Research article

Evaluation of safe and effective administration of nitrous oxide after a postgraduate training course

Valérie Collado¹ , Emmanuel Nicolas¹ , Denise Faulks¹ , Corinne Tardieu² , Marie-Cécile Manière³ , Dominique Droz⁴ , Peter Onody⁵ and Martine Hennequin¹

¹  Univ Clermont1, EA 3847, UFR d'Odontologie, and CHU Clermont-Ferrand, Service d'Odontologie, Hôtel-Dieu, F-63003, Clermont-Ferrand, France

²  Faculté d'Odontologie and Service d'Odontologie, Hôpital la Timone, 27 boulevard Jean Moulin, 13385 Marseille Cedex 5, France

³  Faculté d'Odontologie et Hôpital Civil, 1 place de l'Hôpital, 67091 Strasbourg, France

⁴  Faculté d'Odontologie, Département d'Odontologie pédiatrique, 96 Avenue de Lattre de Tassigny, 54004 NANCY Cedex, France

⁵  Air Liquide Santé International, 10 rue Cognacq-Jay, 75341 Paris Cedex 7, France

author email corresponding author email

BMC Clinical Pharmacology 2008, 8:3doi:10.1186/1472-6904-8-3

Published:	11 June 2008

Abstract

Background

Conscious sedation is used in dentistry to improve access and quality of care in patients who have difficulty coping with treatment. The aim of this prospective study was to describe a postgraduate training course in conscious sedation for dentists, with specific evaluation of the safe and effective administration of a 50% nitrous oxide in oxygen premix.

Methods

45 practitioners were trained between 2002 and 2004. They carried out 826 sessions of inhalation sedation in 662 patients. The clinical competency of this group was compared with an expert group.

Results

There was no difference between trainees and experts in ability to complete the planned dental treatment under sedation (89.6% vs 93.2%). Trainees were less successful than experts for patients with intellectual disability (87.4% vs 94.2%, p < 0.01). For both groups, the degree of cooperation improved between initial induction and each perioperative step (Wilcoxon test, p < 0.01). However, for trainees, Venham behaviour scores varied with the type of patient (Kruskal Wallis test, p < 0.001). No major adverse effects were recorded. Trainees reported more minor adverse effects than experts (13% vs. 5.3% respectively, Fisher exact test, p < 0.001)

Conclusion

The trainee practitioners provided effective and safe inhalation sedation. This challenges the current French restriction of the 50% nitrous oxide in oxygen premix to the hospital setting. Further emphasis is required on the teaching of behaviour management skills for patients with intellectual disability.