The environmental impact of free-flow versus on-demand gas release for dental inhalation sedation.

Aim To evaluate three clinical techniques (current practice, Silhouette with a flow rate protocol, and eAdvantage) for inhalation sedation.Methods This study was conducted at the Eastman Dental Hospital (London, UK) using quality improvement methodology. The three clinical techniques were used over a six-week period. Data were collected on the volume of nitrous oxide (N2O) gas used per patient, success rate, as well as patient and staff feedback.Results Ninety-eight episodes of inhalation sedation were observed during the pilot period. Both Silhouette and eAdvantage techniques demonstrated impressive reductions in the volume of N2O used per patient (58% and 70%, respectively) when compared to current practice. The success rate was 97% for current practice and eAdvantage, and 86% for Silhouette.Conclusion Current practice for inhalation sedation relies on a flow rate that is set by the clinical team, with the patient breathing from a reservoir of gas. This technique is potentially over-delivering gas, and new techniques and equipment that reduce or eliminate this free-flow rate show significant environmental benefits.