Laughing Gas can make a dental visit fun
A comprehensive overview of nitrous oxide
Laughing gas is also called inhalation sedation, happy gas, nitrous, nitrous oxide or N2O-O2. It has more synonyms than any other sedation technique! And deservedly so. Inhalation sedation with nitrous oxide (N2O) and oxygen (O2) has been described as
“representing the most nearly ‘ideal’ clinical sedative circumstance”…
What is Laughing gas? And what does it do?
Nitrous oxide (N2O) is simply a gas which you can breathe in. It’s colorless, sweet-smelling, and nonirritating. It was discovered in 1772. Humphrey Davy (1778-1829), one of the pioneers of N2O experimentation, described the effects of Laughing gas on himself following self-administration for a toothache and gum infection as follows:
“On the day when the inflammation was the most troublesome, I breathed three large doses of nitrous oxide. The pain always diminished after the first four or five inspirations; the thrilling came on as usual, and uneasiness was for a few minutes swallowed up in pleasure.”
How Does Laughing Gas Make You Feel
Sounds like fun!! The extract above pretty much summarizes the effects of Laughing gas: it minimizes pain – and it induces a pleasureable feeling. After 5 minutes or so of breathing in the gas, you should feel a euphoric feeling spread throughout your body. It really kind of feels like a ‘happy drunk’ feeling. Some people find that there are auditory or visual effects as well. You will feel a bit light headed and often people get ‘the giggles’ (hence the name laughing gas!).
First-hand accounts of laughing gas
“I started feeling warm all over. The elevator-type music they had on was starting to all sound the same and I could have sworn that they were looping the same song over and over and over. I remember somewhat the dentist coming in and telling me that this is going to be a “Three Martini Cleaning” and asked me if I preferred Strawberry Daiquiri or Pina Colada. The taste of Pina Colada filled my gums and then I saw the needle with the local anesthesia for a second, but he must have decided not to use it because I seriously didn’t feel anything. I was already under a nice level buzz from the N20 and I could feel myself relaxing into the chair — the drugs were finally kicking in. The Pina Colada taste in my mouth made me start thinking of previous Caribbean vacations and next thing I know I faded into sleep.
About a minute later (or at least that’s what it felt to me), I started waking up and heard that “Rock the Boat” song AGAIN or was it still the same one that was on when I closed my eyes? I couldn’t tell and to be honest, I didn’t care. They told me to swish some water in my mouth and spit in the sink thing. It was all kind of blurry, not sure if I made it entirely inside the sink, but they were all very good about it. They let me breathe in some oxygen and some of the buzz started to go away, though I kinda liked it and wished it hadn’t.”
What to expect
Laughing gas that it’s safe to use for long periods of time if you mix it with oxygen (O2). Hence, the “laughing gas” used these days is called N2O-O2, and contains at least 30% oxygen (that’s all the machines used nowadays will permit!). Usually, the mix is about 70% oxygen to 30% nitrous oxide.
Levels of sedation
Depending on the concentration and length of administration of laughing gas, four levels of sedation can be experienced (after an initial feeling of light-headedness):
(1) a tingling sensation, especially in the arms and legs, or a feeling of vibration (“parasthesia”), quickly followed by
(2) warm sensations, and
(3) a feeling of well-being, euphoria and/or floating (“drift”). During heavier sedation, hearing may dissolve into a constant, electronic-like throbbing.
(4) At a deeper level of sedation again, sleepiness, difficulty to keep one’s eyes open or speak (“dream”) can occur.
How is it administered?
The equipment used for delivering “happy gas” is quite simple. It consists of a supply of compressed gases and an apparatus which delivers the gases to the client. By turning some knobs and flipping on/off switches, the dentist can produce the desired mix of N2O-O2 in the desired quantities. Flowmeters and pressure gauges allow the administrator to keep an eye on the flow of gases.
The desired N2O-O2 mix is fed through a tube to which a nasal hood is attached. This hood is put over your nose. All you have to do now is breathe normally through your nose – bingo!
