Evaluation of the efficacy of nitrous oxide inhalation sedation on anxiety and pain levels of patients undergoing endodontic treatment in a vital tooth: A prospective randomized controlled trial

Abstract

Context:Anxiety and fear of pain are the two major deterrents for which patients avoid dental treatment. Local anesthetic, which forms the foundation for the delivery of pain-free endodontic treatment, does not serve the purpose in anxious patients and requires augmentation with other pharmacological agents.Aims:The aim of this study is to observe the effectiveness of nitrous oxide in alleviating patient anxiety and pain during endodontic treatment of a vital tooth.Settings and Design:The present in vivo study was conducted on sixty healthy patients from the Outpatient Department of Genesis Institute of Dental Sciences and Research, Ferozepur, Punjab, India.Subjects and Methods:Sixty anxious patients having irreversible pulpitis in their lower molar were selected and divided into two groups, namely control group and intervention group, with thirty patients placed in each group. In control group, access opening and pulp extirpation was done under local anesthesia only, whereas in intervention group, access opening and pulp extirpation was done under local anesthesia and nitrous oxide sedation. The anxiety levels of patients, before and after the treatment, were measured using the Modified Dental Anxiety Scale. Pain felt by the patients during administration of local anesthesia and during access opening was measured using the Visual Analog Scale.Statistical Analysis Used:The data were analyzed using ANOVA and paired t-test, and graphical analysis of the data was done.Results:Significant reduction in anxiety and pain levels of patients during endodontic access opening including significant reduction in pain during administration of local anesthesia was observed under nitrous oxide sedation.Conclusions:Conscious sedation with nitrous oxide is a useful technique to add to the armamentarium used in the treatment of teeth with symptomatic irreversible pulpitis.

Success rate of nitrous oxide-oxygen procedural sedation in dental patients: systematic review and meta-analysis

“…Hand searches of the bibliographies of full-text articles identified 28 additional articles. After full-text evaluation, 19 RCTs [ 13 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 ] published between May 1988 and August 2019 were finally selected for the review. The study screening, selection process, and reasons for exclusion are depicted in Fig.…”

“…The proportion of nitrous oxide in the gas mixture did not exceed 50% in any trial. Although ASA considers a concentration of < 50% as minimal sedation [ 2 ], this maximum was just slightly overpassed by some trialists [ 39 44 46 47 53 ] and it was always maintained within the limit established by AAP (≤ 50%) [ 7 ]. Furthermore, this proportion was reached only in some patients.…”

Present status and future directions—Mechanisms and management of local anaesthetic failures

“…It is extremely important that all complications and side effects of any medications, techniques and interventions should be reported in clinical trials. One of the shortcomings of previously published investigations was not reporting complications following the use of anaesthetic solutions, techniques and premedication (Aggarwal et al, 2018b; Gupta et al, 2019; Kaladi et al, 2019). Future studies should more focus on these subjects.…”

“…In anxious patients, nitrous oxide inhalation significantly improved the success rate of IANB and decreased the levels of anxiety compared with the controls. In addition, postoperative anxiety was significantly less in the test group compared with the control group (Gupta et al, 2019).…”

Effect of chromotherapy on the anxiety level in the patients undergoing endodontic treatment: A randomized clinical study

“…One of the dental procedures which is feared by many people is endodontic treatment. [ 1 ] Threatening stimuli set it off, causing the person to behave in specific ways. Many people avoid or postpone dental care due to apprehension over the procedure.…”