I understand that Nitrous Oxide is commonly called “laughing gas” and provides relaxation. Nitrous oxide is used for anxiety and pain control, as well as control of gagging. I understand that my child will be awake, fully conscious, aware of surroundings, and able to respond rationally to questions and directions.
Local anesthesia will also be required for most procedures.
I accept and understand that Nitrous Oxide is an elective procedure and not required to provide the necessary dental treatment. I am aware that the alternative to completing the necessary treatment with Nitrous Oxide is to use local anesthetic ONLY.
Nitrous Oxide is very effective for many children, however, some may not like the feeling it produces, or it may produce increased activity in some children, at which time the DENTIST may decide to discontinue Nitrous Oxide. If Nitrous Oxide sedation does not provide adequate sedation to allow for the planned dental treatment a referral for other sedation techniques may be required.
I have provided an accurate medical history, including current and history of medical conditions, allergies, current medications, and surgeries. I understand that it is my responsibility to notify the Dentist and his/her staff of any changes in my child’s medical history. I understand some conditions which may increase risks during Nitrous Oxide treatment include:
Cold or upper respiratory infection
Asthma, or difficulty breathing
Bleomycyin Sulfate Treatment
Current Ear Infection
Sickle Cell Anemia
Chronic Obstructive Pulmonary Disease
I have been advised of the possible complications associated with Nitrous Oxide. They include but are not limited to:
Nausea and vomiting. This is the most frequent side effect of Nitrous Oxide, but its frequency is quite low. Early
may be required to lessen the likelihood of this complication.
Temporary tingling in the fingers, toes, cheeks, lips, tongue and head or neck area.
Temporary warm feeling throughout the body with accompanying flushing/blushing.
Temporary detachment or “o
ut of body” sensation.
Temporary sluggishness in motion and/or speech.
usually at the end of the procedure.
I acknowledge that every effort will be made on my child’s behalf for a positive outcome, but no guarantees have been made as to the result and/or effectiveness of Nitrous Oxide.