Do Dentists Use Laughing Gas Anymore?
When it comes to dental procedures, anxiety and apprehension are feelings that many patients know all too well. Dentistry has long been aware of this, leading to the advent and progression of sedation dentistry.
What Is Dental Sedation?
According to Brisbane Dental Sleep Clinic, dental sedation is a technique a dentist employs to help a nervous patient relax during a dental procedure. It is essential in managing dental anxiety, reducing discomfort, and ensuring a more pleasant experience for the patient undergoing treatments.
It can range from minimal sedation, where patients are awake but relaxed, to deep sedation and general anesthesia, where patients are completely unconscious.
One of the primary objectives of sedation dentistry is to minimize discomfort and fear, making the dental visit a more comfortable and less stressful experience. Sedation can be particularly beneficial for longer procedures or for a patient with a low pain threshold, who can’t sit still in the dentist’s chair, have very sensitive teeth, have a strong gag reflex, or need much dental work done.
Here are some commonly used forms of dental sedation:
Nitrous Oxide (Laughing Gas): Nitrous oxide is a colourless and odourless gas inhaled through a mask that will be placed over the patient’s nose. Upon inhalation, the lungs rapidly absorb nitrous oxide into the bloodstream. Once in the blood, it quickly travels to the brain. It induces relaxation and euphoria while keeping the patient awake and conscious. Nitrous oxide is often used for mild to moderate dental anxiety and is known for its rapid onset and quick recovery time.
Here’s a more detailed look at its effects and uses:
- Anxiety reduction: Dental procedures can cause a significant amount of anxiety for many patients. Nitrous oxide has a calming effect that can help reduce this anxiety, making the dental experience more comfortable and less stressful.
- Pain management: Nitrous oxide has analgesic effects, meaning it can help to reduce pain. While it’s not a strong painkiller, it can be effective in combination with local anesthetics to make dental procedures more comfortable.
- Safety and rapid recovery: Nitrous oxide is safe for use in most patients, including children and adults. One of the advantages of nitrous oxide is that it’s quickly eliminated from the body after the gas supply is stopped, allowing patients to recover rapidly and even drive home after their procedure.
- Conscious sedation: Nitrous oxide provides what’s known as “conscious sedation.” This means that patients remain awake and can respond to questions or instructions, but they feel relaxed and may not remember much about the procedure afterward.
- Adjunct to local anesthesia: Nitrous oxide is often used alongside local anesthesia in dental procedures. The nitrous oxide helps to reduce anxiety and provide general comfort, while the local anesthetic numbs the specific area where the dental work is being done.
In conclusion, nitrous oxide is a valuable tool in dentistry for its combined analgesic and anxiolytic effects, making dental procedures more tolerable for patients and easier for the dental professionals performing them. It’s worth noting that while nitrous oxide is safe for most people, it’s not suitable for everyone, such as those with certain respiratory diseases or women in the first trimester of pregnancy. Always, medical history and current health status should be evaluated before its use.
Oral Sedation: Oral sedation involves taking medication in pill or liquid form before the dental procedure. Oral sedation provides a deeper relaxation level than nitrous oxide and is suitable for patients with moderate anxiety. The patient remains conscious but may feel drowsy and have limited memory of the procedure.
Intravenous Sedation: Intravenous sedation is administered through a needle inserted into a vein, allowing the medicine to take effect quickly. This form of sedation can provide a moderate to deep level of sedation, depending on the dosage used. IV sedation allows for a higher level of control over the patient’s consciousness and is often used for more complex or invasive procedures.
General Anaesthesia: General anaesthesia renders the patient completely unconscious during the dental procedure. It is typically administered through an IV or inhalation, and it requires careful monitoring of vital signs by an anaesthesiologist or a specially trained dentist. General anaesthesia is typically reserved for extensive procedures, a patient with special needs or severe dental anxiety.
Effects of General Anesthesia
- Loss of Consciousness: General anesthesia puts you into a deep sleep. You’re not aware of the procedure and do not feel any pain.
- Analgesia: It provides pain relief during and, often, after surgery.
- Muscle Relaxation: General anesthesia can help your muscles relax, which is particularly important in some surgeries.
