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Clinical Nitrous oxide


Janet Pickles of RA Medical Services looks at the basic requirements that need to be adhered to when employing inhalation sedation in a modern dental practice


The immediate answer is – if you do not, then it is a direct contraven- tion of health and safety on the part of yourself and your staff. Of course, the subject is much more complicat- ed than any simplistic answer and this article will assist with offering a guide to a somewhat misunder- stood area of dentistry. Perhaps a start could be made by looking at some of the standards and white papers that touch on the sub- ject. A white paper commissioned by the Department of Health and published in 2003; Conscious Sedation in the Provision of Dental CareReport of an Expert Group on Sedation for Dentistry mentions scavenging in chapter nine and states: “Scavenging of waste gases must be active and sufficient to fully conform to current COSHH standards. Breathing systems should have a separate inspiratory and expiratory limb to allow proper scavenging. Nasal masks should be close fitting providing a good seal without air entrainment valves.” The definition is fair enough but how does it translate into a good workable system? The paragraph offers three reference sources: • Anaesthetic and analgesic machines BS4273: 1997 British Standards Institution • Anaesthetic Agents: Controlling


A


exposure under COSHH. HSAC. HMSO. 1995 • Witcher CE, Zimmerman DC,


frequently asked question – ‘Why should I scavenge when using nitrous oxide sedation?’


scavenging in the 21st Century


Yom EM, Piziali RL Control of occu- pational exposure in the dental operatory. Journal of the American Dental Association (ADA) 1997, 95: 763-776. Perhaps most interesting is the


reference to the ADA. This is a reflection on the fact that the majority of inhalation sedation equipment in use today in the UK is of American origin. Manufacturing of the Quantiflex range; MDM and Mark I (later replaced by Mark II) by Cyprane, began in Keighley in the 1960s under license from Fraser Sweatman. At that time two types of system were available: • Non-scavenging system (side tubes, exhaling valve) • Passive system (clear corru-


gated 22mm hose, blanking cap) Manufacturing in the UK ceased


“Perhaps a start could be made by looking at some of the standards and white papers that touch on the


subject” Janet Pickles


in the early 70s, but continues to this day in the USA. Use of the non- scavenging system declined rapidly from the late 90s, but use of the Passive system continued until the then manufacturer, Porter Instruments, ceased production in early 2010. As a result, the standards for scavenging between the UK and USA have always seemed to be intertwined and dependant on the types of equipment available. As standards and attitudes have changed, then what is considered acceptable in scavenging has changed also. In 1994, NIOSHH (National


Institute for Occupational Safety and Health) published a technical report: Control of Nitrous Oxide in Dental Operatories.1


The


section on scavenging systems states: “A scavenging system, simply


Scottish Dental magazine 47


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