Laughing Gas

Sedation can help overcome dental fear or phobia.

Many people avoid going to the dentist because of the fear of dental procedures. Conscious sedation can provide anxiety relief and often overcome fear.

Sedation is the use of a drug which relaxes the central nervous system enabling treatment to be carried out by the dentist, while still allowing you to communicate.

We will recommend the simplest form of sedation which will enable successful treatment to be given. For example, some patients respond well to laughing gas and oxygen while others cope better with a valium-type drug.

There are many ways of being sedated and your dentist will discuss with you what treatment best suits you. Before sedation can be offered, we will take a full medical history and may liaise with appropriate medical practitioners if necessary.

Laughing gas and oxygen sedation can be administered through a nose mask making you feel warm and relaxed. This technique is also known as Relative Analgesia (RA) and works particularly well with children. We simply place a small mask on the nose and vary the amount of laughing gas through a special machine until you are comfortable and relaxed.

Oral sedation is another option to help alleviate fear. This is achieved simply by your dentist prescribing a medication which will make you drowsy and relaxed. This technique can also be used in conjunction with laughing gas for deeper sedation.

Laughing Gas, Relative Analgesia, N2O-O2 Sedation

The actual mechanism of action of N2O is still unknown (it appears that there are quite a few different mechanisms at work). It has been observed that N2O depresses almost all forms of sensation - especially hearing, touch and pain, and that it seems to disinhibit some emotional centers in the brain. The ability to concentrate or perform intelligent acts is only minimally affected, as is memory. 

How is laughing gas administered? 

The equipment used for delivering N2O-O2 is quite simple. It consists of a supply of compressed gases (N2O and Oxygen O2) and an apparatus which delivers the gases to the nose. By turning some knobs and flipping on/off switches, we can produce the desired mix of N2O-O2 in the desired quantities. Flowmeters and pressure gauges allow us to keep an eye on the flow of gases. 

The desired N2O-O2 mix is fed through a tube to which a nasal hood. This hood is put over your nose. All you have to do now is breathe normally through your nose. Depending on the concentration and length of administration of N2O-O2, four levels of sedation can be experienced (after an initial feeling of light-headedness): 

1. A tingling sensation, especially in the arms and legs, or a feeling of vibration ("parasthesia"), quickly followed by
2. Warm sensations, and
3. A feeling of well-being, euphoria and/or floating. During heavier sedation, hearing may dissolve into a constant, electronic-like throbbing.
4. At a deeper level of sedation again, sleepiness, difficulty to keep one's eyes open or speak ("dream") can occur.  Should nausea set in, it means you're becoming over-sedated. 

If you experience any unpleasant symptoms, let us know so that we can lower the percentage of N2O. Alternatively, just breathe through your mouth. 

During relative analgesia, you should stay within the first three stages. The "dream" stage means that the N2O concentration is too high, or that the gas has been administered for too long. This stage can be associated with side effects such as nausea and other potentially unpleasant sensations. 

If you choose sedation, you must not eat or drink for at least six hours before your appointment. You should not smoke for at least 24 hours before the appointment. It is important that your dentist knows of all medications you are taking, and also any changes to your medical history including all known allergies. 

What are the advantages of N2O? 

• Laughing gas works very rapidly - it reaches the brain within 20 seconds, and relaxation and pain-killing properties develop after 2 or 3 minutes.
• The depth of sedation can be altered from moment to moment, allowing us to increase or decrease the depth of sedation. Other sedation techniques don't allow for this. For example, with IV sedation, it's easy to deepen the level of sedation, but difficult to lessen it. Whereas with gas, the effects are almost instant.
• Other sedation techniques have a fixed duration of action (because the effects of pills or intravenous drugs last for a specific time span), whereas gas can be given for the exact time span it's needed for. It can also be switched off when not needed and then switched on again.
• There's no "hangover" effect - the gas is eliminated from the body within 3 to 5 minutes after the gas supply is stopped. You can safely drive home and don't need an escort.
• With N2O, it's easy to give incremental doses until the desired action is obtained (this is called "titration").
• No injection is required. In cases of very severe needle phobia, getting laughing gas first can help you feel relaxed enough to allow a local anaesthetic injection.
• Inhalation sedation is very safe. It has very few side effects and the drugs used have no ill effects on the heart, lungs, liver, kidneys, or brain.  

Are there any disadvantages? 

• Some people are not comfortable with the effects of laughing gas (either because they're afraid they might lose control or because it makes them feel nauseous - this is quite rare, though, and usually due to oversedation).
• Some people will not achieve adequate sedation with permissible levels of oxygen.
• If you can't breathe through your nose (either because you're a pure mouth breather, or because your nose is blocked), or you feel too claustrophobic when something is put over your nose, it can't be used.
• The cost of the equipment and gases is high, so you'll have to contribute to the cost.  We will provide an itemised quotation. 

Are there any contraindications? 

There aren't any major contraindications to relative analgesia, except for M.S., emphysema and some exotic chest problems. It hasn't been proven to be safe during the first trimester of pregnancy so we don't use it in early pregnancy. Because you have to breathe it in through your nose, it's not suitable for people who have a cold or some other condition which prevents them from breathing through their nose. 

Oral sedation. 

Oral sedation is another option to help alleviate fear. This is achieved simply by prescribing a valium-type medication which will make you drowsy and relaxed. This medication may need to be taken the evening before, the morning of, and an hour before your dental appointment.

This technique can also be used in conjunction with N2O for deeper sedation.

It is best to have someone bring you in for this appointment as you will feel quite drowsy and not be able to drive.

Instructions will be given to you and your escort after the sedation and dental treatment is completed.

Do not drive vehicles or operate machinery for at least 12 hours after oral sedation.