Protocols and procedures for safe administration of nitrous oxide–oxygen inhalational minimal sedation for anxiolysis in pediatric dentistry: A case series

Abstract

Abstract Fear and anxiety related to dental treatment are the most important causes of avoidance of oral care among pediatric patients. The majority of pediatric dental patients are managed with only behavior management techniques, without any pharmacological intervention. However, several pediatric dental patients, owing to noncooperation or the extent of surgery required may require pharmacological means of management, such as sedation or general anesthesia. Children with mild-to-moderate anxiety are suitable for management with inhalational sedation agents, such as nitrous oxide and oxygen (N2O–O2). An inhalational mixture of N2O–O2 has been used in this setting for over a century and has a high index of safety. With the advent of newer failsafe equipment for the delivery of these agents and the availability of trained dental and anesthesiology teams, this modality of sedation for behavior management of children while rendering dental treatment is gaining more acceptability. Proper case selection, informed consent from parents/guardians before the procedure, preprocedure and preprocedure counseling, and anesthetic evaluation of the child are important steps in the successful administration of sedation. The awareness of guidelines, alertness regarding adverse events, and preemptive preparation to manage any critical incident are essential for the safe administration of this inhalational mixture; thus, providing oral care to pediatric patients with the least amount of discomfort.