Dr. Jeff Shnall
Beech Dental
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Dr. Shnall's Dental Blog

Help for the Fearful Dental Patient: Nitrous Oxide Sedation

October 26, 2016
Fear of going to the dentist is extremely common. Research has shown that approximately 8% of Americans avoid visiting the dentist due to fearfulness, while approximately 20% will only go when they are in pain (Source: Dr. Peter Milgrom, Director of Dental Fears Research Clinic at University of Washington). These numbers are similar for Canadians.

However, there is a simple, effective way to eliminate fear of dental treatment that has been around for over a century but is underused: nitrous oxide sedation.

Nitrous oxide is a colourless odorless gas that is also known as “laughing gas”. I will use both terms interchangeably in this article.

Whenever I meet with a new patient I ask if they are nervous about dental treatment and if they are, what aspects of dental treatment make them anxious?

If they are nervous, I will ask if they have ever had laughing gas? Most patients report they have heard of laughing gas. Some will tell me they have had it before and it really helps them when they have dental treatment, however a very large percentage of nervous patients tell me they have never had it before.

I am surprised by this, as nitrous oxide/laughing gas has been used in dentistry to relax patients for over one hundred years, is very safe and for the majority of people very effective.

Many dentists are trained in the use of nitrous oxide but not all are offering it to their patients.

Using Nitrous Oxide in the Dental Office:

The procedure couldn’t be simpler.  We place a nose piece on you and ask you to breathe in and out through your nose.   Within a few minute you will feel the effect.

How does nitrous oxide make you feel?
  • this can vary from person to person however the goal is for you to feel pleasant and relaxed.
  • you may feel tingling in your fingers, toes or throughout your entire body
  • you may feel like you are floating a few inches above the dental chair.
  • within a few minutes of  starting on nitrous oxide nervous patients become relaxed  and are perfectly fine to start their dental appointment;  for many patients  it makes you so relaxed you won’t care that you are sitting in a dental chair and having treatment.


Benefits of nitrous oxide sedation
  • It relaxes you
 
  • It  acts as a pain killer: often nitrous oxide will cause partial numbing of the mouth and can allow certain minor procedures to be done without freezing.  
 
  • For example:  nitrous oxide is great for people who are nervous about freezing or find it painful;  if you are on nitrous oxide you won't feel the freezing go in or much less so.
 
  • It can be used for almost all ages;  I have used it on patients as young as three years of age to the people in their 80's and older;  as long as the patient can understand and follow instructions and can cooperate by breathing in and out through their nose they are a candidate for nitrous oxide sedation
 
  • With nitrous oxide sedation you are awake but relaxed during the appointment;  you are not asleep.  You are in complete control of your faculties and if you want to lower the amount of gas used or stop using it during your appointment you will be able to speak or raise a hand to have the dentist stop the procedure to address your concerns
 
  • As soon as the dental treatment is completed the nitrous oxide is turned off and you breathe pure oxygen through the nosepiece;  this flushes the nitrous oxide quickly out of your body  and you will feel back to normal after about five minutes
 
  • Immediately after the appointment you can drive,  go back to work or school or resume your normal daily routine.  This  is a big advantage over other forms of dental sedation that have lingering effects for  hours after you have leave  the dental office
 
  • It eliminates or reduces the  gag reflex:  Patients who gag easily can find it very challenging and unpleasant to have certain routine dental procedures done such as:  x rays and  impression taking to name a few.   I have even had some patients  who would gag as soon as a dental instrument is placed in their mouth.  The good news is that for many people  nitrous  oxide reduces or eliminates gag reflex which very often will allow people who gag easily  to have needed xrays, impressions and dental treatment without gagging.
 
  • Nitrous oxide acts as a pain killer.  This can be helpful for people who hate needles. Nitrous oxide will often make an injection painless in patients or far more tolerable in patients that  normally hate getting frozen.  I have given  freezing to children with nitrous oxide and they smiled or laughed during the injection.  I am not making this up.  I am sure many dentists have had the exact same experience.
 
  • the pain killing benefit of nitrous  oxide also helps people that find dental cleanings painful or unpleasant.  Some people have very sensitive teeth or gums and hate getting their teeth cleaned.  For these patients nitrous  oxide can make the cleaning appointment a lot more pleasant.

Is there a downside to using nitrous oxide sedation?

  • Nitrous oxide can make people nauseous, though this is not very common.  
 
  • For patients who have had nausea while on nitrous oxide can take a “Ginger Gravol” (a non-drowsy form of Gravol available at most pharmacies) 30 minutes before the appointment which can help prevent nausea from recurring

To reduce the chance of nausea you should not have a heavy meal before using nitrous oxide.  You may have a light meal two hours before the appointment and nothing after that.

  • While it works well for the vast majority of patients who try it, there is always the occasional patient  that nitrous oxide does not seem to have much effect on and seldomly a patient will not like the way it makes them feel.  It does not work for everyone.
 
  • Nervous patients are often reluctant to try nitrous oxide.  What I tell these patients is that nitrous oxide  is an option they may like to try, as it is very effective.  I recommend they try the mask on their nose and simply try the gas for a minute or two.  If they like it we leave it on;  if they don’t we take it off.  I find that most people who are reluctant to try it go on to find it very helpful.
 
  • Nitrous oxide only works if you can breathe through your nose.  If a patient is stuffed up we will usually use a nasal spray before the appointment.  This almost always solves the problem.
 
  • Cost. Nitrous oxide sedation does add a cost to the treatment but is far less expensive than  being put to sleep for your dental treatment.

There are very few medical conditions that will disallow nitrous oxide from being an option, but one is  emphysema.   Speak to your dentist to ensure nitrous oxide is safe you.


Final Thoughts:

If you hate sitting in the dentist’s chair or avoid dental appointments out of fear, nitrous oxide may be just what you need.

If it turns out that nitrous oxide isn’t right for you but you feel you do need sedation you could discuss with your dentist the possibility of taking an anti-anxiety drug before your appointment.

If all else fails you could see a dental anesthesiologist would could provide all of your dental treatment while you are asleep.

If you would like more information please feel free to contact our office.  If you have any comments on this article please share them with us below.

Sincerely,

Dr. Jeff Shnall

BeechDental.com
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