Nitrous oxide Pediatric Dentistry
XIII. Nitrous Oxide/Oxygen Sedation in Pediatric Dentistry
Within the past two decades, it has become increasingly evident that many dentists have found N2O/O2 sedation to be an effective agent in the management of the child patient. Because of this recent upsurge of interest and because nitrous oxide is administered to children in a different manner than for adults a separate discussion of its use in pediatric dentistry will be undertaken.
Nitrous oxide has a long, colorful history relative to its use in dentistry. Interestingly, however, little can be found concerning the utilization of nitrous oxide in managing children's behavior in the dental office. A few early reports describe its application as an anesthetic agent. For example, in 1925, John S. Lundy, a physician, employed N2O as an induction agent to prepare children for dental extractions. A mixture of 80% N2O and 20% O2 was initially administered through a nasal mask. After a short time, the gas mixture was changed to 75% ethylene, 20% O2 and 5% CO2. When a light surgical plane of anesthesia was established, the teeth were taken out. Dr. Lundy noted that it was often necessary to proceed determinedly to place the mask over the child's nose.
Shortly thereafter Leonard N. Ray, a dentist, advocated using N2O as the sole anesthetic for dental extractions on children. The children were induced with 90% N2O and 10% O2 for 30 seconds; a procedure that he felt would enable the children to move quickly toward a surgical anesthesia. After the induction, the O2 was lowered to 7%, N2O was raised to 93%, and the dental extractions were accomplished. Similar to Dr. Lundy's observation, he noted that children would often resist the mask. Rather than force he recommended suggestion, demonstration and encouragement to get the children to accept the mask.