Nitrous oxide (laughing gas) is an extremely helpful adjunct for dental treatment of the fearful patient. It was first discovered by Joseph Priestley in 1772, however, it was not until 1844 when Horace Wells used it as a medical anesthetic. Today, nitrous oxide is used in conjunction with local anesthetic when performing dental treatment on apprehensive patients. Nitrous oxide on its own cannot reliably anesthetize a patient profoundly enough for a patient not to feel a thing. Therefore, it must be used with novocaine to numb the area. Nitrous oxide is administered with pure oxygen and is breathed through a nasal hood. The machine that delivers the gas is a fail-safe machine which will turn off if the oxygen level falls below 35%. Nitrous oxide is not meant to put one to sleep, but merely relax. When given before the anesthetic injection, it can make that part of the procedure much more comfortable. It will put a patient in a state of mild euphoria and will alter the perception of sights, sounds, and time. It also has a mild amnesic effect leaving much less memory of the procedure. Another extremely nice feature of nitrous oxide is that the patient can be flushed with pure oxygen after the procedure and be totally lucid and able to drive home. Nitrous oxide can make a dental appointment a very pleasant experience.
Fear of dental treatment is very common. Some times, good anesthetic technique, behavior modification, and nitrous oxide (laughing gas) may not be enough for someone who is very fearful. Oral sedation comes to the rescue. It is important to get a good night’s sleep before a dental appointment, but with dental phobics, that can be difficult to do.
At our office, we use Ativan (lorazepam), a relatively long acting sedative. We prescribe two pills. One of those pills is taken before bedtime which helps a patient get a good night’s sleep. The other pill is taken an hour before the appointment. Since Ativan is very long acting, there will still be some blood level left from the initial dose, thus providing for an extremely relaxed state once the dental appointment begins. Conscious sedation is very safe because the patient still has their protective reflexes and is able to respond to commands readily. However, they are extremely relaxed to the point that the sights, sounds, and vibrations associated with dental treatment are minimized immensely. The concept of time is altered so that the appointment seems to fly by and there is also an amnesic effect so that the patient has very little memory of the procedure. Afterwards, the patient is delightfully drowsy and will go home and have a very restful nap.