International Handbook of Clinical Hypnosis - E-Lib FK UWKS

HYPNOSIS IN DENTISTRY 297
NITROUS OXIDE CONSCIOUS SEDATION
Nitrous oxide plays a vital role in creating a euphoric hypnotic state and positive
hypnotic suggestions enhance the experience. Nitrous oxide conscious sedation is
an important adjunct in the contemporary dental practice.
Various studies of the relationship between dental phobia and sensitivity to pain
experienced by dental patients, indicate that the higher the anxiety, the greater the
pain experienced. Dental discomfort can, however, be eliminated without the use of
drugs. Holden 1983) writes, `It is a misconceived idea that sedation, in its strictest
sense, for the purpose of pain and anxiety control in dentistry, must consist of
pharmacological involvement'. He further suggests that the use of drugs to control
discomfort may often be reduced or eliminated by `the application of methods
based on an understanding of psychosomatic principles and applied psychology
which may, or may not, involve the use of suggestion or hypnosis.'
The bene®ts of nitrous oxide/oxygen are widely recognized. Giovannitti 1985)
cites an early study which demonstrated that 20% nitrous oxide was equivalent to
15mg of subcutaneously administered morphine. More recent studies have shown
that nitrous oxide can diminish both the sensory and affective components of pain.
Empirically, nitrous oxide/oxygen has increased success by enormous proportions.
A clinical study conducted by Quarnstrom & Milgrom 1989). found that transcutaneous
electrical nerve stimulation TENS) alone used as an anesthetic resulted in
53% of patients experiencing an acceptable level of pain slight or none), whereas
TENS used in conjunction with nitrous oxide/oxygen resulted in 82% of patients
experiencing pain reduction to an acceptable level. Also, morbidity and mortality
due to nitrous oxide can be linked exclusively to arterial hypoxia, a condition which
develops when the nitrous oxide concentration rises above 80%.
Nitrous oxide has been shown to emulate and enhance the hypnotic state.
Goepherd et al. 1985) wrote that when hypnotic suggestion is combined with
nitrous oxide, in general the patient is able to attain a therapeutic state of relaxation,
euphoria and/or sedation with decreased levels of nitrous oxide. In addition the use
of nitrous oxide enhances the patient's response to suggestion even in an otherwise
resistant patient. As well as its apparent trance-inducing effects, the gas also
preserves both deep tendon and protective re¯exes, and the airway is maintained in
a clear state.
CONCLUSION
The contemporary dentist has to use time ef®ciently to provide high-quality,
comprehensive care. This chapter offered ideas, suggestions and scripts used by the
author for incorporating hypnotic principles in the care and management of dental
patients. The ideas of including audiotapes, video headsets, and nitrous oxide with
hypnotic suggestion are time-tested and effective. The complaint, usually lodged