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Title Nitrous Oxide Or Oral Midazolam
Clinical Question In an anxious patient who is fearful of the dentist, is nitrous oxide more effective at reducing their anxiety compared to oral sedation?
Clinical Bottom Line Nitrous oxide is more effective at reducing the anxiety in patients who are fearful of the dentist compared to oral sedation, but oral sedation seems to be the preferred method.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 12190750Wilson/200210-16 yr oldsRandomized Controlled Crossover Trial
Key resultsAfter the use of nitrous oxide, the patients’ mean state anxiety score was reduced from 44 (first visit) to 35 (second visit); (p < 0.01, 95% CI: 2.55, 14.17)After the use of oral midazolam, the patients' mean state anxiety score was reduced from 47 to 40; (p < 0.001, 95% CI: 3.71, 10.29) After the use of nitrous oxide, the patients’ mean dental anxiety score was reduced from 30 (first visit) to 26 (second visit); (p < 0.001, 95% CI: 2.25, 7.14) After the use of oral midazolam, the patients’ mean dental anxiety score was reduced from 32 to 30; (p <0.5, 95% CI: -0.69, 3.56)
Evidence Search "Conscious Sedation"[Mesh] "Nitrous Oxide"[Mesh] "Dental Anxiety"[Mesh] ...view in PubMed
Comments on
The Evidence
This article is a randomized controlled crossover study where forty-six subjects were chosen. All patients were ASA physical status 1 and required bilateral, identical extraction’s on opposite sides of the mouth. Both groups were treated the same, had an adequate follow up, and the majority of them successfully completed the study.
Applicability While this study’s patient selection criteria specifically consisted of 10-16 year olds, it is not certain whether the same results would occur in adults. However, considering the availability and relative safety, administering nitrous oxide to pediatric and adult patients could be effective in reducing anxiety.
Specialty/Discipline (General Dentistry) (Pediatric Dentistry)
Keywords midazolam, nitrous oxide, oral sedation, conscious sedation
ID# 841
Date of submission: 04/28/2011spacer
E-mail Garzac9@livemail.utshcsa.edu
Author Celina Garza
Co-author(s) e-mail
Faculty mentor/Co-author Mark Littlestar, DDS
Faculty mentor/Co-author e-mail littlestarm@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
Comments and Evidence-Based Updates on the CAT
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by Laura Aguilar, Su Jin Lim (San Antonio, Tx) on 12/01/2017
A PubMed search was conducted in November 2017, and a more recent publication was found (PMID 24036742). In this split-mouth, crossover clinical trial, a sample of 28 male patients undergoing third molar extractions was used to compare midazolam and nitrous oxide effects at reducing dental anxiety. Data was acquired objectively via salivary cortisol levels and subjectively via a dental anxiety scale. Nitrous oxide was shown to have a statistically significant reduction in dental anxiety in comparison to the mean baseline value. However, midazolam was shown to be more effective than nitrous oxide in reducing cortisol levels and thus reducing anxiety in a dental environment.

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