Exposure control practices for administering nitrous oxide: A survey of dentists, dental hygienists, and dental assistants

ABSTRACT

Engineering, administrative, and work practice controls have been recommended for many years to minimize exposure to nitrous oxide during dental procedures. To better understand the extent to which these exposure controls are used, the NIOSH Health and Safety Practices Survey of Healthcare Workers was conducted among members of professional practice organizations representing dentists, dental hygienists and dental assistants. The anonymous, modular, web-based survey was completed by 284 dental professionals in private practice who administered nitrous oxide to adult and/or pediatric patients in the seven days prior to the survey. Use of primary engineering controls (i.e., nasal scavenging mask and/or local exhaust ventilation (LEV) near the patient's mouth) was nearly universal, reported by 93% and 96% of respondents who administered to adult (A) and pediatric (P) patients, respectively. However, adherence to other recommended precautionary practices were lacking to varying degrees, and were essentially no different among those administering nitrous oxide to adult or pediatric patients. Examples of work practices which increase exposure risk, expressed as percent of respondents, included: not checking nitrous oxide equipment for leaks (41% A; 48% P); starting nitrous oxide gas flow before delivery mask or airway mask was applied to patient (13% A; 12% P); and not turning off nitrous oxide gas flow before turning off oxygen flow to the patient (8% A; 7% P). Absence of standard procedures to minimize worker exposure to nitrous oxide (13% of all respondents) and not being trained on safe handling and administration of nitrous oxide (3%) were examples of breaches of administrative controls which may also increase exposure risk. Successful management of nitrous oxide emissions should include properly fitted nasal scavenging masks, supplemental LEV (when nitrous oxide levels cannot be adequately controlled using nasal masks alone), adequate general ventilation, regular inspection of nitrous oxide delivery and scavenging equipment for leaks, availability of standard procedures to minimize exposure, periodic training, ambient air and exposure monitoring, and medical surveillance.

KEYWORDS:

• Dental anesthesia providers
• exposure controls
• nitrous oxide
• web survey

Acknowledgments

The authors thank Westat, Inc., for their collaboration in developing, testing, and implementing the survey. The authors are grateful to the professional practice organizations and members who participated in the survey. We also thank John Moenning and Alberto Garcia for their valuable comments and suggestions of an early draft of the manuscript.

Funding

This project was supported by the National Institute for Occupational Safety and Health.

Disclaimer

The findings and conclusions in this article are those of the authors and do not necessarily represent the views of the National Institute for Occupational Safety and Health. Mention of company names or products does not constitute endorsement by the National Institute for Occupational Safety and Health.