We report the case of a 10-year-old female patient with caries of teeth 3.6 and 4.6. The young patient was very anxious and non-collaborating.

Despite the application of the usual persuasion techniques like ?tell-show-do?, the child did not accept to take the necessary cure. Therefore, we decided to interrupt the session.

The next appointment was useful to establish the baseline of N2O necessary for the treatment and to increase the child?s trust in the dental surgeon by simple positive reinforcements.

By a nasal mask linked to a machine, we administered a mixture composed of N2O and O2 at 50% and, after a few minutes, we assessed some objective signs such as the capacity to respond to simple orders, face relaxation, eyelids position and the maintaining of protective reflexes.

One can increase or reduce the percentage to produce the desired effect. During the second session, we administered the N2O and O2 mixture at the concentration established in the previous visit and performed the required conservative treatment.

In order to obtain the child?s trust more easily, the presence of a homely colored environment, maybe with a waiting area with game equipments is a good expedient in this sense.

However, in some cases these expedients do not succeed in overcoming the child?s resistance, so we are forced o have recourse to premedications with hydroxizine, promethazine, diazepam. When the premedication is not enough, one can have recourse to conscious sedation with nitrogen protoxide. The fast induction and reversibility of the conscious sedation is certainly one of the most important advantages.

Moreover, this procedure can be performed in the dental practice and it rarely causes side effects, but these are always of little importance like nausea, vomiting, vertigo and abdominal pain.

During surgery, the patient can be monitored with the saturation meter. It cannot be used in children under 7 years of age, as in this age range there still is a considerable degree of oral breathing.

This technique determines an optimal sedation, where the patient will be relaxed at the muscular level but still conscious, and a slight amnesia.

Conscious sedation with nitrogen protoxide certainly is a very good aid for the pedodotist in consideration of both its effectiveness and minimal side effects that may cause.

F. Inchingolo 1-4, A. D. Inchingolo1, M. Tatullo 2, M. Marrelli 4 , A.M. Inchingolo 3, F. Carbotti 1, A. Palladino 1, M. De Carolis 1, V. Angelini 1 , A.D. Inchingolo1, G. Dipalma1-4
Department of Odontostomatology and Surgery, University of Bari, Bari, Italy
Private Doctor in Dental Sciences
Department of Odontostomatology and Surgery, University of Milano, Milano, Italy
Department of Maxillofacial Surgery, Calabrodental Srl, Crotone, Italy