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Nitrous Oxide and Oxygen Sedation: An Update (AGD 340)

Presenter: Ann Brunick, RDH, MS & Morris S. Clark, DDS, FACD; Contributing Author: Natalie Kaweckyj, LDA, RF, CDA, CDPMA, COA, COMSA, CPFDA, CRFDA, MADAA, BA


Nitrous oxide and oxygen (N2O/O2) in combination have been used safely and successfully for over 160 years to assist in the management of pain and anxiety. Dr. Horace Wells, a dentist in the early 1800s, dedicated his life to promoting its use for both dental and medical procedures. Because of his persistence in advocating the use of nitrous oxide as a method of pain control, he was posthumously recognized as the “Discoverer of Anesthesia.” Since that time, N2O/Ohas been commonly used in many dental specialties and is used by approximately 70% of the dental practices today that use any type of sedation techniques. Other health disciplines have also benefited from the use of the medical gas and is used at the start of all general anesthesia cases. 

In many instances, patients present to medical and dental offices with both pain and anxiety. Dental offices have seen an increase in dentally-related anxiety in patients of all ages. It is necessary to manage both, since they are interrelated. Nitrous oxide and oxygen sedation can assist patients with their pain and anxiety and can be employed safely and effectively with minimal concerns.

This course will teach about the desirable characteristics of nitrous oxide, indications and contraindications for N2O/O2 use as well as facts and myths surrounding chronic exposure to nitrous oxide, the biologic effects associated with high levels of the gas, and ways to assess and minimize trace gas contamination in an outpatient setting.


Ann Brunick, RDH, MS, is Chairperson and Professor of the Department of Dental Hygiene at the University of South Dakota. She received an A.A. degree from the University of South Dakota, a B.S. degree from the University of Minnesota, and a master’s degree from the University of Missouri-Kansas City, School of Dentistry. She has served on numerous committees at the local, regional and national levels, including the ADHA Institute for Oral Health Scholarship and Research Review Committees, the National Dental Hygiene Board Examination Construction Committee, the International Federation of Dental Hygienists’ editorial board and the ADA Commission on Dental Accreditation as a site visitor. Ms. Brunick has published numerous articles and abstracts. Her most recent work is the third edition of a textbook entitled Handbook of Nitrous Oxide and Oxygen Sedation that she co-authored with Dr. Morris Clark.

Morris S. Clark, DDS, FACD, is a nationally and internationally recognized expert on the subject of nitrous oxide/oxygen therapy. His is a graduate of the University of California School of Dentistry and completed his training in Oral Maxillofacial Surgery at Columbia University. He is a Professor at the University of Colorado School of Dental Medicine and on the faculty of the medical school there as well. He has been President of the American Society for the Advancement of Anesthesia in Dentistry and the American Dental Society of Anesthesia for the states of Colorado, Arizona, Kansas, Utah, Wyoming and New Mexico. Dr. Clark did the original clinical research on Versed (Midazolam) and Romazicon (Flumazenil), the antagonist for all the benzodiazepine class of drugs. He is on the Board of Directors for the American Dental Society of Anesthesia and a member of the American Dental Association Council on Scientific Affairs. He is co-author of the best-selling text Handbook of Nitrous Oxide and Oxygen Sedation, published by Elsevier.

Contributing Author:

Natalie Kaweckyj began her dental assisting career over 25 years ago after graduating from the CODA accredited program ConCorde Career Institute. She spent twelve years working in a private practice where she worked clinically nine years and administratively the remaining three. She then moved onto teaching dental assisting and eventually became director of that program. Over lapping with teaching, Natalie began her tenure with Children’s Dental Services in 2007 in management and currently serves as clinical coordinator responsible for the day to day operations at over 600 locations where services are provided throughout Minnesota. Natalie enjoys the challenges of the public health sector and is gratified in serving those that are underserved, especially in a hospital setting under general anesthesia. With over a decade of restorative functions experience under her belt, she enjoys working with professionals new to dentistry as her love for teaching comes into play with the utilization of clinicians to the full scope of their licenses. The clinic keeps Natalie busy with billing management when not at the hospital. Natalie also graduated with a BA in Biology and Psychology from Metropolitan State University in 2005.

Ms. Kaweckyj served two terms as ADAA President (2017-2018; 2010-2011). She remains active on several councils, and serves as a President of the Professional Dental Assistants Educational Foundation (PDAEF). She served as a three-term president for MnDAA and remains as the state business secretary. Natalie has been recognized with several ADAA awards, was one of the first ADAA Fellows in 1999 and became the first ADAA Master in 2004. She has published numerous continuing education courses, over 200 articles and lectures on a variety of dental subjects locally, nationally and internationally. Organized dentistry gave Natalie the insight that you can make a difference as a dental professional, and she was instrumental in seeing licensure for dental assistants come to fruition in MN in 2009 as well as several expanded functions. Her dream would be to see mandatory credentialing become a reality in all states for protection of the public and maintaining integrity of the dental assisting profession.


Upon completion of this course, the dental professional should be able to:

• Recognize characteristics of nitrous oxide that make it desirable to use for most patients.
• Evaluate indications and contraindications for the use of N2O/O2 sedation.
• Differentiate between the facts and myths surrounding chronic exposure to nitrous oxide.
• Explain what the NIOSH and ACGIH recommended exposure limits signify.
• Identify biologic effects associated with high levels and/or misuse of nitrous oxide.
• Describe methods for detecting and assessing levels of trace gas in an outpatient setting.
• List methods for minimizing trace levels of nitrous oxide in an outpatient setting.


The ADAA has an obligation to disseminate knowledge in the field of dentistry. Sponsorship of a continuing education program by the ADAA does not necessarily imply endorsement of a particular philosophy, product or technique.

The ADAA cautions participants taking this course on the hazards of using limited knowledge when integrating new techniques into their practices.

Credits earned upon completion of this course may be used to meet DANB’s Recertification Requirements.


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