Study Finds Lacking Adherence to Precautionary Practices during Dental Procedures

Published June 21, 2017

​A recent study by NIOSH researchers found that while scavenging systems—equipment used to prevent nitrous oxide gas from escaping into dental operatories—are widely used by dental anesthesia providers, adherence to other recommended precautionary practices during dental procedures was lacking. The article, which was published in this month’s issue of the Journal of Occupational and Environmental Hygiene (JOEH), describes work practices that increase exposure risk. According to the authors, most dental professionals who were part of the study reported that they always used either a nasal scavenging mask or local exhaust ventilation (LEV) near the patient’s mouth when administering nitrous oxide. However, 51 percent of dental professionals who administered anesthesia to adult patients reported not checking nitrous oxide equipment for leaks, and 16 percent reported starting nitrous oxide gas flow before turning off oxygen flow to the patient. Thirteen percent of professionals said that they lacked standard procedures to minimize occupational exposure, and three percent reported lacking training on safe handling and administration methods.

“Successful management of nitrous oxide emissions should include properly fitted nasal scavenging masks, supplementary 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,” the study authors conclude.

The study results are derived from the 2011 Health and Safety Practices Survey of Healthcare Workers, a federally sponsored survey of U.S. healthcare workers that addresses safety and health practices relative to use of hazardous chemicals. According to the authors, this is one of the first national surveys to examine use of controls during administration of nitrous oxide by type of dental anesthesia provider and patient.

AIHA members can access the full JOEH article by logging in to the AIHA Member Center, clicking the Journal of Occupational and Environmental Hygiene link under the “Communications” subhead, and searching “exposure control practices for administering nitrous oxide” via the search field near the top of the page. The article will appear first in the search results.