Ahmad, Sarah; (2025) Nitrous Oxide Mitigation in Dentistry. Doctoral thesis (D.Dent), UCL (University College London).

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Abstract

Nitrous oxide (N₂O) remains a cornerstone of paediatric dental sedation, valued for its safety profile, anxiolytic effect, and ease of delivery. However, its high global warming potential presents a significant environmental challenge, particularly within the context of the NHS Net Zero agenda. This thesis aimed to evaluate whether paediatric sedation can be delivered more sustainably without compromising patient care, and to provide practical tools to support this transition. The research was conducted in three interlinked phases. First, a literature review and scoping review were undertaken to assess the range of sedation options for children, explore emerging alternatives to N₂O, and evaluate their clinical effectiveness, safety, and potential environmental impact. Second, a multi-cycle local quality improvement project (QIP) was implemented at a UK dental hospital, measuring N₂O use, justification, success rates, carbon dioxide equivalent (CO₂e) emissions, and wastage over four audit cycles. The QIP achieved a 20% reduction in CO₂e emissions, aligning with national sustainability targets. Third, drawing on these findings, a simplified N₂O mitigation toolkit was developed, refined through peer review, and piloted with UK-based dental professionals using qualitative feedback gathered via focus groups. Results indicated that baseline awareness of N₂O’s environmental impact was limited, yet participating clinicians demonstrated strong motivation to adopt sustainable practices when provided with clear, practical, and visually intuitive resources. The toolkit was regarded as relevant, usable, and implementable, with feedback highlighting minor adjustments to improve accessibility. Key barriers to widespread adoption included time constraints and limited visibility of national guidance. This thesis demonstrates that sustainable paediatric sedation is achievable and deliverable without compromising safety or clinical outcomes. By integrating evidence synthesis, real-world audit, and co-designed implementation tools, it provides a scalable, evidence-based pathway for reducing N₂O emissions in dentistry, contributing to both patient wellbeing and environmental stewardship.

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