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


CONCLUSIONS
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.
Collado
Valérie
V
Univ Clermont1, EA 3847, UFR d'Odontologie, and CHU Clermont-Ferrand, Service d'Odontologie, Hôtel-Dieu, F-63003, Clermont-Ferrand, France. valerie.collado@u-clermont1.fr
Nicolas
Emmanuel
E
Faulks
Denise
D
Tardieu
Corinne
C
Manière
Marie-Cécile
MC
Droz
Dominique
D
Onody
Peter
P
Hennequin
Martine
M
D000766:Anesthesia, Dental / Q000009:adverse effects / Q000379:methods / Q000592:standards; D016292:Procedural Sedation / Q000009:adverse effects / Q000379:methods / Q000592:standards; D003815:Dentists / Q000592:standards; D004498:Education, Dental, Continuing / Q000379:methods* / Q000592:standards; D006801:Humans; D008137:Longitudinal Studies; D009609:Nitrous Oxide / Q000008:administration & dosage* / Q000009:adverse effects*; D017060:Patient Satisfaction; D011446:Prospective Studies
D009609:Nitrous Oxide