Inhalation sedation with nitrous oxide as an alternative to dental general anaesthesia for children

This review paper examines (using systematic methodology) the evidence for the use of inhalation sedation (IHS) instead of dental general anaesthesia (DGA) for dental treatment. It finds that this is an area of healthcare lacking high-quality clinical evidence (i.e. derived from randomized controlled trials). However, evidence from seven case series studies (level of evidence 3) of variable quality and design is examined. Those studies suggest that IHS is effective for a large proportion (83-97 percent) of selected subgroups of children who would have otherwise required DGA. This may represent 45-64 percent of all children who are referred for DGA. There is a remarkable degree of consistency between all studies in the reported treatment effectiveness of IHS, despite differences in design and populations treated. IHS is particularly suitable for orthodontic treatment, for older children, and for children requiring no more than four extractions. Morbidity associated with IHS is minor and infrequent, and user satisfaction is high, or higher compared with DGA. Comparing with DGA, IHS requires significantly longer time per episode and more treatment sessions per patient. In teaching dental hospitals, staffing costs for IHS are estimated to be cheaper by about a third compared with outpatient DGA. Indications for further areas of research are made.