The student will be able to:

1. Describe the historical background and evolution of nitrous oxide/oxygen sedation in dental practice.
2. Explain the physiology of pain perception and the biological, psychological, and cultural factors that influence pain experiences among diverse patient populations.
3. Describe the physiological responses to dental anxiety and stress, and their impact on patient behavior and care outcomes.
4. Describe the pharmacological and physiological actions of nitrous oxide/oxygen, including its uptake, distribution, metabolism, and excretion.
5. Evaluate the clinical benefits, limitations, and risks of nitrous oxide sedation for patients across various health profiles.
6. Explain the occupational hazards and patient safety concerns related to nitrous oxide exposure and abuse.
7. Identify and operate the components of nitrous oxide delivery systems (armamentarium).
8. Safely administer nitrous oxide/oxygen sedation to patients.
9. Analyze the indications and contraindications for nitrous oxide sedation based on evidence-based guidelines and patient-specific factors.
10. Demonstrate appropriate infection control measures during the administration of nitrous oxide analgesia and breakdown of nitrous oxide equipment.
11. Accurately document nitrous oxide sedation procedures in accordance with legal, ethical, and institutional standards.

1. History of nitrous oxide/oxygen sedation
   1. Discovery
   2. Early uses
   3. Dental applications
2. Guidelines for best practice
   1. Sedation guidelines
   2. Virtues of nitrous oxide sedation
3. Pain and anxiety management
   1. Mechanism of pain
   2. Assessing and measuring pain
   3. Understanding fear and anxiety
   4. Acknowledgement of pain, fear, and anxiety
4. Desirable characteristics of nitrous oxide/oxygen sedation
   1. Analgesic properties
   2. Anxiolytic properties
   3. Amnestic properties
   4. Onset of action
   5. Titration
   6. Depth of sedation
   7. Elimination and recovery
   8. Acceptance
5. Physical properties, pharmacokinetics/pharmacodynamics of nitrous oxide and oxygen
   1. Gas properties of nitrous oxide
   2. Gas properties of oxygen
6. Manufacturing, use, and distribution of nitrous oxide and oxygen gases
   1. Users of nitrous oxide
   2. Regulations and control of nitrous oxide
   3. Storing nitrous oxide
   4. Nitrous oxide cylinders
   5. Oxygen cylinders
7. Nitrous oxide/oxygen equipment and delivery system
   1. Central gas supply system
   2. Portable gas delivery system
   3. Flowmeter
   4. Reservoir bag
   5. Conducting tubing
   6. Nasal hood
   7. Equipment safety features
8. Anatomy and physiology of respiratory system
   1. Respiratory physiology
   2. Onset of sedation
   3. Metabolism
   4. Tidal volume
9. Interactions of nitrous oxide with the body
   1. Indications of use
      1. Pain
      2. Anxiety
      3. Calming
   2. Contraindications
      1. Pregnancy
      2. History or current drug/substance abuse
      3. Inability to communicate
      4. Tympanic membrane surgery
      5. Bowel impaction
      6. Ocular surgery with specific implants
      7. Cystic fibrosis
      8. Respiratory diseases: COPD, emphysema
      9. Psychoses or mental illness
      10. Upper respiratory infection
10. Patient assessment and evaluation
    1. Preoperative patient evaluation
    2. Assessment of patient risk
       1. ASA classification system
       2. Vital signs
       3. Informed consent
       4. Patient monitoring
       5. Emergency preparedness
11. Signs and symptoms of nitrous oxide and oxygen sedation
    1. Appropriate minimal sedation
    2. Inappropriate minimal sedation
12. Technique for nitrous oxide and oxygen administration and assessment and recovery
    1. Procedure initiation
    2. Induction
    3. Titration
    4. Observing/monitoring patient
    5. Termination of nitrous oxide flow
    6. Continuation of oxygen flow and assessing recovery
    7. Postoperative procedures
    8. Sterilization and disinfection
    9. Recordkeeping
13. Multidisciplinary applications of nitrous oxide/oxygen sedation
14. Nitrous oxide and oxygen sedation in pediatrics
15. Potential biohazards of health personnel associated with chronic exposure to nitrous oxide
    1. Scavenging trace nitrous oxide gas
    2. Best practices
16. Nitrous oxide abuse issues
17. Ethical and legal considerations regarding nitrous oxide and oxygen administrations
    1. California Dental Practice Act
    2. Direct supervision

Hands-on instruction and clinical practice in the administration of nitrous oxide/oxygen analgesia will be conducted on three patients in the pre-clinical lab and on two patients in the clinical lab.

During the nitrous oxide sedation lab, students will begin by putting on gloves, a mask, and eye protection. They will then open the oxygen (green) and nitrous oxide (blue) tanks and verify that the pressure gauges are functioning properly. Next, students will attach the reservoir bag, breathing tubing, nasal hood, and connect the scavenging system to the vacuum line. After turning on 100% oxygen and confirming that the reservoir bag inflates correctly, students will place the nasal hood on their partner and gradually introduce nitrous oxide, starting at 5%, while adjusting the oxygen to maintain at least 30%.

At the conclusion of the exercise, students will turn off the nitrous oxide first, continue administering 100% oxygen for 3 to 5 minutes, then turn off the oxygen and close both tank valves. They will bleed the lines by opening the flow knobs until the pressure gauges read zero, then remove and dispose of any single-use parts, disinfect all reusable equipment, and thoroughly wipe down all surfaces to complete the lab safely.

Student performance in this course will be assessed through a combination of written, practical, and clinical evaluations to ensure mastery of both theoretical knowledge and hands-on skills related to nitrous oxide/oxygen sedation. Evaluation methods include:
1. Written examinations
a. Midterm examination: Assesses understanding of foundational concepts, including the history, pharmacology, physiology, and safe use of nitrous oxide/oxygen sedation
b. Final examination: Comprehensive assessment of all course content, including indications/contraindications, patient management, legal considerations, and emergency procedures
2. Laboratory competency evaluations
a. Students will be assessed on their ability to safely and correctly administer nitrous oxide/oxygen sedation in simulated and live-patient settings
b. Competencies include equipment setup and operation, patient assessment, gas titration, communication, monitoring, and infection control
3. Clinical performance assessments
a. Students must demonstrate proficiency in administering nitrous oxide/oxygen sedation to patients under supervision, following clinical protocols and safety standards
b. Emphasis is placed on professionalism, patient-centered care, accurate documentation, and adherence to legal and ethical guidelines

Presentation using videos
Lecture
Skill demonstrations
Clinical skills practice

Clark, Morris S., and Ann L. Brunick. Handbook of Nitrous Oxide and Oxygen Sedation, 5th ed.. 2019.

Although this textbook is older than five years, it remains relevant in the field and is the newest edition published.

Weekly reading assignments in textbook, 1-3 chapters per week.