Why do dentists no longer use nitrous oxide?

October 8, 2025 •

4 min read

According to a 2023 study published in the Journal of the American Dental Association, there has been a noticeable decade-long decrease in nitrous oxide use in dental practices across the United States. This shift prompts many to ask, "Why do dentists no longer use nitrous oxide?" The answer lies in the evolution of dental technology, an expanded understanding of patient needs, and the advent of more sophisticated sedation options.

Quick Summary

Dentistry's shift away from routine nitrous oxide use is driven by safer, more effective sedation options, patient expectations for deeper comfort, and environmental concerns. The gas is still used, but more advanced and personalized alternatives are often preferred, especially for complex procedures or higher anxiety levels.

Key Points

Advanced Alternatives: Modern oral and intravenous (IV) sedation methods offer deeper, more effective relaxation than nitrous oxide.
Mild Effectiveness: Nitrous oxide is a mild sedative, often insufficient for lengthy or complex dental procedures or patients with severe anxiety.
Patient Preference: Patients with moderate to severe anxiety often prefer stronger sedation options that can induce amnesia of the procedure.
Side Effects: Potential side effects like nausea, vomiting, and headaches have contributed to its decline in use.
Environmental Impact: Nitrous oxide is a potent greenhouse gas, influencing some eco-conscious practices to choose alternatives.
Personalized Care: The trend is towards matching the sedation method to the patient's specific needs, anxiety level, and procedure complexity.
Continued Use: Despite the decline, nitrous oxide is still used in some cases, particularly in pediatric dentistry or for patients with mild anxiety.
Safety Features: Modern sedation systems, particularly IV, offer enhanced control and precision, making them a better choice for medically complex patients.

The Historical Significance and Recent Decline

For decades, nitrous oxide, affectionately known as "laughing gas," was the gold standard for dental sedation. Administered as a gas inhaled through a small nasal mask, it produced a feeling of mild euphoria and relaxation that made dental procedures more tolerable for anxious patients. Its fast-acting nature and quick dissipation of effects made it a convenient option, allowing patients to drive themselves home shortly after treatment. However, the reliability and safety of modern alternatives have contributed to its declining use as the default sedative.

Reasons for the Shift Away from Nitrous Oxide

Several interconnected factors have led dental practitioners to prioritize newer, more advanced sedation techniques over the once-dominant laughing gas.

The Rise of Advanced Alternatives

One of the most significant drivers of the decline is the development of more effective sedation alternatives. While nitrous oxide provides minimal to moderate relaxation, options like oral and IV sedation offer a more profound, predictable experience.

Oral Conscious Sedation: This method involves a patient taking a prescribed pill, typically a benzodiazepine, before the appointment. This induces a deeper state of relaxation, and while the patient remains conscious, they may remember little to nothing of the procedure afterward.
Intravenous (IV) Sedation: For patients with severe anxiety or those undergoing lengthy, complex procedures, IV sedation provides the deepest level of conscious sedation. The sedative is delivered directly into the bloodstream, allowing the dentist to precisely and instantly control the dose.
Improved Local Anesthetics: Modern local anesthetics are more effective and longer-lasting than their predecessors. This has reduced the need for supplemental sedation like nitrous oxide, as pain can often be managed with a targeted injection.

Limitations in Sedation Depth and Effectiveness

Nitrous oxide's mild effect is often a significant drawback for many patients and procedures. For patients with moderate to severe dental anxiety or for more invasive treatments like extractions or implant placement, the level of sedation provided by laughing gas is simply insufficient. This has led many practices to move towards alternatives that can provide a more reliable and deeper sense of calm. Additionally, not all patients respond uniformly to nitrous oxide, with some failing to achieve the desired level of relaxation even at maximum doses.

Managing Side Effects and Patient Reactions

While generally considered safe, nitrous oxide is not without potential side effects. Some patients experience nausea, vomiting, dizziness, or headaches, especially if they have a full stomach or the dosage is inconsistent. For some, these adverse reactions can make the experience more uncomfortable rather than less. The risk of these side effects, while manageable, makes other sedation options with fewer common issues more attractive to both dentists and patients.

