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Meta-Analysis
. 2025 May 20;61(5):929.
doi: 10.3390/medicina61050929.

Efficacy and Safety of Nitrous Oxide (N2O) Inhalation Sedation Compared to Other Sedative Agents in Dental Procedures: A Systematic Review with Meta-Analysis

Francesca Piccialli  1 , Marco Fiore  1 , Roberto Giurazza  1   2 , Fabrizio Falso  2 , Vittorio Simeon  3 , Paolo Chiodini  3 , Diana Russo  4 , Luigi Laino  4
Affiliations
Meta-Analysis

Efficacy and Safety of Nitrous Oxide (N2O) Inhalation Sedation Compared to Other Sedative Agents in Dental Procedures: A Systematic Review with Meta-Analysis

Francesca Piccialli et al. Medicina (Kaunas). .

Abstract

Background and Objectives: Dental procedures can be distressing, particularly for patients who are anxious or uncooperative. In such cases, effective sedation not only facilitates the clinician's work but also enhances patient comfort and acceptance of dental care. Nitrous oxide (N2O) has been widely employed as a sedative agent in dental practice. This systematic review aimed to assess the efficacy and safety of N2O compared to alternative sedative agents and techniques in dental surgical procedures. Materials and Methods: This review protocol was prospectively registered on PROSPERO (CRD42020213429) and conducted in accordance with PRISMA guidelines. Results: A total of 1809 records were screened (1134 from Embase, 638 from PubMed, and 37 from CENTRAL). The meta-analysis focused on the following three primary outcomes: 1. Patient satisfaction: Eight studies comprising 422 participants (165 treated with N2O and 176 with other sedatives) were included. 2. Recall of the procedure: Five studies with a total of 288 patients (68 receiving N2O and 64 other agents) assessed patients' ability to recall tooth extraction. 3. Successful completion of the procedure: Three studies involving 1578 patients (434 treated with N2O and 989 with alternative sedation methods) were analyzed. Conclusions: No statistically significant differences were observed between N2O and other sedative techniques across all outcomes evaluated. Safety could not be adequately assessed as none of the included studies systematically investigated this outcome. Further high-quality research is warranted to rigorously evaluate the safety profiles of various sedation strategies in dental surgery.

Keywords: dental procedures; meta-analysis; nitrous oxide; patient safety; sedatives; systematic review.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Preferred reporting items for systematic reviews and meta-analyses (PRISMA) flow diagram.
Figure 2
Figure 2
Forest plot of the eight studies, involving 422 patients, evaluating patient satisfaction [29,30,31,32,33,34,35,36].
Figure 3
Figure 3
Forest plot of the 5 studies, involving 288 patients, evaluating the ability of the patient to recall tooth extraction [31,32,33,36,37].
Figure 4
Figure 4
Forest plot of the 3 studies, involving 288 patients, evaluating the ability of the patient to recall tooth extraction [31,32,33,36,37].
See this image and copyright information in PMC

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