Is used to help anxious children and adults have dental treatment. It is often used along with other techniques to help the patient relax.

• It is also called ‘happy gas’ or ‘happy air’.
• Type of conscious sedation brought on by breathing in a combination of two gases, nitrous oxide and oxygen in proportions.
• The gases are breathed in and out through a small mask resting over a nose that remains in place throughout treatment.
• The gases produce a calming and relaxing effect. Most patients become less aware of their surroundings, but they will not go to sleep. Sedation is not general anaesthetic.
• Lavender smell recommended in dental surgery – to boost the N2O effect
• SLASH acronym for IS, especially students undergoing training in IS
• good for patients with mild and moderate anxiety, but may not be optimal for more phobic patients
• some patients with special needs may not be able to breath via nose adequately
• technique sensitive, personality sensitive, nasal hood has to be well sealed
•  semi-hypnotic imaginations
• voice-sensitive and imaginations-sensitive technique
• N2O/O2 particularly indicated for patients with heart conditions due to extra oxygen inhalation (minimum 30%, ie. more than in the air – 21%)
• special caution in case of patient who had eye surgery (intraocular) recently
• patients who tolerant to benzodiazepines may be also tolerant to N2O
• Autistic patients (ASD) may not respond well to IS as they do not listen verbal instructions

 

 

 

Before the appointment:

• Have a light snack or small meal 2 hours before your appointment (however, there is no need for fasting according to evidence based data)
• Please take any medications as normal
• Children under 16-years of age must be accompanied by a responsible adult who must remain on the premises while treatment is received.
• If the escort is pregnant it is recommended she does not remain in the surgery whilst inhalation sedation is used.
• Wherever possible do not bring any other children to the appointment.
• Adults receiving happy air must be accompanied to the fist appointment by a responsible adult escort. Depending on the response to sedation – the treating dentist will advise on the suitability of attending subsequent appointments alone.

 

What can parents do to help ?

• Always speak positively about your child’s dental care. Don’t talk about your fears in front of them.
• Have confidence in your child’s ability to cope.
• Practice nose-breathing at home with your child
• Follow the instructions as detailed.

 

 

At the time of the sedation appointment please let us know:

• About any change in your health
• About any changes in the medications taken.
• If the patient is pregnant
• About any concerns regarding the proposed treatment.
• Due to the tiredness following inhalation sedation , activities should be restricted and no sports should be undertaken.
• It is recommended that the journey homeis in a car or taxi, rather than public transport.
• Adults are advised not to return to work and must adopt caution before driving, operating machinery or signing legal documents.

 

After the appointment:

•  After inhalation sedation patient should make a full recovery within 30 minutes.
• Children should not return to school, and should rest under the supervision of an adult for the remainder of the day.
• Due to tiredness following inhalation sedation, activities should be restricted and no sports should be undertaken.
• It is recommended that the journey home is in a car or taxi, rather than public transport.
• Adults are advised not to return to work and must adopt caution before driving, operating machinery or signing legal documents.

 

N2O/O2 use practical advice:

Ideal sequence:  music – chat – topical – IHS – chat – check – the Wand LA – chat – treatment – more chat

Tip: use a ‘fancy’ , disposable cover for IHS oxygen and nitrous oxide cylinders, eg. with flowers, toys, cartoons, etc.

Do not overestimate the efficiency of IHS, it depends on individual susceptibility.

Take into consideration patient cooperation and whether patient is able to understand the planned procedure.

Sometimes, ‘mask can be scary’  for little children. They need lot more reassurance. Silhouette mask for IHS  (“oxygen-like” mask) may be a good alternative (EBD data required).

IHS usually works well for ie. ‘borderline’ cases, when child is initially anxious but can be managed well using BM or CBT

Chaperone (escort) person not necessary for adult, mandatory for children below 16 y.o.

