Nitrous oxide: What dental assistants need to know

Nitrous oxide has been used in the dental setting for well more than 100 years, and it is commonplace in the dental office of today. States differ on what involvement the dental assistant will have in utilizing nitrous oxide.

Some states allow dental assistants to administer while most only allow them to monitor. Some states require dental assistants to attend a course, pass a competency test and be certified while other states don’t require any sort of course work or certification. Google "nitrous oxide" and you can find many dangers yet in some states you can work one job one day and monitor nitrous oxide the next or, worse yet, administer it. Do you know what you’re looking for? Do you know the dangers? Are you prepared for a medical emergency? Do you know the long-term effects of working with nitrous oxide?

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My intent is not to scare you and make you believe nitrous oxide is a bad sedative choice. I want you to be educated on the effects, benefits and dangers of nitrous oxide. After all, accidents aren’t planned; they happen. If you don’t ever plan for an emergency, you won’t know how to handle one once it comes up. You should review planning for medical emergencies in the dental office yearly with your team members. Knowing your role in any emergency will help ease the stress and provide a game plan when one happens.

Nitrous oxide is a nonirritating, colorless gas with a sweet taste and odor. Many people say they can smell it, and many who can’t smell it say they get a headache when around it for any length of time. It causes the patient to have a “floating” feeling or, some say, like they have had a glass of wine. The occupational threat to dental office personnel could result in many health issues.

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Trace amounts of nitrous oxide unavoidably leak into room during administration from the machine itself, hoses, the nasal mask or nosepiece and the patient’s mouth. With chronic exposure, like what dental personnel receive during daily administrations to patients, it is potentially toxic. Possible side effects include increased kidney and liver diseases, increased spontaneous abortion (miscarriage), increased cancer and decreased bone marrow.

Prevent these things by minimizing exposure. Have your equipment tested for leakage and provide preventive maintenance four times a year. Make sure your patient has a properly fitting nosepiece, and, most of all, be sure to minimize patient conversation. Manufactured devices for collection and disposal of gases are a huge help so don’t overlook employing a scavenging hose, outdoor ventilation system or air-monitoring program. Your long-term health is worth taking care of.

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Nitrous oxide can be safely used and may be a benefit to the dental patient who suffers from fear and anxiety. In some cases, medically compromised patients can also benefit when special consideration is given to each patient. It is critical to determine whether the medical condition is under treatment and control. If not, administration is not recommended. A physician consultation is recommended prior to administeringnitrous oxide sedation for these patients. As long as the following conditions are not severe, nitrous oxide can effectively be used safely on patients with cardiovascular disease, asthma, epilepsy and seizures, thyroid disease or cerebrovascular disease (stroke). It can also be used on patients taking tranquilizers, analgesics, antidepressants or hypnotics. Chronic alcohol abusers and pregnant patients shouldn’t have nitrous oxide, and, likewise, a pregnant dental assistant shouldn’t work on a patient who is under the gas because nitrous oxide crosses the placenta to the fetus and affects the central nervous system.

Obtaining a health history is important for any patient seeking treatment, but when sedatives, such as nitrous oxide, are employed during treatment, it becomes necessary. The health of the patient and drugs they may take can weigh heavily on whether to proceed with treatment because nitrous oxide causes a depression action on the body’s CNS with many drugs.

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I’m a huge believer in taking a new health history each time a patient walks in my door. If he or she was here for a cleaning one week and back the next for restorative treatment, I want an update. Who says the patient didn’t have a heart attack over the weekend? For some unknown reason, patients think dentist aren’t doctors so any medical issues they may have don’t need to be reported to the dental team. They think there is this imaginary wall separating their oral health from their overall health, and we all know that’s not true! By obtaining a new health history each time a patient walks in and having them date and sign it, we have done all we can to protect our patients from an emergency. 

I also use a nitrous oxide consent form. I want the patient to understand the risk and benefits of using it. I also want mom/dad to read it so they know they shouldn’t let their child talk while on it and shouldn’t have him/her eat a heavy meal prior to treatment. It warns patients of the dangers of getting up from the dental chair if they still feel “woozy.” Remember: If we don’t tell our patients to expect these things, then they don’t know if it’s natural to feel that way. 

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Always ask the patient how they feel without allowing them to speak too much, and never allow your patient to fall asleep during treatment. Keep an eye on the gauges and never, under any circumstances, leave the patient unattended!

Taking vital signs is important for a few reasons. First, I don’t think patients believe we are concerned with their overall health until we show them we are. Second, they call heart disease the silent killer for a reason. While taking vitals, many times we find patients with blood pressure that is too high to proceed with treatment. Concern yourself with your patients' health, and they will appreciate that you have taken the time to take care of them.

Keep in mind your patients don’t know what you know. They are in strange territory in your office. It’s our job to educate them, ease their fear and be professional. Explain their treatment in terms they understand. Ask them if they have questions, and, if you feel as if you can’t answer them properly, get the doctor. Know your limitations, and don’t overstep your boundaries.

The best way to handle a medical emergency in the dental office is to prevent one altogethe.! By taking vitals, talking to your patient about upcoming treatment and obtaining a comprehensive medical health history, you are doing your job and possibly saving a life! Isn’t that worth an extra few minutes?  

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