Dental Teams May Be Ignoring Precautions to Control Exposure to Nitrous Oxide

A survey by the National Institute for Occupational Safety and Health (NIOSH) has found that while scavenging systems are widely used by dental teams to prevent nitrous oxide from escaping into the operatory, adherence to other recommended practices is not as strong. An analysis of responses from 284 dental practitioners who administered nitrous oxide in the seven days prior to the NIOSH Health and Safety Practices Survey of Healthcare Workers found that 93% of respondents reported they always used a nasal scavenging mask or local exhaust ventilation (LEV) when administering nitrous oxide. However, 51% of respondents reported they did not check for leaks when using the gas on adult patients, while 47% said they did not check the equipment for leaks prior to using it on pediatric patients.

Other practices that increase exposure risk include starting nitrous oxide gas flow before the delivery or airway mask is placed on the patient (14% pediatric patients; 16% adult patients), and not turning off nitrous oxide gas flow before turning off oxygen flow (8% pediatric patients; 10% adult patients). The survey also revealed that 13% of respondents reported lacking standard procedures to minimize occupational exposure. In addition, a lack of training in safe handling and administration methods was reported by 3% of practitioners.

According to NIOSH, “Successful management of nitrous oxide should include nasal scavenging masks, supplementary LEV if needed, adequate general ventilation, regular inspection of nitrous oxide delivery and scavenging equipment for leaks, availability of standard procedures to minimize exposure, periodic training and medical surveillance.”

From Decisions in Dentistry. August 2017;3(8):11.