- Amnesia: It prevents memory of the surgery.
Uses of General Anesthesia in Dental Procedures
- Extensive Dental Procedures: If the procedure is long or complex, such as a full mouth reconstruction or wisdom tooth extraction, general anesthesia may be used.
- Patients with High Anxiety or Phobia: Some people have a severe fear of the dentist. For these individuals, general anesthesia can help them get the care they need without the associated anxiety.
- Special Needs Patients: Patients with certain physical or mental conditions may be unable to cooperate or stay still during a dental procedure. General anesthesia can allow these patients to receive treatment safely and comfortably.
- Children: In some cases, general anesthesia may be used for children who are extremely anxious, have a high level of dental disease, or have special healthcare needs.
What is Laughing Gas, Nitrous Oxide, and How Does It Work?
Laughing gas is widely recognized for helping an anxious patient relax before and during dental treatment, effectively combating dental anxiety. Its significant impact on patient comfort and compliance has made it a commonly used tool in many dental practices worldwide.
Nitrous oxide is a colourless gas with a slightly sweet odour and taste. It is typically mixed with oxygen when used in a dental setting. This gas mixture is administered to dental patients through a mask that fits over the nose.
The dentist can control the ratio of the gases, allowing for adjustments to the level of sedation throughout the procedure.
Once inhaled, nitrous oxide quickly takes effect. The gas promotes pain relief and a sense of well-being, allowing the patient to relax while still being awake and able to interact with their dentist. Laughing gas is a type of conscious sedation, meaning the patient can respond to questions and instructions but is relaxed.
The Benefit of Using Laughing Gas In a Dental Treatment
One of the benefits of nitrous oxide sedation is its short-lived effect. Once the gas supply is stopped, the effects wear off very quickly, allowing dental patients to recover swiftly, often able to drive themselves home after receiving treatment.
Different Dental Procedures Where Laughing Gas is Used
From routine cleanings to more complex surgeries, most dentists find laughing gas helpful in calming anxious patients and ensuring a comfortable experience. Here are some instances where the gas can come in handy: Teeth Cleanings, Fillings, Root Canals, Extractions, and Orthodontic Treatments.
Who Can Receive Laughing Gas?
Most patients are suitable candidates for nitrous oxide, provided they have good overall health. Children, adults, and seniors can all benefit from this sedative.
However, some health conditions may alter the risk-benefit balance. Therefore, always talk to your dentist about your complete health history at the appointment.
How is Happy Gas Administered in Dentistry?
Administered by a trained professional, laughing gas is delivered via a small mask that fits over your nose. You’ll be asked to breathe in the gas mixed with oxygen.
Most patients feel light-headed or tingling in their arms and legs, signifying that the nitrous oxide is working. Towards the end of the treatment, you will receive oxygen to help flush out any remaining gas from your lungs.
Side Effects and Risks of Happy Gas in Dentistry
Although laughing gas is generally safe when administered by a professional, some risks and side effects exist. These may include nausea, vomiting, or a headache. The risk increases if too much nitrous oxide is administered or the gas is breathed in too quickly.
Comparing Laughing Gas to Other Sedation Dentistry Methods
While nitrous oxide is one option, dentists have various sedative drugs. Some, like oral sedatives and intravenous sedation, might make you sleepy, unlike nitrous oxide.
In contrast to laughing gas, local anesthetics numb the mouth and do not typically induce feelings of lightheadedness or euphoria.
Do Dentists Still Use Laughing Gas?
Yes, many dentists still utilize nitrous oxide due to its proven safety, quick onset, and the fact that it can be quickly reversed with oxygen. This makes it a reliable choice for mild to moderate sedation during dental procedures.
The dentist can administer this sedative during treatments ranging from simple tooth cleanings to more intricate surgeries.
Laughing gas works swiftly, generally taking effect within minutes. Its influence on the brain induces a sense of calm and relaxation, easing patients’ anxiety. Moreover, it does not put the patient to sleep; instead, it keeps them in a state of conscious sedation. This enables them to respond to the dentist’s instructions and answer any queries during the procedure, aiding in a more efficient treatment process.
