Fear of the dentist is extremely widespread. Often, too often, the anxiety caused by the fear prevents or delays dental prevention or care. In children this becomes a bad habit that, once acquired, ends up affecting the oral health of the future adult. Sedation, and in particular conscious sedation with nitrous gas, is undoubtedly the best solution to this problem.
Let’s see what it consists of:
What is conscious sedation?
Conscious nitrous oxide sedation is an anaesthetic technique used in dentistry and oral surgery to reduce anxiety and the perception of pain and to offer patients who are “afraid of the dentist” a state of peace and well-being. This technique makes the treatment faster and more pleasant.
How does it work?
The patient is given a gas mixture of oxygen and nitrous oxide. The percentage of nitrous oxide/oxygen can vary from 10/90 to 70/30, which is the maximum dosage. The nitrous oxide is increased progressively based on the patient’s desire and operational needs. The most frequently used dosage is 40% nitrous oxide and 60% oxygen. We should also consider that using oxygen with a percentage that is higher than the atmospheric level promotes an excellent oxygenation of the patient.
The nitrous gas is quickly eliminated by the airways and is not metabolized. This way the body does not need to transform it into a different compound, thus avoiding any load on the organs.
The administration and complete elimination of the nitrous oxide are therefore very quick – just a few minutes – and therefore extremely safe for adults and children.
Am I asleep?
No, you always remain conscious, although often the sedated patient closes his eyes and ignores the procedure in progress. However, with the technique of conscious sedation the patient always remains awake even though he feels a pleasant sensation of numbness and relaxation. Of course, the effect depends on the proportion of the gaseous mixture, but in any case the awareness and decision-making abilities are maintained even if the reflexes appear slower and the sensitivity to pain decreases.
Is the technique of conscious sedation safe?
Nitrous oxide is one of the safest anaesthetics thanks to the rapid elimination and above all because it does not need to be metabolized by the body. These elements make it almost free of contraindications, as well as easy to handle and highly predictable for the operator. The fast elimination without significant accumulation in the tissues allows the patient to move autonomously a short time after the therapy. The widespread use of the technique over the last 20 years, the excellent patient feedback and the near absence of complications confirm that the technique is extremely safe.
What are the advantages of conscious sedation?
Most systemic complications (fainting, cardio-circulatory problems, panic attacks, tachycardias, etc.) during outpatient therapy present a common risk factor: anxiety and fear of surgery. In these cases, sedation, in all its processes, offers a reduction in the risk of systemic complications by acting precisely on their primary cause: anxiety.
Who is a good candidate for conscious sedation with nitrous oxide?
The use of conscious sedation with nitrous oxide it recommended:
- in case of adults with dental phobia or who simply feel anxiety about dental treatment
- for uncooperative children due to age or prior negative dental experiences
- in subjects of all ages with mild or moderate cognitive deficits, such as autism
Conscious sedation reduces the patient’s state of anxiety and reactivity, so that he faces the sessions more and more willingly. This often creates a virtuous circle which in the best cases then makes the sedation no longer necessary.
Are there any contraindications?
The technique is not recommended in very rare cases:
- in case of taking some specific and uncommon pharmaceuticals and in the rare syndromes of vitamin D malabsorption (a good medical history is able to highlight these cases easily).
- in children under 3 years of age (generally they cannot be made to wear the mask properly for long enough!)
- conscious sedation is temporarily contraindicated also for patients with partially obstructive inflammatory pathologies of the airways such as rhinitis or bronchitis