key: cord-0963684-hcjxcn1n
authors: Namineni, Srinivas; Mallineni, Sreekanth Kumar
title: Practice of nitrous oxide inhalation sedation in dentistry during and after the COVID-19 pandemic
date: 2020-08-27
journal: J Dent Anesth Pain Med
DOI: 10.17245/jdapm.2020.20.4.261
sha: c3c08191b0ea6d41d0aec4b116dc013fd6b5518c
doc_id: 963684
cord_uid: hcjxcn1n

nan

The recent outbreak of the coronavirus disease (COVID-19) has attracted global attention to the health care profession. The COVID-19 pandemic has affected every medical profession worldwide, including dentistry [1] . The incubation period of COVID-19 is approximately 7-12 days, and the major signs and symptoms of the disease include dry cough, sneezing, respiratory depression, and dyspnea. The mode of transmission is mainly through infected droplets. The effect of this pandemic on dentistry is significant, as most of the treatments in dentistry involve aerosol-generating procedures that may increase the chances of the spread of the infection [2] . Many national and international societies have conveyed safety guidelines for the handling of patients during this pandemic. Despite the guidelines, there seems to be a deficiency in dental care around the usage of additional sedation with nitrous oxide. This letter is intended to shed light on care to be taken while using inhalation sedation with nitrous oxide in dental practice. The unique symptoms of COVID-19, such as cough, sneezing, and difficulty in breathing, make the choice of inhalation sedation limited. Therefore, other non-inhalational options need to be considered (needless to mention, behavioral methods), such as the usage of oral and intravenous routes for anxiolysis. Universally accepted safety methods involving the use of personal protective equipment (PPE) and surface disinfection methods are strictly recommended in dental practice while using inhalation sedation. While administering sedation, an appropriately sized nasal hood, without any gap around the nose, should be used [3] . Additionally, the use of a rubber dam provides an advantage by reducing salivary contamination from splatters, by isolating the mouth [2] .

With a proper nasal seal, and the hood and the rubber dam isolating the mouth, salivary contamination should significantly reduce contamination from aerosols. Once the procedure is completed, the disposable nasal hoods should be carefully removed, placed into a zip-lock plastic cover, and disposed appropriately into biomedical waste bins. This disposal should be done before the clinician/nurse removes PPE and gloves. If autoclavable hoods are used, they should be washed under running water after removal from the circuit and sterilized using the standard method for sterilizing rubber materials [4] . The next step is to handle the delivery tubing that is connected to the machine to deliver gases to the nasal hoods. The whole delivery tubing should be washed and autoclaved. All the attachments must be double-sealed for the next session.

The surface of the sedation machine should be disinfected [4, 5] . Because it is based on an inhalational route that involves the respiratory tract, lungs, and alveoli for gaseous exchange, respiratory anatomy and physiology have a significant influence on nitrous oxide sedation [3] . The passage of the gases through the airway systems (in and out) not only contributes to the viral load of the external environment in the dental setup but also puts the dental team at a higher risk because of the proximity of the oral cavity while performing dental procedures. An extra-oral vacuum device is assumed to reduce the risk burden.

However, the scientific value of such a device is yet to be proved. Until proven otherwise, the utility of this device 

Transmission routes of 2019-nCoV and controls in dental practice

Coronavirus disease (COVID-19): Characteristics in children and considerations for dentists providing their care

Nitrous oxide inhalation sedation in dentistry: An overview of its applications and safety profile

Cleaning and sterilisation of anaesthetic equipment

Guideline for disinfection and sterilization in healthcare facilities