Outline for identifying and correcting any risks associated with Dental Nitrous Oxide Sedation

Outline for identifying and correcting any risks associated with Dental Nitrous Oxide Sedation provision to allow provision of a Risk Assessment

To allow compliance with NIA-2017-001

  1. Identify in how many surgeries Inhalation Sedation is used within the facility.
  1. Identify and name the equipment used i.e. type of flowmeter and whether supplied by medical gas piped system or mobile 4-cylinder stand mounted.


  1. Identify a member staff to be appointed to overall management of this equipment. If a central medical gas piped system is in place, then this should have a regular plan of inspection and care, over and above the annual maintenance visit to the sedation equipment.
  1. Note service record for this equipment and provider. Regular annual maintenance should be taking place.
  1. Identify and name the scavenging arrangement. This is normally divided into two sections; breathing system and method of active draw. Both must be identified and named along with the type of nasal hoods/sizes available.
  1. Monitoring; this is a grey area and whilst good practice, is not currently mandatory. However, it would be an excellent idea in the current circumstances to consider conducting some monitoring using Diffusion Pens during a normal sedation session. Pens should be worn by dentist, dental nurse with a control for background levels in the dental surgery. Current exposure levels in the U.K. are 100 PPM (Parts Per Million) over an 8-Hour TWA (Time Weighted Average). This should be easy to achieve with good Active Dental Scavenging. Be wary of Companies offering expensive on-site monitoring as these do not consider the wider picture and can be a waste of time and money.


  1. Also note all and any methods of passive scavenging; open doors or windows, low level extraction fan, room air changes (12-15 p/hour). Staff Rotation.


  1. Note all records of sedation training, where trained and when.


  1. Note any ongoing vCPD training in inhalation sedation and where conducted.


  1. Consult your equipment supplier or maintenance company for current help and advice.


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Janet Pickles

R A Medical Services Ltd

Ref: RAM/09/17/001

Tel: 01535 652444