One of your first client centered, and therefore most important, tasks to learn in this level is how to set up the client using nitrous oxide. Here are the potential benefits to our client from using nitrous oxide:
What advantages to us when our client is more relaxed?
Is it safe?
First, learn some of the history of nitrous oxide. While you are discussing whether a client wants to use it or are inducing a client, it is useful information to share.
What safety procedures are used?
Discussion with the client who has never used nitrous.
Administering Nitrous Oxide
* Overhead paddle fans should always be on when nitrous is in use.
*The dentist is the only person to turn on the nitrous
When you seat the client, look at his/her yellow treatment sheet. Have they used nitrous before? If they have, your question should indicate you are familiar with their past treatment. “Mrs. Brown, you’ve used Nitrous Oxide during treatment in the past. Would you care to use it today?”
If this is a new client, or there is no record of nitrous in the treatment sheet, ask them differently, “Mrs. Brown, (new client) have you used nitrous oxide to make your treatment more comfortable in the past?” or “Mrs. Brown, (established client),in reviewing your record, I don’t see that you’ve used nitrous oxide. Would you care to use it today?”
If your client asks you about it, you can say, “Mrs. Brown, nitrous oxide is a totally safe combination of gases designed to help you relax during the treatment.”
If the client prefers not to use nitrous make a note of this in the remarks section of the client’s yellow treatment sheet.
If the client decides to use nitrous and they have used it in the past, plug in the lines, attach the suction to the vent line. Go to your doctor. Tell him/her that your client would like to use nitrous oxide. Turn on the oxygen, turn on the suction within the green zone, and then place the nosepiece on and check that it seals the nose well. If you put the nosepiece on before you turn on the gases, the client will have trouble breathing. Ask your client “Are you comfortable?” If not, readjust the nosepiece or have the client do so. When the client is comfortable, ask the doctor to turn on the nitrous oxide and adjust the concentration.
If the client decides to use nitrous and hasn’t worked with it before, use this procedure. Turn on the oxygen and set them at 4 1/2 liters O2. Hold the nasal inhaler up so the client can see it and put it on your nose lightly and say, “Mrs. Brown, this piece fits over your nose like this, and you breathe through it.” Place the inhaler over the client’s nose and ask the client to adjust it for comfort.
Say the following to your client. “______ although N20 is completely safe for you, there are some health concerns for those of us that are exposed every day. For our safety, we ask you not to breath through your mouth or talk, since this would let N20 escape into the room where your doctor or I would breathe it. Is this okay with you? Here, let me place the nosepiece. Go ahead and adjust it so it’s comfortable. (you make sure the nosepiece makes a good seal.) Remember, lips together, breathe through your nose. No talking, deep “breaths”.
If the client talks or breathes through her mouth, give her one warning. Then switch to 100% 02 and let your dentist know (don’t say anything to your client)
After your doctor has set the level of nitrous oxide at 2 1/2 liters you should stay with the client to monitor his/her reactions. Memorize the following speech. It is designed to provide your client all the information they need while keeping them from talking, which pollutes our air and slows their uptake of nitrous oxide.
“Mrs. Brown, be sure to breathe in and out through your nose. That whooshing sound you hear is the used gas you exhale being removed from the room and then from the office. Although nitrous oxide is harmless to you, it could be a problem for us if we inhaled it for several hours everyday. Everyone responds to nitrous oxide a little differently. The first thing you will probably notice is that the tips of your fingers or your toes will feel a little tingly. Next, you’ll notice a warm, floaty, fuzzy, relaxed, nice feeling. Everyone has their own level at which they feel the best. If you get too little nitrous oxide, you’ll just feel normal. If you get too much it will make you feel like you’re going to float right out of the room. We have started you at a low dose. You may not notice any change at this level. Remember to breathe in and out through your nose. Can you tell a difference yet?” Stay with the client until the doctor comes. Try not to talk with them.