Growing Environmental Awareness

An increasingly important consideration in modern dentistry is environmental impact. Nitrous oxide is a potent greenhouse gas, with an effect on global warming hundreds of times greater than that of carbon dioxide. As healthcare providers become more eco-conscious, many are opting to reduce or eliminate their use of nitrous oxide in favor of more environmentally friendly alternatives. This reflects a broader trend of sustainability within the medical and dental fields.

Enhanced Safety and Dosing Precision

Modern sedation techniques, particularly IV sedation, offer dentists a higher degree of control and precision. Unlike nitrous oxide, which must be titrated manually, IV sedation allows for immediate dosage adjustments based on the patient's vitals. Furthermore, certain health conditions, including some respiratory illnesses, first-trimester pregnancy, and substance abuse issues, can contraindicate nitrous oxide use. The availability of alternative methods that can be more safely tailored to complex patient health profiles has made them a better choice for many practices.

Comparing Modern Dental Sedation Options

To illustrate the options now available, here is a comparison of the different sedation methods used in modern dentistry, contrasting them with the traditional approach of nitrous oxide.


Feature	Nitrous Oxide	Oral Sedation	IV Sedation
Administration Method	Inhaled through a nasal mask.	Pill taken orally before appointment.	Administered directly into a vein.
Onset of Effects	Rapid, within minutes.	Gradual, takes about an hour.	Immediate, as medication enters bloodstream.
Level of Sedation	Mild to moderate, conscious.	Moderate, conscious but drowsy.	Deep, but conscious and responsive.
Effect on Memory	No amnesic effects.	Can induce partial or no memory of the procedure.	Often results in little or no memory of the procedure.
Recovery Time	Very fast, effects wear off immediately.	Slower, requiring a driver and rest afterward.	Slowest, requiring a driver and extended rest.
Suitability	Minor procedures, mild anxiety.	Moderate anxiety, longer procedures.	Severe anxiety, complex or long procedures.

Conclusion: A Shift Towards Personalized Care

The declining use of nitrous oxide is not a rejection of its historical value but rather an embrace of progress in dental care. Modern dentistry has moved toward a more personalized approach, where the sedation method is chosen to best match the patient's specific needs, anxiety level, and the complexity of the procedure. While nitrous oxide remains a safe and effective option for some cases, the rise of more potent, controlled, and effective alternatives means it is no longer the automatic choice it once was. Patients today have more options than ever to ensure a comfortable and anxiety-free experience. If you suffer from dental anxiety, discussing these options with your dentist can help you find the right solution for your care. For additional guidance on dental anxiety management, resources like the American Dental Association's website can be helpful.

Frequently Asked Questions

Yes, but less frequently than in the past. It is still used, especially for pediatric patients and those with mild anxiety, but many dentists now prefer more advanced sedation methods for a variety of reasons.

Modern alternatives include oral conscious sedation (a pill taken before the procedure) and intravenous (IV) sedation, which offers a deeper, more controlled state of relaxation.

Nitrous oxide provides only mild sedation and does not offer sufficient relaxation or pain control for more complex or invasive dental procedures. For some patients, it simply does not provide enough anxiety relief.

Yes, nitrous oxide is a potent greenhouse gas, and its environmental impact is a factor for some dental practices choosing to use alternatives as part of a move toward sustainability.

Potential side effects include nausea, vomiting, headaches, and dizziness, which can occur if the dosage is too high or if the patient eats a heavy meal beforehand.

Yes, it is contraindicated for patients in the first trimester of pregnancy, those with certain respiratory conditions (like COPD), and individuals with a history of substance abuse or severe vitamin B12 deficiency.

Dentists consider the patient's level of anxiety, the complexity and duration of the procedure, and their overall medical history to recommend the most suitable sedation option.