International Journal of Clinical Pediatric Dentistry

Register      Login

VOLUME 14 , ISSUE S2 ( Special Issue (Behaviour Management), 2021 ) > List of Articles


Physiological Effects, Psychomotor Analysis, Cognition, and Recovery Pattern in Children Undergoing Primary Molar Extractions under Nitrous Oxide Sedation Using Two Different Induction Techniques: A Split-mouth Randomized Controlled Clinical Trial

Vineet Khinda, Dinesh Rao, Surender PS Sodhi, Nikhil Marwah

Keywords : Cognition, Conscious sedation, Induction, Nitrous oxide, Oxygen, Psychomotor analysis, Rapid analgesia, Recovery

Citation Information :

DOI: 10.5005/jp-journals-10005-2090

License: CC BY-NC 4.0

Published Online: 01-02-2022

Copyright Statement:  Copyright © 2021; The Author(s).


Nitrous oxide inhalation sedation (NOIS) has been in use as a tool for pharmacological behavior modification and relative analgesia (RA) for well over 170 years now since its discovery in 1844 by the American Dentist Horace Wells. Advantages include raising of the pain reaction threshold, alteration of both pain sensitivity and pain reaction, reduction of fatigue, and time awareness that helps to handle stress and lengthy appointments. In addition, the most important clinical consequences of Nitrous Oxide (N2O) pharmacokinetics are rapid induction and recovery, reversibility, titrability, and adjustability. The goal of the current investigation was to analyze the safety aspects of nitrous oxide sedation. It was carried out on 25 patients within the age group 7–10 years requiring extractions of two primary molars in each patient. Split-mouth design was followed, with the first extraction done under traditional slow induction while the second extraction was done following the rapid induction technique of NOIS. N2O was studied for its physiological effects, psychomotor analysis was done, cognition and recovery patterns were analyzed utilizing the two different induction techniques. Based on the results obtained, it was found that N2O is a very safe and useful drug that delivers a comfortable patient for dental treatment.

PDF Share
  1. Brahm C-O, Lundgren J, Carlsson SG, et al., Dentists’ views on fearful patients. Problems and promises. Swed Dent J 2012;36:79–89.
  2. Klingberg G, Broberg AG, Dental fear/anxiety and dental behaviour management problems in children and adolescents: a review of prevalence and concomitant psychological factors. Int J Paediatr Dent 2007;17:391–406. DOI: 10.1111/j.1365-263X.2007.00872.x.
  3. Chanpong B, Haas DA, Locker D, Need and demand for sedation or general anesthesia in dentistry: a national survey of the Canadian population. Anesth Prog 2005;52:3–11. DOI: 10.2344/0003-3006(2005)52[3:NADFSO]2.0.CO;2
  4. Armfield JM, Heaton L, Management of fear and anxiety in the dental clinic: a review. Aust Dent J 2013;58:390–407. DOI: 10.1111/adj.12118
  5. ADA Sedation guidelines for dentists. Adopted by ADA House of Delegates, October 2016. [Accessed 16/04/2020]
  6. Ryding HA, Murphy HJ. Use of nitrous oxide and oxygen for conscious sedation to manage pain and anxiety. J Can Dent Assoc 2007;73(8):711.
  7. Malamed SF. Sedation-E-Book: A Guide to Patient Management: Elsevier Health Sciences 2017.
  8. Clark MS, Brunick AL. Handbook of nitrous oxide and oxygen sedation: Elsevier Health Sciences 2008.
  9. Safe Sedation Practice for Healthcare Procedures. Standards and Guidance Academy of Medical Royal Colleges London; 2013.
  10. Kupietzky A, Blumenstyk A. Comparing the behavior of children treated using general anesthesia with those treated using conscious sedation. ASDC J Dent Child 1998;65(2):122–127.
  11. Hirisave U, Oommen A, Kapur M. Physiological Assessment of Children in Clinical Setting 1st ed. Bangalore: NIMHANS; 2002.
  12. Letourneau JE, Denis R. The reliability and validity of the Trieger tests as a measure of recovery from general anesthesia in a day-care surgery unit. Anesth Prog 1983;30(5):152–155.
  13. Hallonsten A-L, Jensen B, Raadal M, et al. EAPD guidelines on sedation in paediatric dentistry European Academy of Paediatric Dentistry, 2013;7:12. Internet:http://www eapd gr/dat/5CF03741/filepdfStand
  14. Cheong SI. Complications caused by nitrous oxide in dental sedation. J Dent Anesth Pain Med 2018;18(2):71–78. DOI: 10.17245/jdapm.2018.18.2.71
  15. Samir PV, Namineni S, Sarada P. Assessment of hypoxia, sedation level, and adverse events occurring during inhalation sedation using preadjusted mix of 30% nitrous oxide + 70% oxygen. J Indian Soc Pedod Prev Dent 2017;35(4):338–345. DOI: 10.4103/JISPPD.JISPPD_15_17
  16. Samur ES, Deliibasi EA, Isik B, et al. The effects of conscious sedation with nitrous oxide/oxygen on cognitive functions. Turk J Med Sci 2016;46(4):997–1003. DOI: 10.3906/sag-1504-37
  17. Khinda VI, Bhuria P, Khinda P, et al. Comparative evaluation of diffusion hypoxia and psychomotor skills with or without postsedation oxygenation following administration of nitrous oxide in children undergoing dental procedures: a clinical study. J Indian Soc Pedod Prev Dent 2016; 34(3):217–222. DOI: 10.4103/0970-4388.186751
  18. Mohan R, Asir VD, Shanmugapriyan, et al. Nitrous oxide as a conscious sedative in minor oral surgical procedure. J Pharm Bioallied Sci 2015; 7(Suppl 1): S248-S250. DOI: 10.4103/0975-7406.155939.
  19. Bonafé-Monzó N, Rojo-Moreno J, Catalá-Pizarro M. Analgesic and physiological effects in conscious sedation with different nitrous oxide concentrations.J Clin Exp Dent 2015;7(1):e63–8. DOI: 10.4317/jced.52034
  20. Baeder MF, Silva FD, de Albuquerque CLA, et al. 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):384–390. DOI: 10.5005/jp-journals-10005-1470.
  21. Hennequin M, Collado V, Faulks D, et al. A clinical trial of efficacy and safety of inhalation sedation with a 50% nitrous oxide/oxygen premix (Kalinox™) in general practice. Clin Oral Investig 2012;16(2):633–42. DOI: 10.1007/s00784-011-0550-y
  22. Leelataweewud P, Vann WF, Dilley DC, et al. The physiological effects of supplemental oxygen versus nitrous oxide/oxygen during conscious sedation of pediatric dental patients. Pediatr Dent 2000;22(2):125–33.
  23. Hirisave U, Oommen A, Kapur M. Physiological Assessment of Children in Clinical Setting 1st ed. Bangalore: NIMHANS; 2002.
  24. Zoccolotti P, Antonucci G, Judica A, et al. Incidence and evolution of the hemineglect disorder in chronic patients with unilateral right brain damage, Int J Neurosci 1989, 47:3–4, 209-216, DOI: 10.3109/00207458908987435
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.