University of Iowa dental clinics warn of ‘laughing gas’ gaffe affecting pediatric patients

IOWA CITY - More than 120 pediatric patients treated at the University of Iowa dental clinics between March 1 and April 20 might have received more nitrous oxide gas than intended, and the administration is notifying families.

The UI College of Dentistry and Dental Clinics on April 20 discovered the problem - that tubing carrying nitrous oxide and oxygen to the clinic had been improperly installed during a remodel of the Pediatric Dentistry Clinic - after receiving reports of unusual responses among several patients.

'Most had no problems at all,” said Michael Kanellis, associate dean for patient care at the UI College of Dentistry and Dental Clinics. 'But there were a handful of kids that they didn't seem right. They weren't responding like we would usually see them responding.”

Of the 124 pediatric patients potentially affected by the gaffe, 16 reported some level of concern or negative feedback, according to Kanellis. Of those, 11 fell within the normal range of side effects for nitrous oxide, including falling asleep during the appointment or feeling nauseated.

Five of the kids reported more concerning symptoms, 'like they were difficult to arouse at the end of the appointment,” Kanellis said.

'We feel very fortunate that, by the end, all were alert and leaving on their own two feet,” he said.

As individual providers began sharing those reports with the department chair, administrators brought their concerns to building staff, who discovered a mistake had been made while installing the new piping.

The error caused patients to receive more of the gas than intended, Kanellis said. Upon discovering the problem April 20, the clinics promptly suspended use of all nitrous oxide until correcting the issue. The suspension lasted about two days, Kanellis said, and the system has been certified safe and is back in use.

Clinic staff confirmed the risk was limited to patients who underwent procedures between March 1, when the remodeled Pediatric Dentistry Clinic opened, and April 20. All other areas in the College of Dentistry that use nitrous oxide were tested to confirm they were not affected. Officials report no other UI pediatric dentistry clinics, including the Center for Disabilities and Development on the UI campus and a clinic in Muscatine, were affected.

College administrators on Thursday mailed letters to the homes of 124 families affected by the error, asking parents to call the clinic both to confirm their children are doing well and to ask any questions they might have, Kanellis said.

'Though the risk of any long-term effects is extremely small, we believed it was important to notify all of our patients who received nitrous oxide during the time period affected,” Kanellis said.

He told The Gazette the college and clinics consulted with pediatric anesthesia and neuroglia experts at UI Health Care about potential long-term effects, and they said children should be fine if they left the procedure that day alert and reportedly normal.

Still, Kanellis said, in the interest of transparency and safety, the university sent the letters to all the affected patients and made phone calls to the families of those patients who reported concerns during the procedures.

'We know that this information may be concerning to our patients and their families,” Kanellis said. 'As always, the safety and health of our patients is our first concern. We are focused on helping them understand the risk and to seek the appropriate evaluation and treatment if needed.”

Kanellis said parents have been calling the clinic, reporting their children are doing well and they appreciate being notified.

Nitrous oxide is the chemical compound commonly known as 'laughing gas.” It is a colorless, non-flammable gas used in surgery and dentistry for its anesthetic and analgesic effect, and patients can feel some form of euphoria during its administration - earning it the 'laughing” label.

It is given through an automated machine designed to deliver the gas mixed with oxygen, and in the dentistry clinic it's given via the nose using a rubber mask. Pediatric dentistry patients can receive the gas for a variety of reasons - including the filling of cavities or the extraction of a baby tooth, according to Kanellis.

'It doesn't put them to sleep,” he said, adding that it's often added to 'reduce anxiety and make the appointment go smoother.”

Because the gas often is administered through the nose, Kanellis said, patients also often only get a portion of the nose - if they are moving or crying, for example.