Conscious Sedation: Reducing Anxiety and Pain in Dental Procedures with Nitrous Oxide

Conscious Sedation

A sensation so unpopular, yet so important for most medical and dental conditions, most feared, and yet so crucial in diagnosis – Pain. Dental problems fall into one such category where the pain might be dampened with medicinal approaches for a while, but it requires operative care to be done with it. Loud, unpleasant sounds are an integral part of a dental setup, generated by suction devices, high-speed rotary instruments, and compressors, among others.

Adding up to a child’s anxiousness, a lot of factors like the doctor-patient rapport, and familiarity with the environment, act as determinants of instilling fear or memory of a healthy dental experience. Working with such a patient is an uphill task, and a dental professional is expected to employ all available methods at hand to reduce anxiety and create a positive environment.

A popular pharmacological approach – Conscious sedation, used in combination with behavior-shaping techniques, helps to improve the suggestive behavior of the patient and creates a workable environment. It can be defined as a technique where the use of a drug/drugs produces a state of depression of the central nervous system, enabling treatment to be carried out, but during which verbal contact with the patient is maintained throughout sedation. Additionally, it can also help in developing a long-term positive psychological response to dental procedures.

Adequate spontaneous ventilation, easy airway, and maintained cardiovascular functions are characteristic features that define the depth of conscious sedation. Various modes of administration are available and put to use as and when required. These are inhalation, oral, intravenous, rectal, and intramuscular. Nitrous oxide is the gas used for the procedure because of its analgesic, anxiolytic, relatively amnestic characteristics, and minimal side effects. Another phenomenon called the second gas allows for the uptake of a second gas at a much faster rate than normal and allows minimal amounts of a more potent anesthetic to be administered simultaneously with nitrous oxide.

Apart from all the fear and anxiety brought under control with nitrous oxide, it also helps in the management of the gag reflex. As is with most things in the world, nitrous oxide too, with all its benefits, has some contraindications for its use. These include chronic obstructive pulmonary diseases, upper respiratory tract infections, recent middle ear surgery, and the 1st trimester of pregnancy, to state a few. Some adverse effects might also be seen, including nausea and vomiting. Here, it is of utmost importance that the fail-safe system of nitrous oxide delivery is regularly checked and calibrated.

During analgesia concentration between 20-40% nitrous oxide is adequate for most dental procedures, which should be followed by 100% oxygen for about 2 minutes. A safety kit should always be readily available to manage the worst of scenarios. Though nitrous oxide and conscious sedation itself alone cannot mold the very nature of a patient, it greatly increases the success of a doctor in reducing stress-induced anxiety and pain. The painless procedure tales are now a daily thing in dental practice, specifically in children, which themselves speak for the success of nitrous oxide for conscious sedation across the globe.

Written By:
Dr. Prince Rathee
Faculty of Dental Sciences
SGT University

Tag:Conscious Sedation

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