Evaluation of the effect of nitrous oxide combined with local anesthesia in extraction of impacted teeth

doi:10.19438/j.cjoms.2024.02.009

Abstract

Abstract: PURPOSE: To evaluate the effect of nitrous oxide combined with local anesthesia in the extraction of impacted teeth and its effect on patients' anxiety. METHODS: A total of 188 patients undergoing impacted tooth extraction in Shaoxing Stomatological Hospital from December 2021 to December 2022 were selected and randomly divided into experimental group and control group, with 94 patients in each group. The control group was treated under local anesthesia, and the experimental group was treated under local anesthesia combined with nitrous oxide. The heart rate(HR), Ramsay sedation score and pain VAS score during local anesthesia, tooth extraction and 5 min after tooth extraction were compared between the 2 groups. The Modified Dental Anxiety Scale(MDAS) scores and the comfort level of patients after treatment were compared between the two groups. SPSS 22.0 software package was used for data analysis. RESULTS: With the change of treatment time, HR in both groups showed a trend of increasing at first and then decreasing (P<0.05). HR in the experimental group was significantly lower than that in the control group during local anesthesia, tooth extraction and 5 minutes after tooth extraction(P<0.05). The MDAS score of the experimental group was significantly lower than that of the control group(P<0.05). Ramsay sedation scores in both groups decreased at first and then increased with the change of treatment time(P<0.05). The Ramsay sedation score of the experimental group was significantly higher than that of the control group during local anesthesia, tooth extraction and 5 minutes after tooth extraction (P<0.05). With the change of treatment time, the VAS score of the two groups gradually increased (P<0.05). The VAS score of the experimental group was significantly lower than that of the control group during local anesthesia, tooth extraction and 5 min after tooth extraction(P<0.05). The comfort of the experimental group was significantly better than that of the control group(P<0.05). CONCLUSIONS: Nitrous oxide combined with local anesthesia for extraction of impacted teeth can reduce HR, improve patients' anxiety and sedation, reduce pain and improve comfort.

Key words: Comfortable laughing gas, Minimally invasive tooth extraction, Impacted wisdom teeth, Anxiety

CLC Number:

R782.05

KANG Cheng, ZHU Ting, HAN Shuang, LOU Yi-yi. Evaluation of the effect of nitrous oxide combined with local anesthesia in extraction of impacted teeth[J]. China Journal of Oral and Maxillofacial Surgery, 2024, 22(2): 165-169.

