Efficacy and Safety of Nitrous Oxide Inhalation Sedation in Paediatric Dental Patients: A Comparison of Different Concentrations

Abstract

Introduction: In order to effectively treat children, managing terrified and nervous paediatric dental patients is crucial. The choice of a specific behaviour control strategy is at the operator’s discretion, but it may be influenced by parental approval. Clinically beneficial pharmacological therapies, such as Nitrous Oxide-oxygen Inhalation Sedation (NOIS), have been demonstrated. However, prolonged exposure to specific amounts of these therapies could pose health hazards for medical personnel. Aim: To evaluate the clinical efficacy and safety of utilising N2 O inhalation sedation at a 70% concentration in a paediatric dental setting, compared to administering it at 50% and 60% concentrations. Materials and Methods: A non randomised clinical trial was conducted in the Department of Paediatric and Preventive Dentistry at Saveetha Dental College, Chennai, India. The duration of the study was three months, from June 2022 to August 2022. A total of 42 young patients between the ages of 4 and 10 who required mandibular pulpectomy and crown were selected. During the study, the researchers recorded each patient’s levels of sedation and cooperation at four specific time points while administering a fixed concentration of N2 O. The concentrations at these time points were 50% at the 10th minute, 60% at the 20th minute, 70% at the 30th minute, and 70% at the 40th minute. The study compared the primary outcomes of sedation and cooperation levels, along with the secondary outcome of adverse effects, between the different time intervals using the Kruskal-Wallis test followed by post-hoc tests for pairwise comparison. The level of significance was set at p<0.05. Results: The mean age of the children included in the present study was 7.4±1.324 years. At the end of 40 minutes at a 70% concentration, a deep sedation score of six was achieved by 7 (16.7%) of the patients, while none of the patients achieved this sedation level at concentrations of 50%, 60%, or 70% at the end of 30 minutes. The mean sedation score of patients at the end of 40 minutes at a 70% concentration (4.86±0.683) was higher than the sedation score of patients at the end of 30 minutes at a 70% concentration (4.36±0.656). Cooperation at a 70% concentration was better at the end of 40 minutes (5.83±0.377) than at the end of 30 minutes (5.40±0.497). At 50% and 60% concentrations, no adverse effects were observed. Conclusion: Sedation at a 60% concentration was more effective than 50% in achieving satisfactory cooperation to complete dental treatment without any adverse effects. Additionally, at a 70% concentration, sedation and cooperation were higher, but adverse effects were noted, warranting caution when considering its use for extended periods.

Keywords

• cooperation
• nitrous oxide
• paediatric dentistry
• sedative agent