Dentists are famously avoided by many who would rather endure their aching teeth and bleeding gums than face a dental procedure. Luckily, varying levels of sedation are available to make any dental procedure possible without causing anxiety and stress in the patient.

The available levels are:

• Minimal – This allows the patient to relax while remaining awake.
• Moderate – Under this form of sedation, the patient is not fully awake and does not recall much of the procedure.
• Deep – In deep sedation, the patient is unconscious during the procedure.
• General anesthesia – General anesthesia puts the patient completely unconscious.

These sedation options differ from local anesthesia, which is required in addition to these to relieve any pain involved in the procedure.

Nitrous Oxide

Nitrous oxide is also known as laughing gas, happy gas, inhalation sedation, and relative analgesia. It is a colorless and odorless gas that is used to relax the patient before and during a dental procedure. The patient breathes a combination of nitrous oxide and oxygen through a face mask over the nose. Once inhaled, the gas reduces feelings of pain and anxiety, bringing on a feeling of general euphoria and making the patient feel happy and giggly (hence the nickname).

Advantages

Nitrous oxide is an advantageous form of sedation for several reasons:
• It is fast-acting.
• Dosage is easily adjusted by the dentist.
• The dentist has full control over the duration of the sedation.
• Recovery is quick and causes minimal inconvenience to the patient.
• This form of sedation is extremely safe and presents little or no side effects.
• The patient remains conscious and able to follow instructions and cooperate with the dentist during the procedure.

Disadvantages

While generally advantageous, there are some disadvantages to using nitrous oxide sedation.
• It is not very strong and so may be ineffective in patients with strong or compulsive personalities.
• The gas mask may cause feelings of claustrophobia.
Application in Dentistry
Nitrous oxide is used broadly in the field of dentistry.
• Restorative dentistry: Nitrous oxide may be used to relieve anxiety during initial examinations, removal of crowns and bridges, insertion of wedges between teeth before placing restorations, etc.
• Periodontics: It can be useful when scaling and root planning, treating for gingivitis, using ultrasonic instruments, performing periodontal surgery, and during the initial examination, especially when the patient has inflamed and sensitive soft tissues or deep periodontal pockets.
• Oral and maxillofacial surgery: Nitrous oxide is often used during long surgical procedures, when managing abscesses, and when addressing post-operative complications.
• Endodontics: Accessing the pulp chamber and filling root canals are times when nitrous oxide can be useful.
• Prosthodontics: It can be used to reduce gag reflexes and raise the pain threshold when removing crowns and bridges, preparing abutment teeth, and taking impressions, among other things.

Is it safe?

Nitrous oxide is safe to use over short periods of time and when combined with oxygen. Dentists typically use a ratio of 50:50 or 70:30. It is important for the dentist to be familiar with the patient’s medical history, particularly any chronic respiratory problems or gastrointestinal distention. Patients who experience claustrophobia may not be suitable candidates for this type of sedation because of the necessity of the face mask. Pregnant women and children should be assessed for their suitability for nitrous oxide sedation.