Efficacy and Safety of Nitrous Oxide (N<sub>2</sub>O) Inhalation Sedation Compared to Other Sedative Agents in Dental Procedures: A Systematic Review with Meta-Analysis

<i>Background and Objectives</i>: Dental procedures can be distressing, particularly for patients who are anxious or uncooperative. In such cases, effective sedation not only facilitates the clinician’s work but also enhances patient comfort and acceptance of dental care. Nitrous oxide (...

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Main Authors: Francesca Piccialli, Marco Fiore, Roberto Giurazza, Fabrizio Falso, Vittorio Simeon, Paolo Chiodini, Diana Russo, Luigi Laino
Format: Article
Language:English
Published: MDPI AG 2025-05-01
Series:Medicina
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Online Access:https://www.mdpi.com/1648-9144/61/5/929
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author Francesca Piccialli
Marco Fiore
Roberto Giurazza
Fabrizio Falso
Vittorio Simeon
Paolo Chiodini
Diana Russo
Luigi Laino
author_facet Francesca Piccialli
Marco Fiore
Roberto Giurazza
Fabrizio Falso
Vittorio Simeon
Paolo Chiodini
Diana Russo
Luigi Laino
author_sort Francesca Piccialli
collection DOAJ
description <i>Background and Objectives</i>: Dental procedures can be distressing, particularly for patients who are anxious or uncooperative. In such cases, effective sedation not only facilitates the clinician’s work but also enhances patient comfort and acceptance of dental care. Nitrous oxide (N<sub>2</sub>O) has been widely employed as a sedative agent in dental practice. This systematic review aimed to assess the efficacy and safety of N<sub>2</sub>O compared to alternative sedative agents and techniques in dental surgical procedures. <i>Materials and Methods:</i> This review protocol was prospectively registered on PROSPERO (CRD42020213429) and conducted in accordance with PRISMA guidelines. <i>Results:</i> A total of 1809 records were screened (1134 from Embase, 638 from PubMed, and 37 from CENTRAL). The meta-analysis focused on the following three primary outcomes: 1. Patient satisfaction: Eight studies comprising 422 participants (165 treated with N<sub>2</sub>O and 176 with other sedatives) were included. 2. Recall of the procedure: Five studies with a total of 288 patients (68 receiving N<sub>2</sub>O and 64 other agents) assessed patients’ ability to recall tooth extraction. 3. Successful completion of the procedure: Three studies involving 1578 patients (434 treated with N<sub>2</sub>O and 989 with alternative sedation methods) were analyzed. <i>Conclusions:</i> No statistically significant differences were observed between N<sub>2</sub>O and other sedative techniques across all outcomes evaluated. Safety could not be adequately assessed as none of the included studies systematically investigated this outcome. Further high-quality research is warranted to rigorously evaluate the safety profiles of various sedation strategies in dental surgery.
