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Policy on Minimizing Occupational Health Hazards Associated with Nitrous Oxide

Policy statement

The AAPD encourages dentists and dental auxiliaries to maintain the lowest practical levels of N2 O in the dental environment. The AAPD also encourages practitioners to weigh the risks and benefits of using N2 O when treating pediatric patients. Adherence to the following safety practices can help minimize occupational exposure to N2 O.

  • Educate dental personnel on minimizing occupational exposure to and potential abuse of nitrous oxide.
  • Use scavenging systems that remove N2 O during patient’s exhalation.
  • Ensure that exhaust systems adequately vent scavenged air and gases to the outside of the building and away from fresh air intake vents.
  • Use, where possible, clean outdoor air for dental operatory ventilation.
  • Monitor ambient N2 O levels in dental operatories in accordance with local and state regulations.
  • Implement a plan for careful, regular inspection and maintenance of the nitrous oxide/oxygen delivery equipment according to manufacturer’s recommendations.
  • Carefully consider patient selection criteria (e.g., tolerance of nasal hood, ability to breathe from the nose, cooperative potential, recent illnesses, indications, contraindications) prior to administering N2 O.
  • Select a properly-fitted double-chambered mask size for each patient.
  • During administration, visually monitor the patient and titrate the flow/percentage to the minimal effective dose of N2 O.
  • Encourage patients to minimize talking, moving, and mouth breathing during N2 O administration.
  • Use high volume dental suction when possible during N2 O administration.
  • Use a rubber dam or isolation devices with suction evacuator when possible during operative treatment.
  • Administer 100 percent oxygen to the patient for at least five minutes after terminating N2 O flow to replace the N2 O in the gas delivery system.

The AAPD encourages an interprofessional approach between dental team members who are pregnant or trying to conceive and their physicians regarding the effects of N2 O on reproductive health to assure comfort and safety with the administration of nitrous oxide/oxygen analgesia/anxiolysis.

The AAPD encourages research on the efficacy of newerstyle (e.g., disposable mask, disposable mask/circuit) nasal hoods in scavenging waste gases. Furthermore, because of the paucity of literature on health effects of occupational N2 O exposure in the dental setting with modern delivery, scavenging, ventilation, and monitoring systems, the AAPD encourages additional studies and periodic review of the occupational exposure recommendations by NIOSH.