The Tinkerer

PlayWell Pediatric Blog

Laughing Gas and Pediatric Dentistry

March 21, 2023

Nitrous oxide (N2O) AKA “laughing gas” is an inhaled gas we use as a mild sedative. Classically, this is an “anxiolytic,” but it’s very much not used just to relieve anxiety. I like to use it for most of my kids needing restorations as it makes the experience more enjoyable overall. I like to think of it as a way to extend the time any given child is happy and content. I’ll have a 4-year-olds who lets me do ANYTHING… for about 30 seconds… then we go from 100% OK to 0% in a flash as someone decides they are DONE and they want to GO! I always feel it works best in kids about whom you wouldn’t say, “oh, they need that.” It works best to keep happy kids happy, to remember the day positively and to make coming back for next time, if more treatment is needed, even easier! 

Some parents will have a child who is in shut-down mode because of a tantrum, being uncooperative, unwilling to even lay down and parents ask – “can’t we use the laughing gas?” Unfortunately, it’s not a cure-all. I like to say that it’s like you’re at a bar and you’ve had 1-2 drinks. You can feel a nice warm buzz feeling, but then your boss comes in and sits down next to you. You can absolutely sit up, shake it off, and act however you’d like as if you’ve had zero drinks. If a child doesn’t want to cooperate, they will still have that choice whether nitrous oxide is on board or not. If a child isn’t developmentally/emotionally ready, doesn’t want to cooperate and can’t lay down, or won’t speak to the dentist, they can still choose to NOT feel the buzz. Some such kids may not breath the nitrous oxide through their nose in the first place.

We also don’t use N2O usually in children under 3 years of age. Kids under 3 may feel like it’s just 1 thing too many going on. The nitrous nose is big in their field of vision and prevents them from easily sitting up and they feel claustrophobic and trapped. If and when we have to do anything for young kiddos, I find we get a lot farther working in 5-10 second increments and taking frequent breaks. 

Within minutes of titrating up (up to about 50% N2O & 50% O2) kids start to feel a relaxed, tingling, floating-in-the-clouds, mild euphoria, staying awake the entire time. We usually try to stay below the level of actual spontaneous bubbling laughter – while it’s super fun, it can get in the way of safe dental treatment. The nitrous nose remains in place throughout the procedure delivering the air combination and scavenging the exhalations (so the dentist, assistant, and parents aren’t getting dosed) because it is breathed off and needs to be supplied throughout the appointment to continue having its effects. It’s a lot like the carbonation in a soda and not like most drugs (e.g. Tylenol) that have to be metabolized and excreted. Instead, you breathe it into your body and you breathe it out (fortunately, no soda-burps). When the procedure is almost complete, N2O will be discontinued and 100% Oxygen is delivered for at least 5 minutes which helps to quickly and completely flush out any and all N2O from the body. This means that, in adults, one can drive home after N2O (and no hangover). Kids can resume normal activity as well without any lingering effects. 

There are very few medical conditions that give caution to the use of N2O. The biggest concern with N2O is that sometimes kids will experience light-headedness and/or become nauseated and very rarely a child will vomit. N2O actually helps reduce an over-active gag reflex, but some experience nausea. Because it enters and exits the body so quickly, it is easy to titrate to higher or lower doses for optimal comfort, and we always aim for open communication.

N2O (“laughing gas”) is a really helpful medication we use very frequently with great success at the PlayWell. As always, our long-term goal is to maintain oral health (and not get cavities). If any problems arise in the short-term, our goal is to fix those while making and keeping kids happy and healthy.

A kid playing with his toys

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