Nitrous Oxide & Sedation
Everyone hates going to see the dentist…
But, some people (and you know if this is you) have a DEEP phobia of the dentist. I mean, a REAL visceral response to the very thought of going to see the dentist.
Many times, I have found this fear to be connected to a bad past experience that occurred in a dental office when the patient was very young. It’s amazing. I have 90 plus year old patients terrified of the dentist because of a bad experience that happened when they were six!!!
I understand these fears because I’ve had them myself. I’m very relaxed when I’m doing dentistry. But, if you put me in that dental chair (or any doctor chair), my heart starts to race, palms get sweaty, brow dampens, you know the routine. I can’t stop this response no matter how hard I try to relax. And, needles… don’t get me started!!! I give somewhere between 20 and 30 injections a day. No problem. But when I’m the one on the other end of that needle… the heart races, palms sweat, etc!!!
So, I have a deep compassion for these patients who are terrified of the dental office. I understand them, cater to them, and, as a result, have many of them in my practice. In terms of sedation options, I have tremendous success with nitrous oxide. I also offer oral sedation (i.e. taking a pill like valium or halcion.) But, I find many advantages to nitrous oxide.
Nitrous Oxide is “laughing gas”. It’s what you always see in the movies (like Steve Martin in Little Shop of Horrors!!) Basically, it’s a gas that you breathe in through the nose. The gas is combined with oxygen which acts to dilute it. This combination of nitrous and oxygen has two advantages: One, it gives me direct and quick access to OXYGEN which is invaluable to any medical emergency, medically compromised patient, or high anxiety patient. And second, it allows me to regulate the amount of nitrous oxide the patient receives. Unlike taking a pill, you are not stuck with the over effect (or under effect) of the amount taken. Nitrous concentrations can be changed at will throughout the appointment until a perfect “level” of sedation is attained. If my patient has too much of an effect, I turn it down. If my patient is not relaxed enough, I turn it up. Very simple. And, in the RARE cases where the person does not like the feeling of nitrous oxide, I turn it off, run 100% oxygen, and the person is back to normal in less than 2 minutes. This is something you CAN NOT do with a pill.
All patients can drive home after nitrous oxide, by the way.
A lot of people ask me, “What is it like being on nitrous?” Well, I always the start the person on 100% oxygen and slowly bring in the nitrous. The beginning effects are a very gentle, tingle in the fingertips or a warm “fuzzy” feeling inside. (It’s hard to explain.) But, it is a comforting, good, feeling. As the person becomes used to this initial feeling, I SLOWLY turn the nitrous up and talk to the patient as the effect increases. I adjust the concentration until the patient tells me they are in a good place. A “good place” is comparable to having a glass (or two??) of wine….
I never put my patients “to sleep”. My goal is to get them in a comfortable and relaxed place. Sometimes, people say that they don’t feel any different, but they notice they are no longer nervous. This, to me, is the perfect level of sedation. I like people to be awake, communicative, in control, and, most importantly, relaxed. If the person is still nervous, I will increase the nitrous concentration to a deeper state of sedation until my patient is comfortable.
Once my patient is comfortable, I ask them if they are ready to be numbed. (I never proceed until the patient is ready.) In terms of local anesthesia, I ALWAYS presoak the area in a topical gel that pre-numbs the area so the person does not feel “the shot”. In addition, I have received special training and have many techniques in giving painless injections. I am confident I can give a painless injection everywhere in the mouth except for the lower molars. Due to anatomy in this area, there can sometimes be a “pinch” (maybe 20-30% of the time??). If the patient is on nitrous oxide, this percentage is more like 5% But, regardless, I always prepare the patient for this and minimize it as much as possible.
Next, I will ALWAYS test the area before beginning the procedure. I will not begin ANY procedure until I know the patient is completely numb, relaxed, and ready. I urge patients to TELL ME if they feel ANY sensitivity or do not feel relaxed at any point in the procedure. To me, a dental procedure is a constant conversation. I explain as I go (if the person wants to know..) and introduce each successive part of the procedure while constantly adjusting the nitrous level.
Overall, I have many “dental-phobics” as patients because I take the time to make sure they are comfortable. I don’t rush through procedures. And, I don’t make patients feel bad if we need to stop and make sure adequate anesthesia is attained.
I am here for you. Nitrous Oxide is great stuff and, believe it or not, can make seeing the dentist actually kind of fun. In addition, I have many patients who have used nitrous oxide as a tool to overcome their fear of going to the dentist. Many people who formerly used nitrous now no longer need it.
So, if you have been putting off going to the dentist for many years (OR if you’ve just begun putting off going to the dentist), you really should give me a try! I also don’t make people feel bad for avoiding seeing the dentist for years and years. In terms of number of years since last seeing the dentist, I NORMALLY get numbers like 20 years, 30 years, even 40 years plus!!! So, don’t feel bad! Just remember, the longer you wait, the more extensive (and expensive) the treatment gets!