Visiting the dentist can trigger
anxiety in some patients, making
treatment difficult. A sedation
service using nitrous oxide, also
known as laughing gas, is now
available to calm young patients
with dental anxiety.
The mere thought of visiting
the dentist is enough to
make some people —adults
or children — break out in
In fact, patients of all ages
can suffer from mild to severe anxiety when
it is time to see the dentist, even if it is for
something as routine as their regular checkup,
said Dr Bien Lai, Senior Consultant and
Head, Paediatric Dentistry Unit, Department
of Restorative Dentistry, National Dental
Centre Singapore (NDCS).
One reason for this is patients
associating dental procedures with
pain. “Most people visit a dentist
only when there are signs and
symptoms of dental issues, such
as decay. As such, most dental
procedures are curative rather
than preventive,” explained Dr Lai.
Curative dental procedures can
range from the minimally invasive,
such as simple fillings, to more invasive
treatments involving extractions and
extensive removal of tooth structure, such
as crowns, for restorations. “When extensive
dental procedures are involved and located
near the nerve in the tooth, local anaesthesia
is often needed to numb the area. The idea
of administering local anaesthesia via an
injection is frequently associated with pain,”
Dr Lai said. She added that the sensory
overload from the dental operatory setup —
for example, loud sounds from the suction tip
and handpieces — can also induce anxiety.
“Patients with dental anxiety often
clam up and tend to not open their mouths
as wide. This hampers the procedure from
being performed optimally as the dentist
may be unable to have adequate access for
dental procedures, resulting in lengthy
treatments,” she said. In extreme cases, the treatment may even have to be aborted
The good news is that there is now help
for children and adults who suffer from
NDCS introduced its nitrous oxide
sedation service for paediatric dental patients
in June 2023. Commonly known as laughing
gas, nitrous oxide is mixed with oxygen and
breathed in through a rubber mask placed
over patients’ nose. This helps patients relax
and cope better with dental procedures while
also providing some pain relief.
When properly used, nitrous oxide
sedation is generally safer than general
anaesthesia (GA) for complex dental
procedures due to its milder nature. It also
presents lower risk to the respiratory system
and haemodynamics (blood flow through
vessels), and allows for a shorter recovery
time as the inhaled gas is eliminated quickly
from the body.
“Nitrous oxide inhalation sedation
is generally very safe. Some common
side effects include vomiting, nausea,
dizziness, light-headedness, occasional
hallucinations, and agitation,” Dr Lai
shared. “Very rarely, a patient may
experience blunting of the cough reflex
that may increase the risk of saliva or
vomitus being inhaled into the lungs and
causing pneumonia. This will require
further medical management,” she said.
There is no minimum age requirement
for children to qualify for the procedure, but
the patient “has to be relatively cooperative”,
shared Dr Lai. They must be able to tolerate
having a nasal hood placed on them.
As of end 2023, the sedation service has
been performed on 24 paediatric patients.
The sedation procedure is unsuitable for
pregnant patients, patients who are taking
drugs, food or drinks that slow down brain
activity (such as opioids, alcohol, etc.) or
herbal remedies, and patients who are not
feeling well, including those with an ongoing
respiratory tract infection, and/or any
Prepare your child before visiting the dentist
Besides relying on nitrous oxide, Dr Lai recommends that parents exercise these good
practices to calm their kids before a dental appointment:
1 Prepare them for their first dentist appointment by screening
videos or reading storybooks depicting a pleasant visit to
the dental clinic.
2 Share with them what to expect during a session to remove
uncertainty, which contributes to anxiety, and refrain from
using scare tactics or triggering words such as ‘pain’,
‘injection’, ‘pluck teeth’, etc.
3 Reinforce the message that dentists help keep their
teeth strong and healthy.
4 If they have had unpleasant experiences before, it is
best to let the attending dentist manage their anxiety
on the day of consultation.
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