The relationship between nitrous oxide sedation and psychosocial factors in the pediatric outpatient setting

Effectiveness and predictive factors of nitrous oxide and oxygen inhalation sedation for paediatric dental procedures: a retrospective cohort study of Thai children

PURPOSE

To investigate the effectiveness and predictive factors of nitrous oxide and oxygen inhalation sedation (NOIS) in Thai paediatric dental patients.

METHODS

A retrospective chart review of children receiving dental treatments under NOIS between March 2022 and August 2024 was conducted. A sedation session was evaluated as effective when the Overall Houpt Behaviour Rating Scale was greater than or equal to 4 and there were no acute adverse events from NOIS during or within 24 h of sedation. Predictive factors were assessed using the Poisson regression with robust error variance and generalised estimating equations.

RESULTS

A total of 224 sedation sessions from 134 Thai patients aged 3-12 years were included. Of these sessions, 86.2% were considered effective. In the multivariable analysis, previous NOIS experience and the child's preoperative anxiety level were associated with the effectiveness of NOIS. The risk ratio for effective sedation was 13% higher for children with prior NOIS experience compared to those undergoing NOIS for the first time (RR: 1.13, 95% CI 1.02-1.25, p value < 0.05). In addition, the risk ratio for effective sedation in non-anxious children was 41% higher than for extremely anxious children (RR: 1.41, 95% CI 1.07-1.86, p value < 0.05).

CONCLUSION

NOIS is safe and effective for dental treatment in Thai children, with minimal adverse events. Its effectiveness is particularly pronounced in children who have prior experience with NOIS and present as non-anxious.