Why Don’t Dentists Use Nitrous Oxide Anymore
Sep 26

Sedation Dentistry - Why Don’t Dentists Use Nitrous Oxide Anymore?

Sep 26

In times gone by, nitrous oxide, also popularly known as laughing gas, was the prevailing method for a painless dental procedure. However, dentists now use other procedures instead of nitrous oxide for painless treatment.

This raises the question, ‘why don’t dentists use nitrous oxide anymore?’ there are a host of reasons why dentists don’t use nitrous oxide anymore. For one, it is no more as potent as it used to be. Over the years, its effectiveness has reduced to a great extent which compelled dentists to try other methods to help their patients have a pain-free experience. Besides that, there have been cases of nitrous oxide causing harm to patients due to improper usage and even deaths in some cases.

Below is a detailed guide to figure out why don’t dentists use nitrous oxide anymore and what it is considered a dreadful substance.

What is Nitrous Oxide in Dentistry?

Nitrous oxide, also called laughing gas, is a colorless combination of oxygen and inhaled nitrous oxide, which provides a safe and effective means of relieving pain and anxiety during invasive dental procedures when used appropriately. It has been used in dentistry for more than 150 years after being discovered in the 1800s by Michael Faraday. In fact, after making the gas publicly available in 1844, it was named laughing gas as it made people laugh uncontrollably upon inhaling.

In dentistry, nitrous oxide is used as a sedative under proper administration with an inherent safety margin. To use this gas clinically, dentists must adopt appropriate work practices and adhere to usage guidelines by ADA Council on Scientific Affairs and Council on Practice for safe usage.

According to the National Institute for Occupational Safety and Health (NIOSH) research, controls like proper ventilation, system maintenance and good work practices can drastically reduce nitrous oxide concentration levels (approx. by 25 ppm) in dental procedures during analgesia administration.

How Does Nitrous Oxide Work?

When nitrous oxide is inhaled, it replaces the air in the lungs and stops oxygen from reaching your blood and brain. As a result, people get giggles, and even suffer hallucinations due to oxygen deprivation. That said, its effect wears off as soon as you stop inhaling. In fact, once the procedure is done, you can drive yourself home or to work and continue your day as you do.

Laughing gas or nitrous oxide affects its users in mainly three ways:

  • It works on your fear and reduces anxiety
  • It numbs you up so you don’t feel any pain
  • It creates euphoria so you zone out.

Initially, when you inhale the gas, you begin feeling light-headed already. According to reports, some patients feel a tingling sensation in their arms and legs immediately after the dosage and some feel heaviness in their arms and legs.

The most common way for its administration is with the help of a mask which is placed on the nose so the gas can be inhaled directly into the nose from the cylinder.

Why Don't Dentists Use Nitrous Oxide Anymore?

Earlier, nitrous oxide was commonly used in dental procedures but in recent years, several dentists have stopped its usage for a variety of reasons. Firstly, it must be administered in a particular amount under fixed conditions; otherwise it can be dangerous for the patient. Secondly, its effect doesn’t last for long. Hence, it’s not always functional. Third, nitrous oxide makes patients light-headed and causes dizziness so not all patients are comfortable with it. Lastly, nitrous oxide is less effective and more costly than other sedatives, meaning there are better alternatives to nitrous oxide.

Should You Use Nitrous Oxide?

Below we have compiled a list of pros and cons of using nitrous oxide. Have a look at them to know in further detail if it’s a wise decision to go for it.

Pros of Not using Nitrous Oxide

Lying under the knife is not always easy for everyone, especially if you have anxiety, depression or other health conditions. Therefore, dentists go for nitrous oxide, also called laughing gas, to make the patient’s experience smooth and painless. However, there are some advantages of not using this gas, for instance:

Nitrous oxide in some patients causes nausea and vomiting which can be extremely dangerous when the patient is lying down on the chair for the treatment.

