Laughing gas — or nitrous oxide — is a colourless, odourless gas that has been used in paediatric dentistry for decades. It helps some children feel calmer and more relaxed during dental treatment, making it possible to complete treatment that the child would otherwise find very difficult to tolerate. It is not used routinely for every anxious child — it is one option among several, chosen when the doctor judges it appropriate for a specific child.
How it works
Nitrous oxide is inhaled through a small nosepiece — a soft mask that sits over the nose. The child breathes normally. Within a few minutes, most children notice a pleasant floating or tingling sensation and feel more relaxed. They remain awake, conscious and able to communicate throughout the appointment — they simply feel calmer.
When the treatment is finished, the nitrous oxide is turned off and replaced with oxygen for a few minutes. The effects wear off quickly — usually within 5 to 10 minutes. The child can eat, drink and carry on normally after the appointment.
How Dr. Bhuvanesswari decides whether to recommend it
Dr. Bhuvanesswari evaluates each child individually before recommending nitrous oxide. The assessment considers:
- The child's age, medical history and any existing health conditions
- The nature and extent of the treatment needed
- The child's level of anxiety and how they have responded to behaviour guidance techniques
- Whether the child can breathe normally through the nose (nasal congestion makes the nosepiece less effective)
Nitrous oxide is not offered as a default option. It is considered when behaviour guidance techniques alone are not sufficient and when the clinical assessment indicates it is appropriate for that child. The AAPD's guideline on nitrous oxide/oxygen inhalation states that patient selection should be based on clinical assessment, with appropriate monitoring throughout.
What it does not do
Nitrous oxide reduces anxiety and makes treatment more tolerable — it does not make the child unconscious or fully numb the area being treated. For any treatment that might cause discomfort, local anaesthetic is still used alongside it.
For children who are extremely anxious or who need extensive treatment that cannot be managed with nitrous oxide, other options exist. Dr. Bhuvanesswari will discuss these individually after assessing your child.
Before the appointment
If nitrous oxide has been planned for your child's visit:
- Give a light meal 2 hours before the appointment. A full stomach can cause nausea in some children.
- Tell us about any nasal congestion or recent illness — this affects how well the nosepiece works.
- Let us know about any changes in your child's health or medications since the last visit.
Sources: American Academy of Pediatric Dentistry, Guideline on Use of Nitrous Oxide for Pediatric Dental Patients, 2023; American Academy of Pediatric Dentistry, Guideline on Behaviour Guidance for the Paediatric Dental Patient, 2023.