The advantages of laughing gas
* laughing gas works very rapidly – it reaches the brain within 20 seconds, and relaxation and pain-killing properties develop after 2 or 3 minutes.
* The depth of sedation can be altered from moment to moment. Other sedation techniques don’t allow for this. For example, with IV sedation, it’s easy to deepen the level of sedation, but difficult to lessen it. Whereas with gas, the effects are almost instant.
* Other sedation techniques have a fixed duration of action (because the effects of pills or intravenous drugs last for a specific time span), whereas gas can be given for the exact time span it’s needed for. It can also be switched off when not needed and then switched on again (though to avoid a roller-coaster effect, you shouldn’t do this too abruptly).
* There’s no “hangover” effect – the gas is eliminated from the body within 3 to 5 minutes after the gas supply is stopped. You can safely drive home and don’t need an escort.
* With nitrous oxide, it’s easy to give incremental doses until the desired action is obtained (this is called “titration”). So the administrator has virtually absolute control over the action of the drug, preventing the possibility of accidental overdoses. While giving incremental doses is possible with IV sedation or general anesthesia, it’s not possible with oral sedation (as a result, oral sedation can be a bit of a hit-and-miss affair).
* Unlike IV sedation, no injection is required. In cases of very severe needle phobia, getting laughing gas first can help you feel relaxed enough to allow the needle required for IV sedation to be inserted in your arm or hand. The very deep state of sedation achievable through IV sedation may then allow you to accept local anaesthetic.
* Inhalation sedation is very safe. It has very few side effects and the drugs used have no ill effects on the heart, lungs, liver, kidneys, or brain.
* For certain procedures, especially those involving soft tissues (e. g. deep cleaning), inhalation sedation may be used instead of local anaesthesia. N2O acts as a painkiller; however, its pain-relieving effects vary a lot from person to person and can’t be relied upon. So if you’re determined to give the needle a miss, you and your dentist will have to try and see what happens…
* Inhalation sedation has been found to be very effective in eliminating or at least minimizing severe gagging.
Are there any disadvantages?
* Some people are not comfortable with the effects of laughing gas . Either because they’re afraid they might lose control or because it makes them feel nauseous. This is quite rare, though, and usually due to oversedation. If you’re prone to nausea, it’s a good idea to have a meal (not a huge one) about 4 hours before your appointment. If that’s not possible , make sure your stomach isn’t completely empty.
* On rare occasions, people have a bad experience with N2O. Usually this is due to oversedation. This is easily reversible by reducing the amount of N2O in the mix.
“You hear EVERYTHING (dentist and nurse talking, the pop music on the radio in the background) with a kind of reverb effect. Imagine someone saying the word “rhubarb”. What you hear is “rhu-rhu-rhu-bar-bar-bar-b-b-b”. It’s not unpleasant, just a little odd… As the gas takes effect and you get a bit sleepy you can’t keep your eyes open.
Don’t confuse “dizziness” with the normal feeling of lightheadedness which many people who’ve never had N2O before experience after maybe 60 or 90 seconds. The feeling of lightheadedness will pass as the concentration of N2O is increased.
Apart from that, most of the disadvantages of inhalation sedation do not affect the client, but the dental team: there’s training required, the equipment is quite bulky and takes up a lot of space. The cost of the equipment and gases is high, so you’ll have to contribute to the cost – but it’s quite a bit cheaper than IV sedation.
When should I not use it?
There aren’t any major contraindications to laughing gas, except for emphysema and some exotic chest problems. It hasn’t been proven to be safe during the first trimester of pregnancy, so you can’t use it then. Because you have to breathe it in through your nose, it’s not suitable for people who have a cold or some other condition which prevents them from breathing through their nose.
You can’t be allergic to N2O. It’s also safe to use if you suffer from epilepsy, liver disease, heart disease, diabetes, or cerebrovascular disease. It is also used quite successfully in many people with respiratory disease.