Nitrous Oxide and Oral Sedation
Nitrous Oxide (laughing gas)
Nitrous Oxide is a sweet-smelling, non-irritating, colorless gas, which you can breathe. Nitrous Oxide has been the primary means of sedation in dentistry for many years. Nitrous oxide is safe; the patient receives 50-70% oxygen with no less than 30% nitrous oxide. The patient is able to breathe on his or her own and remain in control of all bodily functions. The patient may experience mild amnesia and may fall asleep, not remembering all of what happened during their appointment.
There are many advantages to using Nitrous Oxide
- The depth of sedation can be altered at any time to increase or decrease sedation.
- There is no after effect such as a “hangover”.
- Inhalation sedation is safe with no side effects on your heart and lungs, etc.
- Inhalation sedation is very effective in minimizing gagging.
- It works rapidly as it reaches the brain within 20 seconds. In as little as 2-3 minutes its relaxation and pain killing properties develop.
Reasons to not use Nitrous Oxide
You should not utilize Nitrous Oxide if you have been diagnosed with chronic obstructive pulmonary disease (COPD). Though there are no other major contraindications to using nitrous oxide, you may not want to use it if you have emphysema, exotic chest problems, M.S., a cold or other difficulties with breathing. You may want to ask your dentist for a “5 minute trial” to see how you feel with this type of sedation method before proceeding.
Oral Sedation: Anti-Anxiety Medication
The most commonly prescribed dental related drugs that treat anxiety belong to the “benzodiazepine” family. Those drugs include Valium, Halcion, Xanax, or Ativan. These drugs decrease anxiety by binding and toning down activity within “fear” receptors in the brain.
There are two different types of Benzodiazepines:
- Sedative-Hypnotics: These drugs induce calm, including drowsiness and even sleep. This sleep state is actually a form of hypnosis, which is a form of physiological sleep.
- Anti-Anxiety Drugs: These are drugs which relieve anxiety and induce a state of calm and relaxation.
While benzodiazepines act as sedatives AND anti-anxiety drugs, some are highly targeted at areas within the brain which focus on sleep. Others act in a more specific way and target fear centers in the brain. In most cases, higher doses act as sedatives and induce sleep, while in lower doses, they reduce anxiety without sedation. Benzodiazepines are also Central Nervous System (CNS) depressants (i.e. there can be a decline in blood pressure and breathing). It is important to note that they shouldn’t be mixed with other CNS depressants such as alcohol. Its important that you utilize the dose your dentist or doctor recommends. It is possible to overdose, and overdoses could lower your breathing to dangerously low levels, which could result in coma or death. Please note that you shouldn’t travel on your own after you’ve taken any of these drugs. Make sure you have an escort, even if you traveled by bus or foot! It’s easy to become disorientated.
When not to take benzodiazepines:
Some of these drugs can affect your liver and heart. It’s important to check with your practitioner and/or pharmacist. You should be sure to inform your doctor or dentist if any of the following apply: known allergy to the drug, narrow-angle glaucoma, pregnancy, severe respiratory disease (COPD), congestive heart failure (CHF), impaired kidney or liver function, depression/bipolar disorder/psychoses, chronic bronchitis and some other conditions. It’s also important to let us know if you are taking other medications. There could be possible drug interactions.