EFFECTIVENESS OF NITROUS OXIDE–OXYGEN CONSCIOUS SEDATION IN IMPROVING THE COMPLETENESS OF DENTAL DIAGNOSTIC EXAMINATION IN CHILDREN

Abstract

Background: Dental anxiety and limited cooperation may prevent completion of a standardized diagnostic examination in children. Nitrous oxide–oxygen (N₂O/O₂) inhalation can be used as an adjunct to preserve consciousness and verbal contact while facilitating cooperation.

Objective: To evaluate whether N₂O/O₂ conscious sedation is associated with a higher rate of complete pediatric dental diagnostic examinations, fewer interruptions, shorter examination time, and improved behavioral and anxiety outcomes.

Methods: A prospective comparative parallel-group clinical study included 356 children aged 3–12 years: 178 examined with N₂O/O₂ and 178 controls examined without N₂O/O₂. Both groups underwent the same standardized dental diagnostic sequence. The primary endpoint was completion of the full diagnostic protocol without interruption due to insufficient cooperation. Secondary outcomes included examination duration, interruption rate, and Frankl, Venham, Facial Image Scale (FIS), and Wong–Baker scores. N₂O was administered in a reported range of 25–50% with oxygen while consciousness and verbal contact were maintained.

Results: Complete examination was achieved in 154/178 children (86.5%) in the N₂O/O₂ group and 125/178 (70.2%) in the control group. The absolute difference was 16.3 percentage points (95% CI 7.9–24.7); RR=1.23 (95% CI 1.10–1.38; p<0.001). Mean examination time was 19.32±4.81 versus 23.93±4.43 minutes (p<0.001), a mean reduction of 4.61 minutes. Interruptions occurred in 13.5% versus 29.8% (p<0.001). Post-examination behavioral and anxiety measures favored the N₂O/O₂ group: Frankl 3.09±0.79 vs 2.62±0.84; Venham 1.64±1.05 vs 2.20±1.03; FIS 2.72±1.04 vs 3.06±1.15; Wong–Baker 1.19±1.15 vs 1.80±1.17.