Relative Analgesia in Practice, part two

Patients losing a day

With IV sedation there’s no way a patient is trying to make it home on their own afterwards. I did have a case once of a late teenage boy who brought his mum with him, they had both signed the appropriate consent forms, including the escort instructions, I took a tooth out under sedation and unbeknownst to us, she had changed her mind and left. The young lad waited in the waiting room, phoned her and then discharged himself, tried to walk home and ended up asleep on a bank round the corner from the practice!

Even with verbal and signed written consent in advance to bring an escort, patients can arrive for an appointment and say “I’ll just order a taxi”. Of course we then refuse to treat them.

With “Happy Air” nitrous oxide, it’s quite different. The patient is still fully consented but they don’t need to being someone with them. They can even drive to their appointment and return to work afterwards.

This means that life starts to get simpler for all of us! We can consent and treat at the same visit which means we can use it opportunistically.

I love the effect nitrous oxide has on the gag reflex. I have treated the most crazy of gag reflexes using RA. I love the fact that for a while after the RA the gag reflex is still reduced.

Two patients we saw last week.
Patient A was a chap who needs a bridge but we need to plan it first using a wax up. He’s got a pretty bad gag reflex so impression taking was going to be interesting.
After 5 minutes of RA at 40% NO2, I took a lower alginate. nothing! We took the mask off so I could get better access anteriorly. Upper alginate – nothing!

The patient reported that he thought he could feel a gag reflex trying to start but it wouldn’t properly appear. There wasn’t any nausea at all.
He’s now asked to have Happy Air for everything! No problem!

The second chap has the most incredible sounding gag reflex. You know how some people just make slight retching sounds? This guy is can be heard outside the building, even when a mirror touches the side of his tongue.

Everyone in the practice knows about this chap, but in a nice way. He’s a great guy (beats me at table football though) and is really easy to get on with. I think though that over the years, previous dentists have been dreading the thought of ever doing posterior restorations on him.

He comes in one day with a lingual cusp fracture on a lower right posterior amalgam filled tooth. Colleagues said “good luck trying to sort this tooth out!”

I did an opportunistic 10min Happy Air trial session with him, 5 minutes at again 40%NO2 and the gag went completely.

We then saw him a few days later, uses the same dose, put in an ID block, he was able to communicate how numb it was and how comfy he was. Good skin peripheral analgesia, it’s a very nice sensation.

We did the composite restoration for him totally without event. Afterwards he said “would have loved to have seen you try that without Nitrous!”

He drank coffee in the waiting room for about half and hour and then drive back to work.

I’d had my RA machine for years but had got so tied up in IV, I had neglected to realise the potential. So i got to spend some time with Richard Charon in Newbury.

Richard is a great proponent of RA and lectures all over the world. He trains many dentists hygienists and therapists every year to practically allow them the next day to introduce RA to their practices, to start making a huge difference to their patients.

Dr Rob Endicott is a General Dentist and Sedationist based in Stratford upon Avon, carrying out dentistry for patients under sedation almost every day.

Saturday March 23rd sees the training centre at Stratford Dental ( hosting an RA training day with Dr Richard Charon, the RA Coach ( for the whole dental team.


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