Dentists ‘using too much laughing gas’ to sedate children | UK | News
Nitrous oxide may help relieve dental anxiety (Image: Getty)
One study found that dentists use so much laughing gas that the dose and flow rate during sedation vary widely. Nitrous oxide (N₂O) is used to relieve anxiety and help patients relax during procedures such as fillings, crowns, and root canals. Researchers at UCL examined nearly 900 departments across 31 dental wards in the UK, 83% of which involved children aged 15 and under.
Their analysis found that N₂O concentration ranged from 10% to 70%, with an average of 35%, and flow rates ranged from one to 13 liters per minute. Professor Paul Ashley, a specialist in pediatric dentistry at UCL Eastman Dental Institute, said the findings suggested “many patients may be taking in more gas than they actually need”.
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He added: “Our analysis showed that depending on how nitrous oxide was administered, flow rates varied from 1 to 13 liters per minute, with no clear link to patient age.
“Using higher flow rates does not improve patient experience or treatment outcomes, but increases nitrous oxide use and environmental impact, so there is a clear opportunity to deliver equally effective care that is more thoughtful and patient-centered.”
Of the 31 dental services included in the study, 30 were NHS and one was private.
The amounts of laughing gas measured in the study remained safe and effective; 92% of procedures were completed successfully. There was no suggestion that variation in precautions posed a risk to patients.
But the team warned that it is a potent greenhouse gas and unnecessary waste has significant environmental impacts.
The average sedation creates a carbon footprint equivalent to a 72.8-mile trip in a gasoline-powered car, according to the study.
19 of 31 wards also reported using inhaled sedation during conditioning procedures (simple procedures such as polishing to desensitize patients).
However, the study found that conditioning did not increase overall success rates for services.
In the team’s article published in the British Dental Journal, it was stated that the use of N₂O has a high success rate and is the only standard sedation technique available for children.
They therefore supported continued use but called for action to reduce waste, minimize flow rates and update guidelines to take into account the environmental impact of the gas.
Lead author Alexandra Lyne, also from UCL, said: “Nitrous oxide has an important role in dental care, particularly for children and young people, but it is also a potent greenhouse gas.
“Our study shows that environmental impact varies greatly between services, largely due to differences in the way they are supplied and managed.
“Our recommendations include monitoring usage, reducing unnecessary waste and standardizing practices where possible. By doing this, dental services can reduce emissions while maintaining patient care.”
British Dental Association board member and specialist care dentistry consultant Natalie Bradley said research was ongoing into possible alternatives to N.2O in dentistry.
He added: “There are certain groups of patients for whom suitable alternatives are not currently available or practical. Without this method of sedation, more child patients would only be able to access dental care through general anesthesia. “This will increase recovery time and anesthetic gases will contribute significantly more to the carbon footprint.
“Sedation training standards in dentistry also emphasize the least invasive sedation technique for the minimum duration, and the high success rates for the treatment quoted in this study show that it not only provides effective dental care but also means that repeated visits for failed treatments are not required, and we know that the biggest contributor to the carbon footprint in dentistry is patient and staff travel.”