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spelling doaj-art-74d035cfd03d440bb6845dfd50b1d2d22025-08-20T01:56:17ZengMDPI AGMedicina1010-660X1648-91442025-05-0161592910.3390/medicina61050929Efficacy and Safety of Nitrous Oxide (N<sub>2</sub>O) Inhalation Sedation Compared to Other Sedative Agents in Dental Procedures: A Systematic Review with Meta-AnalysisFrancesca Piccialli0Marco Fiore1Roberto Giurazza2Fabrizio Falso3Vittorio Simeon4Paolo Chiodini5Diana Russo6Luigi Laino7Department of Women, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Via Luigi De Crecchio, 2, 80138 Naples, ItalyDepartment of Women, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Via Luigi De Crecchio, 2, 80138 Naples, ItalyDepartment of Women, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Via Luigi De Crecchio, 2, 80138 Naples, ItalyDepartment of Critical Care, AORN Ospedali dei Colli, Via Leonardo Bianchi, 80131 Naples, ItalyMedical Statistics Unit, Department of Public, Clinical and Preventive Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, ItalyMedical Statistics Unit, Department of Public, Clinical and Preventive Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, ItalyMultidisciplinary Department of Medical-Surgical and Odontostomatological Specialties, University of Campania “Luigi Vanvitelli”, 80138 Naples, ItalyMultidisciplinary Department of Medical-Surgical and Odontostomatological Specialties, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy<i>Background and Objectives</i>: Dental procedures can be distressing, particularly for patients who are anxious or uncooperative. In such cases, effective sedation not only facilitates the clinician’s work but also enhances patient comfort and acceptance of dental care. Nitrous oxide (N<sub>2</sub>O) has been widely employed as a sedative agent in dental practice. This systematic review aimed to assess the efficacy and safety of N<sub>2</sub>O compared to alternative sedative agents and techniques in dental surgical procedures. <i>Materials and Methods:</i> This review protocol was prospectively registered on PROSPERO (CRD42020213429) and conducted in accordance with PRISMA guidelines. <i>Results:</i> A total of 1809 records were screened (1134 from Embase, 638 from PubMed, and 37 from CENTRAL). The meta-analysis focused on the following three primary outcomes: 1. Patient satisfaction: Eight studies comprising 422 participants (165 treated with N<sub>2</sub>O and 176 with other sedatives) were included. 2. Recall of the procedure: Five studies with a total of 288 patients (68 receiving N<sub>2</sub>O and 64 other agents) assessed patients’ ability to recall tooth extraction. 3. Successful completion of the procedure: Three studies involving 1578 patients (434 treated with N<sub>2</sub>O and 989 with alternative sedation methods) were analyzed. <i>Conclusions:</i> No statistically significant differences were observed between N<sub>2</sub>O and other sedative techniques across all outcomes evaluated. Safety could not be adequately assessed as none of the included studies systematically investigated this outcome. Further high-quality research is warranted to rigorously evaluate the safety profiles of various sedation strategies in dental surgery.https://www.mdpi.com/1648-9144/61/5/929nitrous oxidesedativesdental procedurespatient safetysystematic reviewmeta-analysis
spellingShingle Francesca Piccialli
Marco Fiore
Roberto Giurazza
Fabrizio Falso
Vittorio Simeon
Paolo Chiodini
Diana Russo
Luigi Laino
Efficacy and Safety of Nitrous Oxide (N<sub>2</sub>O) Inhalation Sedation Compared to Other Sedative Agents in Dental Procedures: A Systematic Review with Meta-Analysis
Medicina
nitrous oxide
sedatives
dental procedures
patient safety
systematic review
meta-analysis
title Efficacy and Safety of Nitrous Oxide (N<sub>2</sub>O) Inhalation Sedation Compared to Other Sedative Agents in Dental Procedures: A Systematic Review with Meta-Analysis
title_full Efficacy and Safety of Nitrous Oxide (N<sub>2</sub>O) Inhalation Sedation Compared to Other Sedative Agents in Dental Procedures: A Systematic Review with Meta-Analysis
title_fullStr Efficacy and Safety of Nitrous Oxide (N<sub>2</sub>O) Inhalation Sedation Compared to Other Sedative Agents in Dental Procedures: A Systematic Review with Meta-Analysis
title_full_unstemmed Efficacy and Safety of Nitrous Oxide (N<sub>2</sub>O) Inhalation Sedation Compared to Other Sedative Agents in Dental Procedures: A Systematic Review with Meta-Analysis
title_short Efficacy and Safety of Nitrous Oxide (N<sub>2</sub>O) Inhalation Sedation Compared to Other Sedative Agents in Dental Procedures: A Systematic Review with Meta-Analysis
title_sort efficacy and safety of nitrous oxide n sub 2 sub o inhalation sedation compared to other sedative agents in dental procedures a systematic review with meta analysis
topic nitrous oxide
sedatives
dental procedures
patient safety
systematic review
meta-analysis
url https://www.mdpi.com/1648-9144/61/5/929
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