Sedation Using Nitrous Oxide in Children with Special Health Care Needs

  • Priyanshi RitwikEmail author


“Know me for my abilities, not my disabilities.”—Robert Hensel. To be able to successfully treat children with special health care needs is one of the most satisfying yet the most challenging aspects of our day. Many of us are in pediatric dentistry to be able to better serve these children. When discussing care for children with special health care needs, we must adopt the “People First” language. This means respecting the child or the individual first, and realize that he/she has unique abilities, interests and needs. They are first and foremost a person, and their “disability” does not define them. This chapter discusses the role nitrous oxide can play to facilitate the delivery of dental care to children who may need little more attention, love, and care from us than other children. Will nitrous oxide be safe for a child with asthma? Will it be helpful for kids with ADHD? Many a times, such patients and their parents are left with no other option but to accept the use of general anesthesia for dental rehabilitation. Perhaps with some experience and understanding of nitrous oxide, the use of general anesthesia may be avoided in some of the children with special health care needs.


Asthma Cerebral palsy Autism spectrum disorder Attention deficit hyperactivity disorder Epilepsy 


  1. 1.
  2. 2.
    Guidelines for the diagnosis and management of asthma (EPR-3). Accessed 6 Feb 2019.
  3. 3.
    Malamed S, editor. Chapter 37. Sedation—a guide to patient management. 6th edn. Elsevier; 2018. p. 529.Google Scholar
  4. 4.
  5. 5.
    Blomqvist M, Augustsson M, Bertlin C, Holmberg K, Fernell E, Dahllöf G, Ek U. How do children with attention deficit hyperactivity disorder interact in a clinical dental examination? A video analysis. Eur J Oral Sci. 2005;113(3):203–9.CrossRefPubMedGoogle Scholar
  6. 6.
  7. 7.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: American Psychiatric Association; 2013.CrossRefGoogle Scholar
  8. 8.
    Delli K, Reichart PA, Bornstein MM, Livas C. Management of children with autism spectrum disorder in the dental setting: concerns, behavioural approaches and recommendations. Med Oral Patol Oral Cir Bucal. 2013;18(6):862–8.CrossRefGoogle Scholar
  9. 9.
    Rada RE. Controversial issues in treating the dental patient with autism. J Am Dent Assoc. 2010;141(8):947–53.CrossRefPubMedGoogle Scholar
  10. 10.
  11. 11.
    Olson LJ, Moulton HJ. Use of weighted vests in pediatric occupational therapy practice. Phys Occup Ther Pediatr. 2004;24(3):45–60.CrossRefPubMedGoogle Scholar
  12. 12.
  13. 13.
    Curl C, Boyle C. Sedation for patients with movement disorders. Dent Update. 2012;39(1):45–8.CrossRefPubMedGoogle Scholar
  14. 14.
    Yoshida M, Nakajima I, Uchida A, Yamaguchi T, Akasaka M. Effect of nitrous oxide on dental patients with cerebral palsy—using an electromyogram (EMG) from orofacial muscles as an index. J Oral Rehabil. 2003;30(3):324–33.CrossRefPubMedGoogle Scholar
  15. 15.
  16. 16.
    Oei-Lim VL, Kalkman CJ, Bouvy-Berends EC, Posthumus Meyjes EF, Makkes PC, Vermeulen-Cranch DM, et al. A comparison of the effects of propofol and nitrous oxide on the electroencephalogram in epileptic patients during conscious sedation for dental procedures. Anesth Analg. 1992;75(5):708–14.CrossRefPubMedGoogle Scholar
  17. 17.
  18. 18.
    Alrayyes S, Compton AA, Kawar N. Oral health considerations for pediatric patients with sickle cell disease. Dis Mon. 2018;64(6):302–5.CrossRefPubMedGoogle Scholar
  19. 19.
    Little J, Miller C, Rhodus N. Chapter 22. Little and Falace’s dental management of the medically compromised patient, 9th edn. Elsevier; 2017.Google Scholar
  20. 20.
  21. 21.
    Camoin A, Dany L, Tardieu C, Ruquet M, Le Coz P. Ethical issues and dentists’ practices with children with intellectual disability: a qualitative inquiry into a local French health network. Disabil Health J. 2018;11(3):412–9.CrossRefPubMedGoogle Scholar
  22. 22.
    Galeotti A, Garret Bernardin A, D'Anto V, Ferrazzano GF, Gentile T, Viarani V, et al. Inhalation conscious sedation with nitrous oxide and oxygen as alternative to general anesthesia in precooperative, fearful, and disabled pediatric dental patients: a large survey on 688 working sessions. Biomed Res Int. 2016;2016:7289310.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Faulks D, Hennequin M, Albecker-Grappe S, Maniere MC, Tardieu C, Berthet A, et al. Sedation with 50% nitrous oxide/oxygen for outpatient dental treatment in individuals with intellectual disability. Dev Med Child Neurol. 2007;49(8):621–5.CrossRefPubMedGoogle Scholar
  24. 24.
    De Veaux CK, Montagnese TA, Heima M, Aminoshariae A, Mickel A. The effect of various concentrations of nitrous oxide and oxygen on the hypersensitive gag reflex. Anesth Prog. 2016;63(4):181–4.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Kliegman R, Stanton B, Schor N, St. Geme J, Behrman R. Chapter 414. Nelson textbook of pediatrics, 19th edn. Elsevier; 2011.Google Scholar
  26. 26.
    Gleason M, Rychik J, Shaddy R. Pediatric practice: cardiology. New York: McGraw-Hill Medical; 2012.Google Scholar
  27. 27.
    Wald C. Nitrous oxide—are there any real contraindications? Quintessence Int. 1983;7(2):213–8.Google Scholar
  28. 28.
    Langa H. Relative analgesia in dental practice. 2nd ed. Philadelphia: W.B. Saunders and Co.; 1976.Google Scholar
  29. 29.
    Baeder F, Silva DF, de Albuquerque ACL, Santos MTBR. Conscious sedation with nitrous oxide to control stress during dental treatment in patients with cerebral palsy: an experimental clinical trial. Int J Clin Pediatr Dent. 2017;10(4):384–90.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of Pediatric DentistryLSUHSC School of DentistryNew OrleansUSA

Personalised recommendations