As Patient Anxiety Rises, Nitrous Oxide/Oxygen Sedation Can Help

| 07-14-2020
Best Practices for Nitrous Oxide/Oxygen Sedation

Help Your Patients Relax While Maintaining Infection Prevention


As dental professionals continue to adapt to the challenges of COVID-19, every aspect of the practice is rightly being reevaluated through the lens of infection prevention, including nitrous oxide/oxygen sedation. Though this technology has been used for decades to manage patient anxiety and improve the overall dental treatment experience for patients, some practices are currently choosing to forego it out of an abundance of caution for infection prevention. This decision, however, may be rooted in misconceptions about using and reprocessing nasal masks and circuits, and it can negatively impact patient flow. 

Age-old anxieties about the dental visit are not going away any time soon. In fact, they are likely exacerbated by the ongoing pandemic. So, with a thorough understanding of the ADA’s updated protocols, conscious sedation can continue to be an integral part of your practice; one that is arguably more important than ever.

 Understanding New Protocols for Best Practices

The ADA’s Return to Work Interim Guidance Toolkit covers the use of nitrous oxide with a succinct statement of best practices: “use [a] disposable nasal hood; tubing should either be disposable or if reusable, sterilized according to the manufacturer’s recommendations.” However, there’s a lot to unpack within that single line to help you ensure you’re taking the right steps for your practice. Let’s start with selecting the appropriate nasal mask.

Single-Use Nasal Masks Reduce Cross Contamination

Single-use masks eliminate the need for sterilization and are thus critical for minimizing cross-contamination. In addition to limiting cross-contamination, single-use masks also help streamline reprocessing, saving time for staff and leaving room for other items in the sterilizer.

As you likely already know, there are two types of nitrous oxide delivery systems – patient demand and positive flow. Regardless of which system you prefer, both are compatible with single-use masks, such as the ClearView™ Nasal Mask for patient demand systems or the Axess™ Low Profile Nasal Mask for positive flow systems.

In addition to the infection prevention and time-saving benefits, a single-use product like the ClearView Nasal Mask enhances the experience for both patients and staff. The clear outer mask allows for visual monitoring of the patient’s breathing, while the soft inner mask creates an improved facial seal. Furthermore, its low profile expands the clinical field of view, making it easier to perform treatments, and it goes without saying that the appealing scents and colors help engage patients and increase relaxation.

Sterilizing Scavenging Circuits

The ADA’s guidance allows for reusable scavenging circuits if they are sterilized following manufacturers’ instructions for use for reprocessing. That means it is important to understand what parts of your scavenging circuits can be sterilized and what parts need to be disinfected or barrier protected, like the vacuum gauge and spiral tubing.

It’s also important to understand that sterilizing scavenging circuits between each procedure takes time, so it may be necessary to invest in additional inventory to ensure you have enough circuits on-hand at any given time to facilitate efficient patient flow. The good news is that it’s easier than ever to invest in the equipment you need, including the autoclavable components of the scavenging circuit, which are available for stocking-up. 

Barrier Protection or Disinfection of Flowmeters

While not explicitly stated in the ADA’s guidance, you don’t want to overlook flowmeters when it comes to infection prevention for nitrous oxide/oxygen sedation systems. Flowmeters should be treated just like any other surface in the operatory, meaning they should either be barrier protected or disinfected following standard operating procedures for room turnover and reprocessing. 

Keep in mind that analog flowmeters may need to be fully bagged since dials and knobs can’t be barrier protected. Alternatively, digital styles like the Digital Ultra™ Flowmeter are easy to barrier protect and wipe down thanks to their flat surface.

Nitrous Oxide and Oxygen Sedation Are More Useful than Ever

While it’s only natural to be concerned about the infection prevention risks associated with all elements of the operatory, the reality is that, when following the proper protocol, nitrous oxide/oxygen sedation remains a safe, practical treatment option for practices. In fact, use of such techniques could actually help lessen exposure to a patient’s respiratory droplets by encouraging them to breathe through their nose into the nasal mask. Additionally, unlike an evacuation line, which has the potential for backflow, nasal masks and scavenging circuits form a one-way flow path.

In today’s fraught environment, nitrous oxide/oxygen sedation remains ideal for relieving dental anxiety. This has always been a challenge to overcome for some patients, but at a time when awareness of infection risks is at an all-time high, that challenge will be greater than ever as you work to get patients back in your chair. Fortunately, with advanced planning and a thorough understanding of the ADA’s guidance, you and your patients can have peace of mind when it comes to nitrous oxide/oxygen sedation. Add in a dose of proactive patient communication to allay their safety concerns, and this should continue to be a robust part of your practice; one that might just help you retain some anxious patients.