No need for fasting, just a light meal prior to procedure

No need for detailed health check, ie. BP, HR, O2% unless some complex medical problems

Following few IHS sessions, patient may accept dental tx in a routine way, with LA alone

Active scavenging prior to equipment check list at the beginning of the day! to avoid occupational health hazard and N2O exposure

Ba careful re: electrical devices use during IHS due to a high concentration of oxygen. No vaseline, avoid static electricity, no open flame burners for denture work.

Young children and adolescents may feel strange sensations, including hallucinations, eg. “people on the sealing who watching me”

Typical sensations as the N20/02 effect: tingling sensations, pins and tins within lips, ‘room is moving around’

First signs of IHS often blinking eyes

To seal mask properly!, needs to be really tight, no air flow from underneath, pt should not feel ‘blowing air around eye area’

Dental chair position sensitive technique, do supine the patient as mas ans tubing will dislodge easily.

Slippery disposable sleeve for head rest deteriorates tubing position, and mask/tubing my slip down, creating gases leakage

Dealing with children, dentist needs to demonstrate a positive attitude with ‘sense of humour’ and take the whole session “not too seriously”. Young patient must feel comfortable and relaxed all the way through.

Gentle pressure on the mask during administration of N2O and O2 may improve the seal and efficacy of N2O/O2 inhalation.

Use of nasal mask with a ‘funny’ colours and even different flavours for young children is making them more attractive and exciting.

Do not flush a reservoir bag after the IHS session as this may cause an unnecessary air contamination with N2O.

Use additional measures, such as: calming music, aromatherapy along with HIS has a synergistic effect along with sedative gas.

It is the good practice to monitor O2 saturation with the use of pulse oximeter

Avoid the adverse effects immediately after the first ‘red alert’ symptoms occur, eg. ‘rollercoster effect’, feeling sick

Warn re: some form of headache after returning home

 

For adult patients, the advice needs to be always given regarding avoidance of some activities till the end of the day when N2O/O2 was administered (not to sign any important documents, not to operate a heavy machinery, etc.)

The alcohol consumption in combination with N2O/O2 administration may trigger unwanted effects in adult patient, often nausea, vomiting

The misuse of controlled drugs in combination with N2O/O2 administration may trigger unwanted effects in adult patient, including  occasionally hallucinations

Helpful tip: when introducing nitrous oxide/oxygen to an extremely anxious patient – place the nasal hood a few inches above the nose and descend slowly into the patient’s nose, enabling gradual desensitization to the experience.

Patient must not use petroleum ointment during IS session as burning injury due to interaction with Vaseline. Only water-based products !

Phobic and generally healthy adolescents are the most unpredictable (worse) group of patients. They may not allow IV cannulation and/or LA as are needle phobic, demand only GA as cannot accept any other options for pain and anxiety control.

Operator and nurse need to use a N2O dosimeter to monitor N2O exposure (pen-like, in top pocket)

Blood pressure may decrease at the end of IHS as the consequence of vasodilatation N2O effect

Good idea is to use “Message to Dentist” option prior sedation for phobic child. He or she may express things he or she does like or not like re: dental treatment. Paper version can be ‘signed’ by both dentist and little patient (sort of contract between :).

Reflection: not all patients want to know everything what is going to happen, so less talking, be more efficient

Discourage patient to be involved in conversation during ihs pr0cedure, eyes closed and mouth close during induction, deep slow calm breathing. Closed questions: yes/no, thumb up signaling, etc.

Tip & Trick: silicone flavored band for nasal hood and ask the little patient for IS – ‘what colour/flavour of gas do you prefer?

Ask patient: “Can we start right now?”

So called “panic buton” during IS to make patient more able to control everything  and feel comfortable?

Some videoglasses can be used along with IS nasal hood if do not obstruct nasal area.

 

 

Frequently Asked Questions

Question: Will my child go to sleep and will not remember anything afterwards ?

