Scuba Nitrox vs. Nitrous at the dentist office?

[Laurence Stein DDS]

JT2

I'm surprised that the dentist's medical history didn't ask for current medications. I do not know what effect will actually occur. You have had time to develope a tolerance to the drug and as a patch, you get a lower, continuous, time dependent effect.

It is concievable that it would interact with the nitrous oxide and cause you to go deeper into a sedated state or there might be little noticed effect since your body has become more "used to " the medication.

Tell your dentist anyway. Fentanyl is a very powerful medication and when I did anesthesia rotation, we used it during anesthetic procedures to supplement the anesthetic and for post operative pain control.

Most dentists do not know what Fentanyl is so explain it to him. Personally, I would not give nitrous oxide to a patient on this medication. The dentist is supposed to "titrate" the nitrous/oxygen mixture to the proper effect but when other medications like this are present, you could suddenly slip into deeper stages of sedation before the dentist realizes it.

BTW a scaling means to scale the hard pieces of tartar off the teeth. Usually, when only a scaling is done, tartar is not located deep and often no anesthetic is necessary. On the otherhand...if it is a scaling and root planing. Most of the time you're gonna need local anesthetic...nitrous oxide or no nitrous oxide. Scaling and root planing take longer and often multiple visits are set asside.

Hopefully, some of the other docs will put in their opinion on this question.

Be safe.

Laurence Stein DDS

 

[Laurence Stein DDS]

JT3

On the otherhand, scaling may mean to rip those damn suckers right off the fishes skin. Usually before it's eaten. If you are having this done, you are probably in the wrong forum and I would get as "stoned" as possible. In fact, you are a walking miracle and should be photographed, weighed and put into an aquarium for observation. Since you can obviously write, ask for a computer terminal and a TV--it makes living in a pool a whole lot easier!

Cheers,

Larry Stein

 

[Iguana Don]

Doc,

That was a really great reply to his post.

Don't ya just love it when the Dentist says,

"You're gonna feel a little pressure"

As he steps up on the arms of the chair with those pliers in his hand!

ID

 

[Laurence Stein DDS]

Iguana Don

Thanks.

What's this proctologist s....oops....proctologist stuff?

If I want to get into this I just turn my chair around! It's the saying AH I don't like!

Talk later.

Larry Stein

 

[JT2]

Thanks Doc, I have already called and informed them about the patches.

 

[chrispete]

My dentist will not put me on nitrous anymore after two incidents that I had involving it - the experiences that I had were akin to what I have heard people describing a very bad acid trip as - i.e. things/reality shattering and falling apart, etc. (sidenote: this is yet another reason that I would never try the stuff myself) I'm now a bit worried about the potential for getting narced if the symptoms are the same as nitrous - I might go out of my gourd and never realize it, or worse yet react like I did in the dentists chair the last time he had me on it (literally slammed my arms into the armrests, went airborne, flipped over in mid-air, and landed hugging the chair - threw my DDS for a bit of a loop.) :bonk: I guess that all I can hope for is that I'd have someone there to keep an eye on me to get me out of dodge if I started to act strangely. Any ideas on this doc(s), esp have you ever had a patient react like this to nitrous? (and on a very low dosage at that, he dropped me way down after the first incident a few months prior to this happening)

 

[Laurence Stein DDS]

chrispete

Sorry you had such a bad experience. First, I'm not saying that Nitrous Oxide and Nitrogen Narcosis are the same thing. My personal experiences with both have been "similar". Keep in mind that I have been mildly "narked" and "properly sedated. Second, you should not draw the conclusion from your dental experience and relate it to an unknown diving experience. Things are different.

When N2O is used, there are many variables. Anxiety levels, age, weight, past or present drug use, medications the patient may be taking, etc. Ideally, "induction" should be slow...cranking the machine up to 70% nitrous/30% oxygen is not the way to do it. It is called "Laughing Gas for a reason...generally, a rapid induction will produce the laughter but then you may go deeper and experience other sensations. It is possible to "decerebrate". Basically, your higher brain functions, reason, thought are gone and you revert back to more primal reactions..."flight or fright" You can become combative, panic, etc.

Some patients can tolerate high concentrations of the gas and others, well you just put the mask on the face and they expect the effect and get it.

Remember, you actually have some control... not much...but you can pull the mask off if you don't feel right.

Diving is different. The effect comes on gradually--somewhere near 100 fsw. It can vary from day to day. Slowly descending is helpful. Ascending even 10 feet can make the effects go away. In the same way your dentist shouldn't "crash induce" you, you shouldn't crash dive to 130 feet.

Again medications that make you sleepy can contribute to it so antihistamines, antiemetics, and narcotic meds can increase the chance of being narced.

Some people are relatively resistent to narcosis while others notice right away. What may actually be happening is the resistent may not be as just not in touch with his body as much and simply ignores the symptoms or wants to brag that they don't get narced.

