Cutting dentistry’s nitrous oxide footprint

Dental Tribune International

Mon. 9 February 2026

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LONDON, England: The National Health Service (NHS) has committed to net-zero carbon emissions by 2040 and is focused on reducing anaesthetic gas use. In UK dentistry, this growing pressure to decarbonise healthcare has placed the environmental impact of the use of nitrous oxide for conscious sedation under scrutiny. A new national quality improvement project has examined how this potent greenhouse gas is used across dental services and where emissions can be reduced without compromising care.

The study analysed nitrous oxide use across 31 dental services in the UK, drawing on data mainly from hospitals and publicly commissioned providers serving patients with additional needs. It confirmed that inhalation sedation carries a meaningful carbon footprint and that this burden varies widely between services, reflecting differences in sedation practice, equipment and gas supply configurations.

One of the clearest findings was the variation in how nitrous oxide is administered, and the authors thus point to the urgent need for more consistent training and auditing of sedation practice. Flow rates, duration of administration and titration levels differed substantially between services, and flow rate emerged as a particularly influential factor in overall emissions. The authors emphasise that flow rates that are higher than clinically necessary do not improve patient outcomes, but significantly increase environmental harm. Given the impact of flow rate, they recommend improved cylinder supply systems and gas use metering to reduce environmental impact.

The study also found that supply infrastructure plays a major role. Services using individual cylinders generally showed lower levels of gas wastage than those relying on central piped systems, although wide variation was seen in both. The study identified wastage as a modifiable factor that can be addressed locally without reducing access to sedation. To reduce wastage, the authors recommend monitoring gas supply against clinical use, improving stock control and checking equipment for leaks or faults.

Despite the environmental concerns, the project reinforces the strong clinical value of inhalation sedation. It found that success rates were high across services, particularly for paediatric patients, and that, while a substantial proportion of patients could theoretically have been eligible for intravenous sedation, access was inconsistent and constrained by age, staffing and governance requirements. The authors recommend pursuing alternative methods of patient management where appropriate. Sedation was used in some services for acclimatisation visits; however, these did not demonstrate higher treatment success and increased nitrous oxide use overall. The authors thus suggest careful consideration of its use for this purpose.

The research corroborates existing research into the environmental dimensions of nitrous oxide usage within UK dentistry which argued that, while the gas remains central to the profession, it is essential that measures be taken to reduce its ecological harmful consequences. To that end, the current study calls for routine auditing of administration and wastage and for more comprehensive guidance in sedation standards. The authors also emphasised the need to investigate alternative inhalation agents and expanded access to non-inhalation sedation techniques, so that reliance on nitrous oxide can be reduced where appropriate.

The study, titled “Reducing the environmental impact of nitrous oxide in dentistry: A national quality improvement project”, was published on 23 January 2026 in the British Dental Journal.