Next, nitrous oxide can affect the patient’s mobility for up to 24 hours. If the patient is to drive themselves home, it is better not to sedate them with nitrous oxide.

Cons of Using Nitrous Oxide

Over the years, nitrous oxide has been used as an effective substance to relieve anxiety and pain. However, nowadays, dentists have switched to its alternative due to a variety of its disadvantages.

Nitrous oxide is administered through a mask and hence causes nausea, vomiting and dizziness in some patients. Prolonged exposure can lead to panic attacks and even nerve damage. Between 2020 to 2001, 56 deaths were registered due to nitrous oxide. In fact, some reports suggest that it is the 3rd most common substance on death certificates.

Several people have died due to its overdose, which raises safety concerns. Lastly, nitrous oxide is not REALLY effective in treating dental anxiety. In fact, some people feel more conscious after taking it.

How is Nitrous Oxide Clinically administered?

How is nitrous oxide clinically administered

When dentists use nitrous oxide before the treatment, they monitor their patients constantly to look for signs of anxiety and discomfort. If any is found, the dentist immediately halts the gas flow.

Back then, nitrous oxide use was common. However, now it has declined as it holds a slight risk of death upon prolonged usage or over dosage. While this is rare, but it is still a risk. Moreover, nitrous oxide is found to cause kidney and liver damage if it is used frequently.

Nitrous oxide is known to cause several birth defects if used incorrectly during pregnancy.

Nitrous Oxide during Labor

Since nitrous oxide is a pain reliever, it is also used by pregnant women to reduce labor pains. During labor, patients can control their nitrous oxide intake. They can remove and take on their nitrous oxide mask themselves. Its effect can be felt in 30 seconds or even less.

Many women opt for nitrous oxide to deal with early labor pain and choose a better alternative during actual labor. Some women even go for nitrous oxide during active labor by putting on the mask when contractions are felt and removing it when they felt none, by their choice.

Other Related Queries Regarding Nitrous Oxide

  • How long does its effect last?

Nitrous oxide is either inhaled from a cylinder or a balloon and lasts for about 10 minutes or less.

  • How does nitrous oxide is used during a procedure?

When you go for your dental procedure, you will be administering nitrous gas 5 minutes before the procedure begins. For that, the dentist will apply a face mask connected to a cylinder filled with nitrous oxide. You will start to feel relaxed within a few minutes after applying the mask.

Once the procedure is done, your dentist will turn off the gas. However, you may resume inhaling oxygen for a few minutes as it will allow you to regain consciousness fast.

  • Are there any national standards and guidelines for safe usage?

The Occupational Safety and Health Administration (OSHA) and NIOSH have laid down safety guidelines for the careful administration of nitrous oxide. NIOSH suggests an exposure limit of 25 ppm as a time-weighted average during the period of anesthetic administration.’ on the contrary, OSHA has not currently laid down guidelines for occupational exposure limits.

  • What are the best practices for a safe dosage of nitrous oxide?

The recommended practices for nitrous oxide dosage are by using a nasal scavenging mask, frequent inspection of the substance delivery, monitoring scavenging apparatus for leaks and abundant room ventilation. It is also recommended to perform periodic inspections of the air in the breathing zone and ensure nitrous oxide levels are below 25 ppm.


Nitrous oxide works differently than other sedatives. It doesn’t put patients to sleep. Instead, it calms them and relieves their distress and pain. Due to this, patients feel more comfortable and lighter during the procedure.

If it’s such a good pain reliever, then why don’t dentists use it anymore? Well, as we said above, nitrous oxide has its own side effects. To ward them off, modern-day doctors don’t mainly rely on it. That doesn’t mean its use is completely halted. Some dentists in the United States still use it in moderate amounts to relieve pain during medical procedures.

If you are someone about to go under a knife, it’s better to confirm with your doctor if they are going to use nitrous oxide. Because if you’re not comfortable with it, you can directly address your concern to them.