For myself, the more I dive, the less susceptible I seem to be. That is not to say I don't get narcosis on occasion. I do but I at least know what is happening and know I have some control.

So please don't assume that because of your dental experiences, you are going to have the same episode under water. You're just making yourself more anxious.

While I have nitrous oxide available for my patients, I rarely use it. The hoses, the nose piece, everything gets in the way and it increases my anxiety trying to work around these devices. Finally, on patients who require high concentrations of nitrous oxide, even with a scavenger system in place enough gas gets out and I am close enough to them that I can both taste the gas and feel a sligth buzz. I would much prefer to do most procedures under local anesthetic.

The use of nitrous oxide on every patient is not called for IMHO. It is, however something the patient can be charged for. Sometimes I wonder why some dentists use so much of it....

Get certified for the deeper dives and learn the feeling of light narcosis. You won't be as anxious.

Dive safely,

Laurence Stein

The opinions stated are my own and do not necessarily indicate improper use of conscious sedation. You should discuss your individual situation with your dental provider.

 

[Laurence Stein DDS]

randyjoy,

This information is from Scubadoc (Ern Campbell, M.D.) regarding the 50:50 mixture of nitrous oxide and oxygen.
The mixture is called Entonox and it appears to be the same gas you called Nitronox.

ENTONOX DANGERS
Warning! ENTONOX NOT to be used in divers suspected of a decompression accident!!
Here is a recent correspondence that I feel should be passed on to the members!
Question:
This topic came up during a discussion on paramedic 'routine' treatments_ where it was said by the paramedics that Entonox_ was a routine treatment for accident victims and that being a diver was 'not'_ a contra-indication. There was general agreement that the 50% O2 (while less good than 100% O2) was not bad there were some very strong statements made by some divers about the undesirability of the N2O. I can understand that in cases of marginal DCS one might not wish to mask symptoms with a general pain killer but there were also claims that the N2O would actively be dangerous as promoting bubble formation.
As this is potentially serious to any diver who requires post dive paramedic treatment, do you have any advice or (preferably simple) references please? I cannot currently find an authorative answer, some of_ the divers concerned were adamant that they were right and the paramedics freely admitted that being non-divers it was not something they knew about.
Answer:
The divers were absolutely right!! Entonox is the trade name for the mixture of 50% nitrous oxide and 50% oxygen, recognised by some patients as "gas and air." Its low fat solubility causes rapid onset of analgesia. Rapid elimination upon cessation of inhalation makes it ideal for procedural pain. Nitrous oxide is eliminated unchanged from the body, mostly by the lungs.
However -- Entonox must never be used in any condition where air is trapped in the body and expansion would be dangerous. For example, it will exacerbate pneumothorax and increase pressure from any intracranial air. Air in any other cavities such as the sinuses, middle ear and gut may also expand. Problem areas are:-
Head injuries with impaired consciousness.
Artificial, traumatic or spontaneous pneumothorax.
Air embolism.
decompression sickness.
Abdominal distension.
Maxillofacial injuries.
In addition, inappropriate, unwitting or deliberate inhalation of Entonox will ultimately result in unconconciousness, passing through stages of increasing light headedness and intoxication, a very dangerous thing with a diver with a decompression accident.
Here are some references which might be helpful:
1.) BOC Gases. (1995). Entonox. Suggested Protocol
Document BOC: Guildford.
2.) Report of the Working Party of the Commission on the Provision of Surgical Services. Pain after Surgery. London: Royal College of Surgeons of England and College of Anaesthetists, 1990.
3.) Gudmarsson, A. N. (1994) "Nitrous oxide as analgesic for painful
procedures outside the operating theatre." British Journal of Anaesthesia, 72: Supp 1:A241:125.
4.) United Kingdom Central Council for Nursing, Midwifery and Health Visiting. (1992). The Scope of Professional Practice. UKCC: London.
5.) Acott CJ, et al._ Decompression illness and nitrous oxide anaesthesia in a sports diver.
Anaesth Intensive Care. 1992 May;20(2):249-50. PMID:
1595871; UI: 92281042.
6.) McIver RG, et al. Experimental decompression sickness from hyperbaric nitrous oxide anesthesia. SAM-TR-65-47. Tech Rep
SAM-TR. 1965 Aug;:1-12. PMID: 5294885; UI: 66052804.
7.) Eger EI II, Saidman LJ: Hazards of nitrous oxide
anesthesia in bowel obstruction and pneumothorax. Anesthesiology 26:61, 1965
Index

Regards,

Laurence Stein DDS

 

[JamesK]

I tell you what, I have a 10lb bottle (we measure it by pounds) of nitrous oxide in the trunk of my car. You are more then welcome to breathe off of it if you like. However, it is $3.25 a pound, so don't use too much. Thanks.

 

[Laurence Stein DDS]

JamesK,

Let me get this straight....you have a rolling dental office...right?

or

You vent it behind you in a police chase so the cops are happy to catch you?

or

You got the baddest hotrod in town.

Be safe.

Larry Stein