Use of nitrous oxide in children with special health care needs

Providing optimal oral health care for children and individuals with special health care needs (SHCN) is an integral professional and ethical responsibility of dentists. Children with special health care needs may have behavioral factors, medical complexities, and/or intellectual disabilities which influence their ability to cooperate for dental treatment. They may have elevated dental fear and anxiety which may not be alleviated with basic behavior guidance strategies alone. The option to offer inhalational nitrous oxide provides an adjunctive method to help reduce a child's pain and anxiety during dental treatment. Inhalational nitrous oxide can be simply administered via a well-fitting nasal hood. Based on the underlying medical condition of the child, it may be necessary to monitor oxygen saturation with pulse oximetry. Administration of 100% oxygen preoperatively and upon completion of treatment is an essential step applicable to all the patients. Children recover quickly from the effects of nitrous oxide after post-treatment oxygenation and can be discharged to the parent without any residual effects. With appropriate case selection and administration technique, inhalational nitrous oxide is a safe and effective technique to provide dental treatment for children with special health care needs.