Current status of nitrous oxide as a behavior management practice routine in pediatric dentistry.

Nitrous oxide (N(2)O) as a behavioral management intervention in children has attained an excellent safety record and is, therefore, used widely. As is true of any diagnostic or therapeutic dental intervention, however, its usage merits periodic review, even if-or particularly when-it is routinely applied. For example, when N(2)O is used in combination with other sedatives, such polypharmacy can produce potentially serious side effects. There are also bioenvironmental risks to patients and staff if ambient air is not properly monitored. Using historical publications, current empirical articles, professional usage policies, and educational textbooks, the purpose of this article was to review indications and contraindications of N(2)O and discuss various factors that should or should not be considered about its use in the United States. Even though today's parents may be more accepting of pharmacologic approaches such as N(2)O, the choice to use it should always be made with the child's best interest in mind.

Ethical considerations in the use of nitrous oxide in pediatric dentistry.

Nitrous oxide (N2O) has become a routine intervention in contemporary American dental practice, especially in the management of children. However, routines translate to confidence which in turn may lead to overconfidence, such that possible risks and misuses are insufficiently acknowledged. This article ethically evaluates the use of nitrous oxide as a practice routine in treating children. Nitrous oxide administration is analyzed in reference to three internationally acknowledged principles of dental ethics: nonmaleficence, beneficence, and patient autonomy. In reference to the principle of nonmaleficence, the potential for adverse effects of N2O is discussed, particularly when it is administered in conjunction with other sedatives and anesthetics. The importance of abiding by clinical protocols is emphasized. Next, in reference to the principle of beneficence, the authors address the problematic application of N2O for the benefit of individuals other than the patient (e.g., dentists and parents). Finally, the importance of respecting patient autonomy is discussed, specifically the need to obtain explicit consent for N2O. The article supports the continued use of nitrous oxide but advises greater attention to how and why it is administered. Four recommendations are offered for an ethically sound usage.