September 19, 2022
Managing a child in a dental situation poses a significant challenge for pediatric dentists. In order to deliver a successful dental treatment to children, the way the child's behaviour is guided and the manner in which successful analgesia and anesthesia is achieved form the pillars of a successful pediatric dental treatment.
What else can be used to manage the patient?
Behaviour guidance of the child can be through pharmacological and non-pharmacological means. Non-pharmacological means should be opted first. These include effective communication, audio-visual distraction, modelling, humour and other such means that does not involve the use of any external drugs. Should these methods be ineffective and treatment delivery is necessary then advanced techniques should be used which includes the use of pharmacological agents.
Conscious sedation as a choice for treating dental patients
The most of invasive of these techniques is when a child has to be scheduled for a full-mouth rehabilitation under general anaesthesia. This option is opted only if the child displays hysterical behaviour, display severe anxiety, has a psychological disorder or cannot afford multiple visits. Another pharmacological technique for behaviour guidance that has gained momentum in the 21st century is by the use of nitrous oxide gas. The technique involved is called conscious sedation.
Nitrous sedation (laughing gas) conscious sedation technique
Nitrous oxide is popularly known as laughing gas. Its use in dentistry is advocated in managing children with dental fear and anxiety. The anxiolytic, amnesic and analgesic properties of nitrous oxide are such that the patient's sedative state of mind is unable to feel the pain upon injection. Nitrous oxide gas is delivered through a mask that the patient wears. Initially, the patient receives 100% oxygen for a few minutes before the concentration decreases gradually to 70% nitrous oxide.
The unit that houses the conscious sedation unit itself comes with a lot of safety features. Any leakage of gas is quickly alerted with the a safety alarm. Some dental clinics also have a wonderful ventilation unit for the removal of the heavier gas that settles below. Conscious sedation is a well-established technique and there are rarely any adverse complications associated with it.
Nitrous sedation side effects that should be managed by the sedation dentist
One of the most commonly reported adverse events is desaturation. This happens when the nitrous oxide gas is not eliminated from the body completely after the procedure. Desaturation can lead to difficulty in breathing and momentary respiratory distress. In order to avoid this, patients should be administered 100% oxygen for around 3 minutes in order to reclaim the normal exchange of gases during respiration. Chest pain has also been reported in some patients. This is likely to occur when treatment under conscious sedation is exceeded beyond the recommended limit of 40-45 minutes. Stridor or wheezing sound during respiration is also assessed after the patient is back to normal consciousness level. If present, it means that there is some abnormal airway exchange. It is more likely to be seen in younger patients. In such a situation, the patient is kept on 100% oxygen again.
Vomiting and nausea are the next two commonly seen side-effects after a nitrous oxide sedation. Vomiting occurs if the patient eats a heavy meal before the procedure. Pre-operative fasting is thus recommended before sedation. Pre-operative fasting is one of the reasons for nausea. However, this lasts for a very short period is not as significant. Other reported but rare side effects of conscious sedation includes laryngospasm. Improper control of nitrous oxide levels can accidently send the patient into a deeper sedation level, thereby causing spasms in the airway space. Hence, it is important for the dental practitioner to know and understand the signs and symptoms of the patient once he or she is sedated.
More severe side-effects include seizures and Vitamin B12 inactivation. Seizures can occur when there is overdose of nitrous oxide sedation. Patients must be asked beforehand about any systemic condition they are suffering from, especially any respiratory disorders. Nitrous oxide sedation should be avoided in these patients. Vitamin B12 plays an important role in our body at a neurological level. It is not formed in our body and the only way to obtain it is through our diet. Nitrous oxide toxicity can cause inactivation of Vitamin B12. This in turn can lead to conditions like anaemia, glossitis, infertility and impairment in neurological functioning which includes brain damage. However, the number of such adverse events reported due to nitrous oxide does not even exceed 1%.
In a nutshell: Is nitrous sedation safe?
Verdict? Nitrous oxide sedation is a safe procedure that has great advantages in patients presenting with mild to moderate anxiety. Trained dental practitioners usually encounter no major complications associated with the procedure and treatment outcomes are most often desirable.