By Dr. Alon Grosman
Like many parents in our community, I tend to approach the use of any medicine for my children with a discerning eye. What are the risks and benefits of its use? How long will it last in the system? Are there any side effects I should look for or take home instructions needed? It is for this reason, that I am happy to educate the public on the use and safety of Nitrous Oxide (also known as “laughing gas”) for use with the apprehensive pediatric dental patient, when indicated.
It is first important to point out the very long history and safe track record of its use. Nitrous oxide (N20) was first discovered by Joseph Priestly in 1772. Interestingly, its use for the first 80 years was mostly for entertainment purposes receiving its current nickname “laughing gas”. In 1845, Horace Wells, a dentist from Hartford CT, demonstrated its use as an anesthetic during the extraction of a wisdom tooth at Harvard University. His work on nitrous oxide would eventually earn him the distinction of being the discoverer of anesthesia. Once accepted by the medical community, its method of delivery had been improved and in turn its impeccable safety record had become established.
Nitrous oxide is a gas that is delivered through inhalation. Although early documentation showed safe delivery in its pure form, safety has increased exponentially with its combination with oxygen. The addition of oxygen assures that there will be no decrease in oxygenation of the body throughout its use. New sophisticated equipment also assures desired concentrations by a titrating delivery mechanism, allows for rapid reversal, and disallows usage of more than 70% nitrous gas.
The combination with oxygen has not only made the use of nitrous safer, but has also made its use more versatile. Its first use was prior to the discovery of the local anesthetic, lidocaine. For this reason, it was administered at higher concentrations in order to achieve some form of anesthesia (relief of pain). In the dental environment, it is given at a much lower dosage (much lower than the recommended limit) in order to achieve anxiolysis, or reduction of anxiety. Its safety record at these lower doses is impeccable. In the 1970’s, H. Ruben had documented 3 million cases of its use for dentistry without adverse reaction.
In answer to my initial questions, nitrous oxide is a safe and odorless inhalant, which exits the body immediately after removal. The only routine recommendation we give is no ingestion of food or drink 60 minutes prior to its use to eliminate chance of nausea. Although we prefer to treat our patients without the need of an anxiolytic, Nitrous Oxide remains a perfect alternative for pediatric patients who may otherwise have a “bad experience”. Negative experiences in youth have been shown to create long term dental anxiety lasting into adulthood for some dental patients. It is for this reason, that over 80% of all pediatric dentists report using it in their practice.
- The office of Dr. Maria Maranzini-Grosman (Board Certified Pediatric Dentist) and Dr. Alon Grosman (Specialist in Orthodontics) is located at South Flamingo Road on the NW corner of Griffin and Flamingo Road. For more information or to schedule an appointment, call 954-236-3434.