Being careful with nitrous: Limit exposure risks with the use of nitrous in the dental setting

By Noel Kelsch, RDH, RDHAP, MS

There are simple things we do on a daily basis in the dental setting that keep us all out of harm’s way. Sometimes we just get into a routine and do not see the impact of harmful things being overlooked. Three things are there to keep you and your patient safe: engineering, administrative, and work practice controls. There are steps using these concepts that have been recommended for many years to minimize exposure to nitrous oxide (N2O) during dental procedures.

It has long been known that delivery of nitrous oxide to patients can expose dental workers to this anesthetic gas, which does have an impact on the clinician. This can range from short-term behavior to long-term reproductive health impacts. It has been shown in several studies that acute exposure to nitrous oxide may cause a variety of symptoms for the clinician, such as lightheadedness, eye and upper airway irritation, cough, shortness of breath, and decreases in mental performance and manual dexterity. Chronic exposure to high levels of nitrous oxide among female dental assistants who worked in offices where scavenging equipment was not used was associated with an increased risk of spontaneous abortion and reduced fertility. Occupational exposure to nitrous oxide has also been associated with an increased risk of neurologic, renal, and liver disease.1-3

The National Institute for Occupational Safety and Health (NIOSH) recently conducted a web-based survey of dental professionals including dentists, hygienists, and assistants with 284 respondents, to look at their compliance levels in use of nitrous oxide regarding engineering, administrative, and work practice controls. To participate in the survey, you had to have administered nitrous oxide within seven days of taking the survey. They looked at those serving adult patients and those serving pediatric patients. The findings were both good and not so good.4

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