Nitrous oxide is also known as laughing gas or magic air. It is used in combination with oxygen to help calm an anxious child so that dental treatment can be done comfortably for him or her. It is administered via a nasal mask. As the child inhales during normal breathing, the gas is absorbed into the body and begins to calm the child down within minutes. Thus, the advantages of nitrous oxide/oxygen combination are:

• No shots or pills needed
• The concentration of oxygen delivered with nitrous oxide is much higher than room oxygen; therefore, the patient is getting more than enough oxygen for normal breathing
• Works quickly - the calming effects are achieved in 2-5 minutes
• Can control the amount of nitrous oxide delivered (dosage can be titrated)
• Once treatment is done, nitrous oxide clears from the patient's body within 5 minutes (no undesirable prolonged effects)
• Most importantly, it is very safe and effective

When nitrous oxide alone is not enough to calm the child down for dental treatment, the next step in helping the child cope with treatment is to give a child a mild sedative by mouth. According to the American Academy of Pediatric Dentistry, the indications for oral sedation are as follows:

• Preschool children who cannot understand or cooperate for definitive treatment
• Patients who are anxious and fearful of having dental treatment done
• Patients requiring dental care who cannot cooperate due to the lack of psychological or emotional maturity, or cognitive, physical or medical disability

The oral medication is used in combination with nitrous oxide to help relax the child, but they DO NOT put the child to sleep. For this reason, oral sedation is considered "conscious sedation." Also, oral sedation will help to calm the child, but it does not alleviate the pain associated with dental treatment. Therefore, local dental anesthesia (lidocaine) is still needed to ensure the patient does not feel anything during treatment.

It is very important that the child does not eat or drink anything on the morning of the appointment (NPO). The reason is that if the child has food in the stomach, he/she can potentially vomit during treatment and the vomitus (stomach contents) can go into the lungs and cause serious health risks (aspiration). Unlike nitrous oxide, the medication used in oral sedation stays in the body for 4 to 8 hours or more. Therefore, the child is still sedated and drowsy after dental treatment and will need to be supervised by an adult and kept indoors at home for the rest of the day.

The American Academy of Pediatric Dentistry recognizes the need for IV (Intra-venous) Sedation in certain situations where challenges relating to the child's age, behavior, medical conditions, developmental disabilities, intellectual limitations, or special treatment needs may warrant it. This is reserved as a last resort if other forms of sedation are inadequate or treatment is so extensive that it would take multiple appointments to complete. Unlike oral sedation, the patient is put to sleep by an anesthesiologist and monitored throughout the treatment (the same type of monitors in a hospital operating room). Once dental treatments are completed, the anesthesiologist will recover and monitor the patient until he/she meets the criteria for discharge. Thus, the advantages of IV sedation are:

• Only one appointment is needed.
• No crying, no restraint.
• Patient does not have any memory of the experience; thus, it does not traumatize the child.
• Quality treatment can be done quickly because the child is perfectly still.
• Anesthesia is provided by an anesthesiologist - - very safe.

The main disadvantage of IV sedation is the cost. Most insurance do not cover for IV sedation in the dental office; therefore, it is an added expense for parents. However, when weighing all the advantages of IV sedation, it is a very viable option for those patients who cannot be treated any other way.