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Administering Nitrous Oxide

We are charged with addressing and managing anxiety during dental treatment, and the use of nitrous oxide is highly effective in treating this type of dental fear. Dental hygienists are allowed to administer N2O-O2 in some states, but not all. There are differences in the dental hygiene scope of practice as it relates to N2O-O2 delivery, with variability in education and training requirements, levels of supervision, and credentialing standards. Are you up-to-date on your state’s scope of practice as it relates to nitrous oxide delivery?

Administering Nitrous Oxide

We are charged with addressing and managing anxiety during dental treatment, and the use of nitrous oxide is highly effective in treating this type of dental fear. Dental hygienists are allowed to administer N2O-O2 in some states, but not all. There are differences in the dental hygiene scope of practice as it relates to N2O-O2 delivery, with variability in education and training requirements, levels of supervision, and credentialing standards. Are you up-to-date on your state’s scope of practice as it relates to nitrous oxide delivery?

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Terminology

The terms administer, monitor, and terminate are used when describing the N2O-O2 procedure. We must understand these terms, as variations of the definitions exist within specific state’s rules and regulations. For example, the word “monitoring” in one state may mean observing or watching a patient while N2O-O2 is being delivered, while in another state, the definition of this same term includes initiation of the flow.

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Regulatory Status

Currently, 32 states in the United States permit the administration of N2O-O2 by licensed dental hygienists. They have the ability to start, adjust, and stop the flow of gases being administered. Two states allow dental hygienists to actively observe or monitor the patient who has been given N2O-O2, but have no administration privileges. Sixteen states prohibit the administration or monitoring of N2O-O2 by dental hygienists.

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Spotlight on Supervision

Weaved into the scope of practice is the level of supervision that each state requires. Typically state practice acts use the terms “direct,” “indirect,” and “general” to describe the levels of supervision needed for dental hygienists. Direct supervision typically means that the dentist needs to not only be present, but also in the room when the procedure is taking place. With indirect supervision, the dentist has authorized the procedure and must be present in the office, while general supervision permits proceeding even when the dentist is not present in the office. Variations of these levels of supervision also exist in some states, including prescriptive supervision and direct-access supervision.

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Educational Requirements

States that permit dental hygienists to administer N2O-O2 have varying educational requirements. Some states require that the education obtained must come from an accredited dental hygiene program, while others allow education from a board-approved course. The majority of states indicate the exact number of didactic hours needed, which range from 3 hours to 36 hours. In addition to a didactic component, several states require additional clinical education or experience that ranges from 2 hours to 15 hours.

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Credentialing

Unlike attaining a dental hygiene or local anesthesia license, a written or clinical national and state examinations are not required by all licensing boards for the use of N2O-O2. The Commission on Dental Competency Assessments offers a 50-question written examination as part of a certification process required by some states. The Commission on Dental Accreditation (CODA) does not specifically require nitrous oxide education. However, the individual state dental practice act determines requirements for the administration or monitoring of N2O-O2 and CODA states that educational institutions need to teach what is in the practice act. Based on the requirements of the state practice act, programs may integrate theory-based N2O-O2 education, while others may include a clinical component.

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Ethical Responsibility

One of the professional responsibilities that a dental hygienist is expected to uphold is to “prevent situations where patient safety and well-being could potentially be compromised.” Understanding the indications and relative contraindications of N2O-O2 use and being familiar with the signs and symptoms of ideal levels of conscious sedation are essential in ensuring safe delivery to patients. Dental hygienists who are permitted to administer an agent that alters patients’ current states are also morally obligated to obtain proper education and training on this subject.

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