Consent for Nitrous Oxide/Oxygen Sedation

Patient

Patient first name

Patient last name

Date of birth

Month

Day

Year

What nitrous oxide is

Nitrous oxide, often called laughing gas, is a mix of nitrous oxide and oxygen breathed through a small mask over the nose. It helps the patient feel calm and relaxed during dental care. The patient stays awake, aware of their surroundings, and able to answer questions and follow directions. At the end, the patient breathes pure oxygen and the effects wear off within minutes.

It is used to make dental care more comfortable and less stressful. It does not replace freezing, and it does not work equally well for everyone, so a particular result cannot be guaranteed.

Temporary effects

Any of these can happen while the gas is being used. All of them pass:

tingling, a heavy feeling, or a light, floating feeling;
warmth throughout the body and flushed cheeks;
giggling, or feeling detached or dreamy;
slow, slurred or repeated speech; and
nausea, vomiting or, occasionally, agitation. Having only a light meal beforehand helps prevent nausea.

Other options

No sedation: treatment with local anaesthetic (freezing) only.
Oral sedation: medication taken by mouth that leaves the patient mildly drowsy but awake.
General anaesthesia: the patient is fully asleep and unaware, and their breathing is supported.

A few questions

Please tick each statement to confirm it is true for you

I have read this form, or had it read to me, and I understand it.My dentist has explained the procedure, why it is recommended, the possible risks, and the other options available to me, including no treatment.I have had the chance to ask questions, and my questions have been answered to my satisfaction.I understand that dentistry is not an exact science and that no particular result has been promised or guaranteed to me.I have given an accurate and complete health history, including medications, allergies, past reactions, and pregnancy if applicable.I will tell the dentist about any change in the patient's health before treatment, including colds, breathing or ear problems, medications and pregnancy.I will follow the instructions given before and after sedation.I consent to the use of nitrous oxide/oxygen sedation during dental treatment.

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