Visiting the dentist can trigger anxiety in some patients, making treatment difficult. A sedation service using nitrous oxide, also known as laughing gas, is now available to calm young patients with dental anxiety.

 The mere thought of visiting the dentist is enough to make some people —adults or children — break out in cold sweat.

In fact, patients of all ages can suffer from mild to severe anxiety when it is time to see the dentist, even if it is for something as routine as their regular checkup, said Dr Bien Lai, Senior Consultant and Head, Paediatric Dentistry Unit, Department of Restorative Dentistry, National Dental Centre Singapore (NDCS).

One reason for this is patients associating dental procedures with pain. “Most people visit a dentist only when there are signs and symptoms of dental issues, such as decay. As such, most dental procedures are curative rather than preventive,” explained Dr Lai.

Curative dental procedures can range from the minimally invasive, such as simple fillings, to more invasive treatments involving extractions and extensive removal of tooth structure, such as crowns, for restorations. “When extensive dental procedures are involved and located near the nerve in the tooth, local anaesthesia is often needed to numb the area. The idea of administering local anaesthesia via an injection is frequently associated with pain,” Dr Lai said. She added that the sensory overload from the dental operatory setup — for example, loud sounds from the suction tip and handpieces — can also induce anxiety.

“Patients with dental anxiety often clam up and tend to not open their mouths as wide. This hampers the procedure from being performed optimally as the dentist may be unable to have adequate access for dental procedures, resulting in lengthy treatments,” she said. In extreme cases, the treatment may even have to be aborted or postponed.

The good news is that there is now help for children and adults who suffer from dental anxiety.

NDCS introduced its nitrous oxide sedation service for paediatric dental patients in June 2023. Commonly known as laughing gas, nitrous oxide is mixed with oxygen and breathed in through a rubber mask placed over patients’ nose. This helps patients relax and cope better with dental procedures while also providing some pain relief.

When properly used, nitrous oxide sedation is generally safer than general anaesthesia (GA) for complex dental procedures due to its milder nature. It also presents lower risk to the respiratory system and haemodynamics (blood flow through vessels), and allows for a shorter recovery time as the inhaled gas is eliminated quickly from the body.

“Nitrous oxide inhalation sedation is generally very safe. Some common side effects include vomiting, nausea, dizziness, light-headedness, occasional hallucinations, and agitation,” Dr Lai shared. “Very rarely, a patient may experience blunting of the cough reflex that may increase the risk of saliva or vomitus being inhaled into the lungs and causing pneumonia. This will require further medical management,” she said.

There is no minimum age requirement for children to qualify for the procedure, but the patient “has to be relatively cooperative”, shared Dr Lai. They must be able to tolerate having a nasal hood placed on them.

As of end 2023, the sedation service has been performed on 24 paediatric patients.

The sedation procedure is unsuitable for pregnant patients, patients who are taking drugs, food or drinks that slow down brain activity (such as opioids, alcohol, etc.) or herbal remedies, and patients who are not feeling well, including those with an ongoing respiratory tract infection, and/or any contagious illnesses.

Prepare your child before visiting the dentist

Besides relying on nitrous oxide, Dr Lai recommends that parents exercise these good practices to calm their kids before a dental appointment:

1 Prepare them for their first dentist appointment by screening videos or reading storybooks depicting a pleasant visit to the dental clinic.

2 Share with them what to expect during a session to remove uncertainty, which contributes to anxiety, and refrain from using scare tactics or triggering words such as ‘pain’, ‘injection’, ‘pluck teeth’, etc.

3 Reinforce the message that dentists help keep their teeth strong and healthy.

4 If they have had unpleasant experiences before, it is best to let the attending dentist manage their anxiety on the day of consultation.

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