Clinical Application of Nitrous Oxide in Pediatric Dentistry

  • Kunal Gupta
  • Priyanshi Ritwik


This chapter is the mainstay of this book as it discusses using nitrous oxide in children in close conjunction with basic behavior management techniques. It includes a step-by-step journey, in an illustrative manner, on how to introduce nitrous oxide to child patients and parents. Few important questions which come to the mind of an operator like preoperative assessment, concentration of nitrous oxide to be used, method of titration, duration of administration, etc. are explained very well with illustrations and flowcharts. Importance of monitoring, through verbal communication during the procedure, along with red flags indicating over sedation has been examined. Possibility of any adverse events is reviewed along with how to prevent them and deal with them, should they occur. Documentation of this technique along with role of dental staff is also a part of this chapter.


Nitrous oxide in children Nitrous oxide titration Monitoring of nitrous oxide sedation Adverse events of nitrous oxide Documentation of nitrous oxide sedation First nitrous visit Rapid titration Diffusion hypoxia Oversedation 

Supplementary material (128.3 mb)
Video 5.1 This video shows a child with a positive behavior who is anxious about undergoing a dental procedure. Nitrous oxide inhalation sedation was used to relieve anxiety. After 3 min, local anesthesia was administered. After few minutes, child appeared to be euphoric. Extraction was carried out without any resistance or anxiety from the child (MOV 131343 kb) (320.3 mb)
Video 5.2 This video portrays the process of introduction of nitrous oxide technique to a child with negative behavior. The child is in distress due to acute inflammation of a tooth leading to cellulitis. Basic behavior management technique along with rapid titration is used to introduce nitrous oxide to this child. On a subsequent visit, which was meant for desensitization, access opening was done. This visit further helped in building trust and confidence and allaying anxiety. On the subsequent visit, child cooperated well for undergoing endodontic treatment. (MOV 328021 kb) (228.6 mb)
Video 5.3 This video shows introduction of nitrous oxide to a child in precooperative age. The dentist tried to build rapport with the child and used tell-show-do, modeling and distraction but still child was not willing for examination. Father wanted to get the examination done under restraint; however, the dentist decided to use rapid titration for carrying out initial examination. On rapid titration, child allowed dental examination and records without any resistance. Also, the child was relaxed and began communicating with ease. On subsequent visit, the child cooperated well for dental treatment. (MOV 234077 kb) (541.7 mb)
Video 5.4 A step-by-step description of standard titration using analog type of nitrous oxide delivery system has been shown in this video. Various steps of titration have been described on two different analog devices. Constant flow technique will be clear to readers on visualizing this clip (MOV 368708 kb) (207.4 mb)
Video 5.5 Rapid titration technique has been explained in this video. How the concentration control knob and total flow rate is regulated has been shown in this video (MOV 212335 kb) (96.5 mb)
Video 5.6 This video shows a visual description of monitoring by operator during nitrous oxide sedation. On finding drooping eye lids of child, operator establishes verbal communication with the child and taps gently on face. The child is easily arousable, and the child responds to verbal commands (MOV 113391 kb) (191 mb)
Video 5.7 This video clearly shows minimal level of sedation. During the procedure, the child (11-year-old female) has eye lids closing slightly, but with a slight tap (with fingers) on the face, child opens eyes. At this stage, nitrous oxide can be reduced by 5–10% to ensure that the child does not slip into moderate level of sedation. The video also highlights how monitoring of facial and eye expressions can ensure that the child remains in minimal level of sedation (MOV 82417 kb) (149.2 mb)
Video 5.8 This video describes a child in moderate level of sedation. Operator observes that the child has eye lids closed, following which he taps gently with fingers on forehead and also verbally tells the child “Aadya don’t sleep … Aadya don’t sleep.” The child opens eye lids only on “repeated” tactile stimulation, looks towards operator, and responds to verbal commands of operator. At this stage, the operator reduces nitrous oxide concentration by 10%. This video also describes the monitoring of facial expressions, eyes, and operators response in such a situation (MOV 99913 kb)


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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Kunal Gupta
    • 1
  • Priyanshi Ritwik
    • 2
  1. 1.Children’s Dental CenterGurugramIndia
  2. 2.Department of Pediatric DentistryLSUHSC School of DentistryNew OrleansUSA

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