Inhalation sedation with laughing gas (N2O) in dentistry – organisational and professional aspects and a systematic review of efficacy and safety

Rosian K, Fischer S, Groessmann N
Record ID 32018000331
Original Title: Inhalationssedierung mit Lachgas (N2O) in der Zahnmedizin – Organisatorische und berufsrechtliche Aspekte sowie ein systematischer Review zu Wirksamkeit und Sicherheit
Authors' objectives: Among other aspects, this report deals with questions of organisational and professional issues regarding the administration of inhalation sedation with nitrous oxide (N2O).
Authors' results and conclusions: With regard to the underlying research questions on the organisational and professional aspects, it has been shown that inhalation sedation with N2O should be used only by dental personnel, who are appropriately trained in the use of sedation and emergency procedures. When inhalation sedation with N2O is performed by qualified dental personnel, with carefully selected patients, and with appropriate equipment, it is considered to be a safe and effective procedure in primary care to support anxiety and behavioural management according to the Council of European Dentists (CED). The respective national framework conditions must be adapted to the guidelines of the CED. Regarding the clinical efficacy and safety analysis, ten studies (three randomised controlled trials and seven randomised controlled crossover trials) were identified. The strength of evidence for the endpoints of clinical efficacy and safety was rated as "low" to "very low". None of the included studies for the clinical effectiveness and safety clearly demonstrated that inhalation sedation with N2O is more effective than placebo (O2/room air) or midazolam. However, the data on adverse events suggest that inhalation sedation with N2O is safe in the administration per se and therefore a useful method in dentistry. In conclusion, inhalation sedation with N2O appears to be a useful and safe procedure in dentistry for the anxiety and behavioural management of children, adolescents, and adults with fears of dental treatment.
Authors' methods: A systematic analysis of the efficacy and safety of inhalation sedation with N2O in dentistry was performed. In order to answer the research questions, a systematic literature search, an additional literature search with Scopus (citation tracking) and targeted manual searches for relevant (professional) guidelines and guiding principles of dentistry on the websites of institutions and professional societies of selected European countries (Germany, Switzerland, Austria, Sweden and the Netherlands) were carried out.
Project Status: Completed
Year Published: 2018
URL for additional information:
English language abstract: An English language summary is available
Publication Type: Full HTA
Country: Austria
MeSH Terms
  • Nitrous Oxide
  • Dentistry
  • Dentistry, Operative
  • Oral Surgical Procedures
  • Conscious Sedation
  • Nitrous oxide
  • inhalation sedation
  • organisational aspects
  • professional aspects
  • efficacy
  • safety
Organisation Name: Ludwig Boltzmann Institute for Health Technology Assessment
Contact Address: Ludwig Boltzmann Institute for fuer Health Technology Assessment (LBI-HTA), Garnisongasse 7/rechte Stiege Mezzanin (Top 20), 1090 Vienna, Austria. Tel: +43 1 236 8119 - 0 Fax: +43 1 236 8119 - 99
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This is a bibliographic record of a published health technology assessment from a member of INAHTA or other HTA producer. No evaluation of the quality of this assessment has been made for the HTA database.