Another crucial factor is the reversibility of nitrous oxide. Once the dental procedure is complete, the dentist administers oxygen to the patient to eliminate any remaining gas from the lungs, quickly counteracting its effects. This allows the patient to leave the dental office without requiring an extended recovery period or assistance, unlike some other forms of sedation.
Nitrous oxide is often used with a local anaesthetic, numbing the area in the mouth being worked on. The mixture ensures that the patient stays comfortable and pain-free throughout the procedure.
Dentists continue to use laughing gas due to its safety profile, ease of administration, and rapid onset and offset.
However, it’s always crucial to have a thorough discussion with your dentist or doctor about your health history, current medications, and any potential diagnosis that might influence the choice of sedation method. Doing so will ensure that the chosen approach is the most suitable for your situation.
Is Nitrous Oxide Suitable For Everyone?
Although nitrous oxide is safe for most patients, it might not be the right choice for everyone. Certain medical conditions, such as respiratory diseases, some mental health conditions, or a history of drug abuse, might preclude its use.
Pregnant women, especially those in the first trimester, are typically advised against nitrous oxide. Before the administration of laughing gas, be open with your dentist about your medical history to ensure the best decision for your health.
Do Paediatric Dentists Use Laughing Gas?
Paediatric dentists in Brisbane use laughing gas for dental treatment of children who are anxious, nervous, or restless children during dental treatments. The American Academy of Pediatric Dentistry recognizes nitrous oxide as a safe and effective technique to reduce anxiety and enhance effective communication between a healthcare provider and a patient.
Laughing gas has a calming effect but does not put the child to sleep. The child will still be aware and able to interact with the dentist, but they will feel more relaxed. As soon as the mask is removed, the effects of the gas wear off quickly.
As always, the dentist will review the child’s medical history and current health condition before administering nitrous oxide. The child’s safety and comfort are of utmost importance. If you have any questions or concerns, don’t hesitate to discuss them with the dentist or paediatrician during an appointment in the dentist’s office.
Laughing Gas Dentist in Brisbane
Pure Dentistry is a laughing gas dentist in Brisbane, your comfort and well-being are our top priorities. We understand that dental treatments can be daunting. But don’t let dental anxiety keep you from having the radiant smile you deserve! Our expert team is highly experienced in administering both laughing gas and general anesthesia for dental work to ensure a comfortable and stress-free experience.
Our skilled professionals are dedicated to creating a safe, soothing environment for every patient. Trust in Pure Dentistry, where we combine modern technology with a gentle touch. Make your appointment today, and let us provide you with the smoothest, most anxiety-free dental visit you’ve ever experienced! Contact Pure Dentistry dental clinic in Brisbane by phone number 07 3343 4869 or book online.
Frequently Asked Questions about Laughing Gas
What is nitrous oxide and how does it work?
Nitrous oxide, also known as laughing gas, is a colourless, odourless sweet-smelling inorganic gas that was first used in surgical and dental anesthesia in the mid-1800s. It is the most used gaseous anesthetic in the world, with a 2007 survey by the ADA estimating that 70% of dental practices using any form of sedation employed nitrous oxide-oxygen sedation. Nitrous oxide is often used with oxygen for conscious sedation, in which patients are relaxed but awake and able to respond to instructions. When used appropriately, this combination is a safe and effective means of managing pain and anxiety in dentistry.
Nitrous oxide works by being inhaled and absorbed into the bloodstream through the lungs. It achieves blood tension and equilibrates more rapidly than other gases because it has low solubility in blood and adipose tissue. This provides the driving force for nitrous oxide to enter the brain, where the anesthetic action occurs. It has the fastest onset among inhalation agents and does not combine with hemoglobin or undergo biotransformation. Instead, it’s transported in the blood as free gas and is removed rapidly from the body through exhalation due to its low solubility.
In terms of safety, there are at least 12 delivery system audio and visual safety features that have been developed to help avoid adverse events during nitrous oxide-oxygen administration. These include alarms, color coding, a diameter index safety system, an emergency air inlet, locks, and an oxygen fail-safe system. Delivery systems typically limit the maximum nitrous oxide to 70% and oxygen to 30%, ensuring the patient is receiving at least 9% more oxygen than is found in ambient room air. Dental practices are recommended to adopt appropriate work practices, including using a scavenging system and ensuring accuracy in flow meter readings.