If your client doesn’t notice a change after 3 minutes, your doctor will increase the nitrous ½ liter and decrease the oxygen ½ liter. Wait 3 minutes. If no change, go to 3L N2 O and 3L O2. Never give more than 50% nitrous oxide. You’ll know a client has the right amount of nitrous when your client:
Make sure the breathing bag is not over (cause excessive leakage around mask) or under inflated. Make sure the exhaust tube monitor is in the green zone. This is the correct amount of suction. Do not have a conversation with the client. This contaminates the operatory. Remind your client to breath in and out through the nose. If the client continues to breathe through mouth or talk, reach over and turn nitrous off and let the client breathe oxygen only and leave the room. Do not say anything to the client. They may not even realize what you have done.
Anytime you offer clients N2O, offer them a movie or music also. The sounds help block out the sound of the drill. The movie or music will help distract your client from what the doctor is doing.
The dentist will say, “Mrs. Brown, I’ve turned off the nitrous oxide. You’re breathing pure oxygen now. This should leave you feeling relaxed and refreshed, like you’ve had a good nap. Isn’t this a great way to have a dental treatment?” If the client isn’t given enough oxygen to flush his/her system, they may develop a headache. Never allow a client to leave the operatory if they are groggy.
Always leave the client on oxygen for at least 5 minutes.
When you are introducing nitrous oxide to children, use some different words. “Amy, doctor ______ got laughing gas just for kids. They really enjoy it. Here’s what it looks like (putting it up against your nose). It’s like what airplane pilots wear. All you do is breath in and out your nose for a few minutes. Some of the kids feel like they’re flying an airplane, others feel like a clown. I like to know which you’re feeling like. Most of the kids today have felt clowny. You tell me how you feel.” It smells like a balloon.
If a client is getting too much nitrous oxide you will notice one or more of these symptoms:
Reduce the level of nitrous by 10% and monitor him/her closely.
Continue further reductions of 10% per minute until your client is comfortable.
If your client loses color, begins to sweat, increases salivation, swallows frequently, or feels nauseous, place him/her on 100% oxygen immediately. There are several causes for nausea
If your client is going to vomit, stop nitrous, flush ambu bag with 100% oxygen, remove the nosehood. Turn the head to the side. Hold an emesis basin under the chin. When finished, put a cold compress on the forehead and replace the nasal and turn on 100% oxygen.
Finally, there are potential health hazards to us when nitrous is used. Spontaneous abortions, depressed blood cell formation, as well as liver and kidney dysfunction have been reported in hospital room personnel. These people are exposed in a closed room to high concentrations.
Most experts believe that exposure to 3000 hours over 10 years is a “heavy” exposure.
Nitrous oxide is stored in fat tissue. Therefore, the heavier a client, the more time s/he should be 100% oxygen. Even though no studies show any damage to dental personnel, use every precaution.
Removing client from nitrous oxide
Extremely Apprehensive Clients
Premedicate the night before and then 1 hour before using one of:
Plus 1 Lomotil tablet 1/2 hour before appointment for those who vomit easily
Contra‑indications to using nitrous
Monitoring badge: Once every 6 months one staff member will wear a monitor to check our level of exposure. Currently the National Institute of Occupational Safety and Health recommends 25ppm while the American Conference of Governmental Industrial Hygienists sets a safe threshold of 50ppm.
When you have read and understand this section, tell your doctor. He will let you try the N2O. This is the best way to understand its effect. Have your doctor take you to a heavy 50‑50 or even 60‑40 range so you can experience the uncomfortable “buzz” of too much N2O. Now go to pure O2 with the nitrous off. Remove the inhaler after 30 seconds. Notices that you can talk ok, but you’ll still feel lightheaded. At this stage it may not wear off quickly enough for you to drive. Now put the inhaler back on and breathe O2 for another 4 minutes. Notice that you have now lost the sensation.
Nitrous oxide is safe for clients with good health histories. The person at risk is you. A 1980 study of 61,000 American dentists and chairside assistants indicated that women assistants exposed regularly to nitrous oxide had a 50% increase in congenital abnormalities in newborns.
We use every safety device to protect you.
You have learned all the necessary safety procedures. These include:
Nitrous Oxide Safety
We have spent most of this section discussing how to keep the client from polluting our air. Now we’ll discuss the other potential sources of contamination.
Use a soap solution once each week on all those connections. If you see bubbles, then the connection is leaking. Rinse the soap off when you finish since the soap could reduce the life of the rubber goods.
Signed off by ____________________ Date ___________