References

[1] Patel PS, Shah JS, Dudhia BB, et al.Comparison of panoramic radiograph and cone beam computed tomography findings for impacted mandibular third molar root and inferior alveolar nerve canal relation[J]. Indian J Dent Res, 2020, 31(1): 91-102.
[2] Rivera-Herrera RS, Esparza-Villalpando V, Bermeo-Escalona JR, et al.Agreement analysis of three mandibular third molar retention classifications[J]. Gac Med Mex, 2020,156(1): 22-26.
[3] Ainscough SL, Windsor L, Tahmassebi JF.A review of the effect of music on dental anxiety in children[J]. Eur Arch Paediatr Dent, 2019, 20(1): 23-26.
[4] Schmitt A, Cardinale C, Loundou A, et al.Nitrous oxide for pain management of first-trimester instrumental termination of pregnancy under local anaesthesia and/or minimal sedation: a systematic review and meta-analysis[J]. Eur J Obstet Gynecol Reprod Biol, 2021, 261: 193-199.
[5] Chi SI.Complications caused by nitrous oxide in dental sedation[J]. J Dent Anesth Pain Med, 2018,18(2): 71-78.
[6] Kushnir B, Fowler S, Drum M, et al.Nitrous oxide/oxygen effect on IANB injection pain and mandibular pulpal anesthesia in asymptomatic subjects[J]. Anesth Prog, 2021, 68(2): 69-75.
[7] Gupta PD, Mahajan P, Monga P, et al.Evaluation of the efficacy of nitrous oxide inhalation sedation on anxiety and pain levels of patients undergoing endodontic treatment in a vital tooth: a prospective randomized controlled trial[J]. J Conserv Dent, 2019, 22(4): 356-361.
[8] 林雪峰. 现代口腔科治疗学[M].广州: 广东科技出版社, 2002: 45-46.
Lin XF.Modern stomatology therapy[M]. Guangzhou: Guangdong Science and Technology Press,2002:45-46.
[9] Facco E, Gumirato E, Humphris G, et al.Modified dental anxiety scale: validation of the italian version[J]. Minerva Stomatol, 2015, 64(6): 295-307.
[10] Rasheed AM, Amirah MF, Abdallah M, et al.Ramsay sedation scale and richmond agitation sedation scale: a cross-sectional study[J]. Dimens Crit Care Nurs, 2019,38(2): 90-95.
[11] Siritham A, Powcharoen W, Wanichsaithong P, et al.Analgesics effect of local diclofenac in third molar surgery: a randomized, controlled trial[J]. Clin Oral Investig, 2023, 27(10): 6073-6080.
[12] 邵云,崔啟春,何欢,等.氧化亚氮/氧吸入舒适化技术在老年高血压患者心电监护拔牙中的应用[J].上海口腔医学, 2023, 32(1): 97-100.
Shao Y, Cui QC, He H, et al.Application of nitrous oxide/oxygen inhalation comfort technique during tooth extraction of elderly hypertensive patients under electrocardiographic monitoring[J]. Shanghai Journal of Stomatology, 2023, 32(1): 97-100.
[13] Kokash M, Darwich K, Ataya J.The effect of hyaluronic acid addition to collagen in reducing the trismus and swelling after surgical extraction of impacted lower third molars: a split-mouth, randomized controlled study[J]. Clin Oral Investig, 2023, 27(8): 4659-4666.
[14] 李燕香, 闫利君, 凌小婉, 等. 微创器械与微动力设备在牙拔除术中的应用进展[J].中国口腔颌面外科杂志, 2023, 21(2): 191-196.
Li YX, Yan LJ, Ling XW, et al.Application and advancement of minimally invasive instruments and micro-power devices in tooth extraction[J]. China Journal of Oral and Maxillofacial Surgery,2023,21(2):191-196.
[15] Kassem EHH, Fares Y, Abou-Abbas L.Assessment of dental anxiety and dental phobia among adults in Lebanon[J]. BMC Oral Health, 2021, 21(1): 48-58.
[16] Arcari S, Moscati M.Nitrous oxide analgesic effect on children receiving restorative treatment on primary molars[J]. Eur J Paediatr Dent, 2018,19(3): 205-212.
[17] Chen LS, Nusstein J, Drum M, et al.Effect of a combination of nitrous oxide and intraligamentary injection on the success of the inferior alveolar nerve block in patients with symptomatic irreversible pulpitis[J]. J Endod, 2021, 47(12): 1890-1895.
[18] Mozafar S, Bargrizan M, Golpayegani MV, et al.Comparison of nitrous oxide/midazolam and nitrous oxide/promethazine for pediatric dental sedation: a randomized, cross-over, clinical trial[J]. Dent Res J (Isfahan), 2018, 15(6): 411-419.
[19] Chompu-Inwai P, Simprasert S, Chuveera P, et al.Effect of nitrous oxide on pulpal anesthesia: a preliminary study[J]. Anesth Prog, 2018, 65(3): 156-161.
[20] 刘靖,王万根,吴永正.笑气吸入辅助拔除儿童埋伏多生牙的临床应用[J].口腔医学, 2020, 40(9): 829-832.
Liu J, Wang WG, Wu YZ.Clinical application of nitrous oxide inhalation in extraction of embedded supernumerary teeth[J]. Stomatology, 2020, 40(9): 829-832.
[21] Liu Q, Gao LL, Dai YL, et al.Nitrous oxide/oxygen mixture for analgesia in adult cancer patients with breakthrough pain: a randomized, double-blind controlled trial[J]. Eur J Pain,2018, 22(3): 492-500.
[22] Froessler B, Malek M, Jila M, et al.The impact of withholding nitrous oxide in labour during the COVID-19 pandemic on maternal and neonatal outcomes[J]. Aust N Z J Obstet Gynaecol, 2022, 62(6): 910-914.