist will then perform the dental treatment needed.
• Recovery and discharge: When the procedure is complete the child will breathe 100% oxygen for a few minutes, to flush the nitrous oxide out of his/her system so that they return to a normal state quickly.
• Postoperative advice: Parents will receive guidance regarding the rest of the day.

Some of the key benefits of sedation with nitrous oxide include:

• Nervousness and anxiety are lessened and help promote cooperation.
• Safety, as the child is conscious and can respond to the dentist.
• Rapid effect and recovery time with little residual effect.
• It's a non-invasive and inhalation-based sedation procedure, and the dosage can be adjusted (titrated) during the procedure.

• Nitrous oxide has a faster onset and also hypnosis effects dissipate relatively quickly.
• With nitrous oxide, you can converse with the child throughout the administration of nitrous oxide.
• Inhaled nitrous oxide, administered by qualified personnel (ie. staff trained in nitrous oxide for dental procedures) has very few side effects, maybe none, associated with it.
• In general children do not have to fast before nitrous oxide.
• The risk of complications from breathing nitrous oxide is low and doesn't require an intravenous line (IV) to be placed in the child.

For the reasons above, nitrous oxide is a front-line treatment option for many routine dental procedures for children.

The actual procedure sedation time varies depending on the procedure:

• Minor treatments: 15-30 minutes.
• Moderate procedure - 30-60 minutes, while an additional 10-15 minutes will occur per visit for preparation and recovery after nitrous oxide administration.

The sedation effects of nitrous oxide may be shorter than oral sedation or IV sedation; however, the overall appointment times do not significantly increase before and after treatment.

While nitrous oxide is considered one of the safest sedative options, some uncommon complications associated with nitrous oxide include:

• Nausea or vomiting especially if the child has eaten shortly before treatment.
• A headache or dizziness post procedure.
• Claustrophobia/discomfort associated with the mask.
• Over sedation (extremely rare if monitored correctly).

Most of the effects are brief and managed reasonably easily, and dental professionals are trained to manage any unexpected reactions at the time of treatment.

There are potential downsides associated with nitrous oxide sedation:

• Not suitable for children who have nasal congestion, proper inhalation is needed.
• The need for extra equipment and trained personnel likely adds to the cost.
• Not appropriate for large surgical procedures or procedures that require deep sedation.

Other forms of sedation in paediatric dentistry include:

• Oral sedation: Medication that a child would take prior to any procedure, longer onset and recovery times.
• Intravenous (IV) sedation: A deeper form of sedation and useful for more complex cases.
• General anaesthesia: Used for large restorative treatment or surgical treatment if the child will be completely unconscious.
• Behavioral techniques: Tell, show, and do; distraction, and positive reinforcement may all work well for mildly anxious children.

Each option has their own indications and are dependent on the child's age, health status and complexity of the procedure.

Following care is easy but as important:

• Approximately 30–60 minutes rest after surgery.
• Light food or fluid may be offered once the child is fully alert (unless contraindicated by the dentist).
• Nausea or dizziness may occur but is mostly rare, so watch the child for these possible symptoms.
• No heavy physical activity for that day after a procedure.
• Follow dentist recommendations on oral hygiene or medication.
• Parents are also asked to monitor the child's behavior and report any unusual symptom.

Most children begin to revert back to their normal selves within a short period.