Occupational exposures to nitrous oxide (N(2)0) were measured in numerous dental operatories. In all cases, the National Institute of Occupational Safety and Health (NIOSH) recommended time-weighted average (for one operation) of 25 ppm was exceeded by wide margins (NIOSH considers 50 ppm to be attainable in dental operatories). However, a new risk assessment is necessary to determine appropriate exposure limits. Many of the operatories were not equipped with scavenging systems and none of them used a scavenging device in combination with a local exhaust ventilation system. Scavenging devices and local exhaust ventilation should be used to control nitrous oxide exposures. Leaks in N(2)0 delivery systems, which were found to be commonplace, should also be controlled. Research and development efforts are needed to improve upon the already existing scavenging devices, and provision for local exhaust ventilation needs to be included in the design of dental operatories.

Occupational exposure to nitrous oxide in dental operatories.

This prospective study of 36 children, ages 44-93 months, receiving nitrous oxide-oxygen under standardized conditions during routine dental procedures was conducted to determine what influence eight selected dental procedures and three patient behaviors had on ambient nitrous oxide (N2O) levels in the dentist's breathing zone. Half the children received nitrous oxide-oxygen via a scavenging nasal mask. An infrared spectrophotometer analyzed the ambient N2O level continuously throughout the procedure and the time-weighted average (TWA) for consecutive 15-sec intervals was recorded by a microprocessor. A video camera was used to synchronize the coded dental procedures and patient behaviors to the TWA ambient N2O levels recorded. The results demonstrated that scavenging significantly reduced the dentist's exposure to ambient N2O (P less than 0.05, nonscavenged mean = 284.7 ppm; scavenged mean = 36.6 ppm), but the mean TWA N2O concentration remained significantly higher, P less than 0.05, than the 25-ppm level recommended by the National Institute for Occupational Safety and Health (NIOSH). Supplemental oral evacuation was the only dental procedure capable of reducing ambient N2O to below NIOSH's recommendation when scavenging was employed. The administration of local anesthesia consistently created a significant increase in ambient N2O levels. Patient behaviors of talking, crying, and movement also resulted in significant increases from baseline ambient N2O levels.

The effects of various dental procedures and patient behaviors upon nitrous oxide scavenger effectiveness.

Concern regarding environmental health hazards for dental personnel chronically exposed to waste nitrous oxide (N2O) prompted this investigation. The influence on ambient N2O levels of scavenging, operatory size, and N2O concentration delivered to the patient was evaluated during treatment of 36 pediatric dental patients. The results showed that scavenging significantly reduced ambient N2O levels measured at 50-56 cm from the patient's nose. Scavenged ambient N2O levels were also observed to decrease when N2O concentrations administered to the patient were reduced from 50 to 30%. This concentration effect was not observed in the non-scavenged groups. ANOVA showed that operatory size exerted a non-significant influence on ambient N2O. The data collected during routine treatment of pediatric dental patients demonstrated that the scavenging system tested significantly reduced waste N2O in the operator's breathing zone, nearly approximating the 25-ppm recommendation established by the National Institute for Occupational Safety and Health (NIOSH).

Influence of Operatory Size and Nitrous Oxide Concentration Upon Scavenger Effectiveness

statistically significant difference in pretreatment lactate concentrations between survivors and nonsurvivors in a group of patients suffering from septic shock. Secondly, Haupt and her colleagues2 confirmed the difficulty of attributing prognostic significance to lactic acidosis in septic patients, some patients with high lactate levels showing an ability to increase oxygen consumption in response to fluid loading while others did not; no difference in outcome was observed between the groups. Thus, we stand by our original conclusion that, on the basis of this study, in shocked, predominantly septic, patients, lactate was a relatively unhelpful predictor of outcome and we do not appear to be alone in drawing this conclusion. Department of Surgery, Western Infirmary. Glasgow GI1 6NT 1. McA. LEVINCHAM

https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/pdf/10.1111/j.1365-2044.1986.tb12714.x

Abortions among dental personnel exposed to nitrous oxide.

/pdf/scientific-basis-for-swedish-occupational-standards-xxiii-4e1tbk4t0u.pdf

Scientific Basis for Swedish Occupational Standards xxiii

: The psychomotor effects of nitrous-oxide oxygen psychosedation has been studied in medical student volunteers not undergoing any kind of treatment and in dental patients both children and adults. These studies, using nitrous oxide in concentrations of 25-35%, concluded that psychomotor impairments, as measured by the tests, were minimal at those concentrations and were rapidly reversed following a 3-5 minute post-treatment oxygenation period. Tecent attention has been directed at the effects of nitrous oxide on the dentist who may be exposed to waste gases for a prolonged period of time. Because of the absence of data on potential impairments of the psychomotor abilities of dentists who use nitrous oxide, this study investigated their psychomotor responses during the course of a treatment period in which nitrous oxide was administered to a patient. The findings for dentists in this study are essentially similar to those reported previously on the effects of nitrous oxide on psychomotor activities during and following dental treatment. One reason for the similarity may be that all of these studies involved investigation of psychomotor abilities during one treatment session. The effects of prolonged exposure to nitrous oxide requires additional study to clarify those effects if, in fact, there are any.

Psychomotor responses of dentists using nitrous oxide-oxygen psychosedation.

: Psychosedation with nitrous oxide and oxygen has shown increasing use as an adjunct in reducing anxiety for dental patients. Current techniques employ machines which deliver a mixture that can be varied up to a maximum of 50% nitrous oxide and a minimum of 50% oxygen. One purported advantage of this psychosedation technique is the rapid recovery by the patient from its effects following its termination. Because nitrous oxide-oxygen psychosedation is used with ambulatory nonaccompanied dental patients it is important that the exent and duration of any residual effect from the clinical application of this technique be assessed. (Author)

Recovery from nitrous oxide-oxygen psychosedation as determined by the fusion frequency of flicker.

: The concentration of waste gas in the ambient air during administration of N2O/O2 analgesia is dependent upon many factors. Three of these--distance from the nosepiece escape valve, position in relation to the direct line of waste gas dissemination and the deviation of the analgesia--were studied. Analysis of the data indicates that all three factors were significant in affecting gas concentration at any given point. Angulation or position in relation to the direction of waste gas dissemination was shown to be the most dominant factor.

Measurement of waste gas contamination during nitrous oxide sedation in a non-ventilated dental operatory.

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Psychomotor responses of dentists using nitrous oxide-oxygen psychosedation.

Recovery from nitrous oxide-oxygen psychosedation as determined by the fusion frequency of flicker.

Measurement of waste gas contamination during nitrous oxide sedation in a non-ventilated dental operatory.