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Patient Management

198 - Behavioral Outcomes in Children Undergoing Multiple Nitrous Oxide–Facilitated Dental Treatments

Friday, May 22, 2026
4:20 PM - 4:35 PM PST
Has Audio

    Presenting Author(s)

  • SD

    Shiqi Dong, DDS (she/her/hers)

    Dental Resident
    University of Rochester, Rochester, NY
    University of Rochester - Eastman Institute for Oral Health
    Rochester, New York, United States

    • Co-Author(s)

  • EE

    Erinn Enany, DMD

    UofR

    • Research Mentor(s)

  • EE

    Erinn Enany, DMD

    Principal Investigator
    University of Rochester, Rochester, NY
    Rochester, New York, United States

    • Program Director(s)

  • Isamar Rivera Ramos, DMD

    Program Director
    University of Rochester, Rochester, NY
    Eastman Institute for Oral Health-University of Rochester Medical Center
    Rochester, New York, United States

Purpose:
To evaluate whether behavior and cooperation in children aged 3–12 years requiring multiple (>2) nitrous oxide (N₂O)–assisted dental visits improved, remained stable, or deteriorated over time, and to identify alternative strategies when N₂O-based care was unsuccessful.

Methods:
A retrospective chart review was conducted of ASA I–II pediatric patients treated at the Eastman Institute for Oral Health between January 2020 and January 2023. Inclusion criteria included more than two N₂O-assisted visits. Data on demographics, treatment outcomes, and sedation changes were analyzed using Cochran-Mantel-Haenszel, linear trend, and Kruskal-Wallis tests.

Results:
Fifty-three patients (mean age 6.7 ± 1.8 years) were included. Most (66%) completed treatment with N₂O alone, while 15.1% transitioned to non-pharmacologic management. Protocol failure occurred in 18.9%, including loss to follow-up (15.1%) and escalation to general anesthesia (3.8%). CMH analysis showed significant differences in outcome progression (p < 0.001). Patients who improved behaviorally required a mean of 2.5 visits, whereas those escalating to GA did so earlier (mean = 2 visits). A significant linear trend (p = 0.0098) demonstrated decreased success and increased failure with additional visits. Outcomes were independent of age (p = 0.96) and treatment interval (p = 0.32). Patients requiring ≥4 visits showed markedly higher rates of loss to follow-up and escalation.

Conclusion:
N₂O may serve as a therapeutic bridge to improve cooperation; however, repeated use (≥4 visits) is associated with increased risk of treatment failure. Early consideration of alternative strategies may reduce attrition and improve outcomes.