Inhalation sedation is not intended to replace the general anaesthesia, neither is not to be a ‘light’ form of general anaesthesia. Therefore, a child may remember the dental procedure carried out, however this memories can be slightly impaired due to the nature of this form of sedation.

Q: As an expecting mother, can I accompany my child during the gas sedation and be with my child in the dental office ?

 No, if you are pregnant it would be safer not to be present in the dental office during the procedure due to the fact that the effect of N2O gas (gas using for sedation) onchild development is not known and can be potentially harmful.

Q: Is there any risk related to inhalation sedation ? Is this safe ?

A: Yes, definitelly. Inhalation sedation is extremely safe technique, the most safe method of conscious sedation used for dental procedures. Very rarely it causes some minor problems, for instance the sedation may not be complete if child is unable to breathe easily through the nose, e.g. if child has a cold. Very ocassionally child may feel sick, that is why it is advisable to eat only a light snack up to 1 hour before an appointment.

Q: May my child try the mask used for inhalation sedation before appointmant ?

 Answer: Some young children can be scared and may dislike wearing the nose mask. It is a good practice to make them familiar with the mask by  showing the mask and getting child to practice using it beforehand. Very

Q: Can my child get seriously dizzy because of the IS ?

 Yes, rarely a child may feel a bit dizzy. This reaction usually goes away immediatelly after the dentist stop administrating the gas.

Q: What the IHS is like ?

 A: Children quite often feel worried about having treatment by the dentist. The ‘inhalation sedation’ – sometimes called ‘happy air’ or ‘laughing gas’ – is one of the ways dentist can help child feel less nervous and child should be able to cope with dental treatment more easily. Child will be conscious the whole time, will be able to communicate with the dentist.

Q: Can inhalation sedation reducing the pain ? Does the child receiving IHS need an injection for dental treatment ?

 A: Well, the IHS itself is not the method designed for pain ellimination, but it is used for reducing the patient anxiety and fear. It means, the standard ‘injection’ can be necessary to anaestetise the tooth. Child may still need to have local anaesthetic (injection) as part of the treatment but this will be carried out once they are sedated.

Q: What are the other benefits of IHS apart from reducing fear and anxiety ?

 A: IHS can be very helpful if your child tends to gag during dental treatment. It can also help if child is severely afraid of injections or extractions. Child may have the dental treatment carried out without being scared.

Q: What are the feelings when child is receiving ‘gas’ sedation?

 A: A ‘soft’ mask will be placed over child’s nose. Breathing of the ‘happy air’ – a mixture of two gases: nitrous oxide and oxygen – is causing the relaxing effect and child will feel more comfortable with dental treatment. The most common reactions include a tingling feeling – ‘tins and pins’ in the arms and fingers, a feeling of well-being, a floating sensations.

 Q: Who can assist me and my child

The dentist and dental nurse will help put your child at ease by talking softly and calmly throughout the treatment. When the dental treatment is finished, the dentist will turn off the ‘happy air’.

Q: If my child is having a cold, can dentist use inhalation sedation?

A: No, if child is unable to breathe through their nose due to heavy cold, the gas sedation will not work. Parent should call the clinic to rearrange the appointment.

Q: Who can help me, if I am having some concern regarding some details of HIS ?

 Parent should contact the HIS provider in case of any other queries relating to child’s health.

Q: What is the alternative sedation method if my child does not respond to IHS ?

 A: Depending on the individual susceptibility, the inhalation sedation may not be sufficient for anxiety control. Therefore, more efficient and deeper form of sedation may be necessary, including a general anaesthesia. Parent can discuss all options with dentist during child’s initial appointment and ask any questions.

Q: Do I need to sign a consent for IHS?

 A:.Yes, parent is asked to sign a ‘consent form’ which is the evidence of parent’ agreement to the treatment. This can be done on the separate, pre-assessment visit. During consenting procedure parent has also the opportunity to ask any questions and to make sure he/she understand what the procedure involves.