However, long-term exposure to nitrous oxide can lead to some adverse health effects as it irreversibly oxidizes vitamin B12, reducing the activity of B12-dependent enzymes. Some reported health effects include infertility, spontaneous abortion, blood dyscrasias, and neurologic deficits in individuals chronically exposed to trace amounts of the drug.
Is nitrous oxide safe to use?
When combined with oxygen, nitrous oxide is considered a safe and effective means of managing pain and anxiety in dentistry as long as it is used appropriately. A systematic review found that the success rate of nitrous oxide-oxygen procedural sedation in dentistry is quite high, with a cumulative mean value of 94.9%
Nitrous oxide has the fastest onset among inhalation agents, and its low solubility allows it to be rapidly removed from the body. It does not combine with hemoglobin and does not undergo biotransformation, meaning that it’s largely excreted as it’s inhaled. However, chronic exposure to nitrous oxide can lead to certain adverse health effects such as infertility, spontaneous abortion, blood dyscrasias, and neurologic deficits due to its interaction with vitamin B12
Safety measures are in place to prevent adverse events during nitrous oxide-oxygen administration. Nitrous oxide-oxygen delivery systems are typically limited to a maximum of 70% nitrous oxide and 30% oxygen delivery, ensuring that the patient is receiving at least 9% more oxygen than is found in ambient room air. These systems have at least 12 safety features, such as alarms, colour coding, an emergency air inlet, and an oxygen fail-safe system. These features have been developed to help avoid adverse events during administration.
The American Academy of Pediatric Dentistry (AAPD) also supports the judicious use of nitrous oxide/oxygen as a safe and effective method of controlling anxiety associated with dental treatment in infants, children, adolescents, and persons with special health care needs. The AAPD recommends that dentists consider a variety of factors before using nitrous oxide/oxygen for pediatric patients, including the patient’s physical and emotional development, medical and dental histories, and dental treatment needed; alternative behaviour guidance options; credentials and training of the dentist and other dental personnel; equipment and facilities; administration techniques and monitoring of use; potential adverse effects and outcomes; and employee occupational safety.
Are there any contraindications or situations where nitrous oxide shouldn't be used in dental procedures?
There are several situations where nitrous oxide may not be advisable for dental procedures.
Relative Contraindications include:
- Nasal obstruction: Nitrous oxide sedation can proceed if, despite some degree of nasal obstruction, the patient is still able to breathe through the nose in such a way that the nasal hood can be fitted to the face and the dental field remains unobstructed.
- Claustrophobia: Nitrous oxide sedation can proceed if, despite a pre-existing fear of feeling trapped or a fear of having objects fitted to the face and nose, the patient can tolerate the nasal hood being secured.
- Uncooperative behaviour/cognitive impairment/psychiatric disorders: Nitrous oxide sedation can proceed if the patient can cooperate to the degree that the equipment can be safely secured and the sedation provides sufficient anxiety relief so that the dental procedure can be completed uneventfully.
- Use of cautery or anticipated sparks intra-orally: Nitrous oxide sedation, including any supplemental oxygen administration, should be discontinued during any procedures where surges of heat will occur, like with the use of electro-cautery or lasers, or if sparks will be produced (e.g. cutting of a zirconia restoration)1.
The document also mentions absolute contraindications but does not list them 2.
Some previously controversial contraindications include:
- Pregnancy: It’s now understood that a single, short-duration exposure to nitrous oxide is safe at any point during pregnancy. Elective dental care should be deferred until after pregnancy.
- Severe Coronary Disease: It’s advisable to consult with the patient’s primary care physician before completing dental work for a patient with severe coronary disease3.
A currently controversial contraindication is:
- Autism: There is some speculation that oxidative stress to the developing brain resulting from nitrous oxide exposure could contribute to pathologic neurodevelopment leading to autism or exacerbations of pre-existing symptoms of autism. However, this theory specifies that nitrous oxide exposure must be chronic in nature. As such, nitrous oxide sedations that are seldom and brief in duration are likely safe for patients with autism. Conscious sedation with nitrous oxide may not be successful for patients with autism because patient cooperation is essential.