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Nitrous OxideNCT04305990

Demand-Driven Method for Gas Delivery in a Dental Setting

A study testing Demand-driven delivery method and Free-flow delivery method in people with Nitrous Oxide and Dentistry, run by University of Toronto at 1 site in Canada.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
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Trial summary

This study compares two methods of gas delivery in a dental setting: 1) demand-driven (DD) and 2) free-flow (FF). Nitrous oxide and oxygen sedation (NOS) is a common form of minimal sedation for adult and paediatric patients undergoing dental procedures. Read more about this study

Who is it for?
Ages 18 years and olderHealthy volunteers can take part
Conditions the study is for
Nitrous Oxide, Dentistry, Drug Delivery System
What is being tested?
Demand-driven delivery method and Free-flow delivery method
Type of treatment
Medical device
Could I receive a placebo?
No, everyone receives an active treatment
How many people
100 participants
Where
1 siteCanada
Study dates
Mar 2020to Oct 2020
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • Healthy volunteers accepted
  • Adult, Older adult

Who may be able to join

  • Participants must be adults, 18 years of age or older.
  • Participants must be ASA I (a normal, healthy patient) or ASA II (a patient with mild systemic disease).

Who cannot join

  • Participants who are ASA III (a patient with a severe systemic disease that is not life-threatening) or higher.
  • Participants who indicate they are claustrophobic.
  • Participants with nasal obstruction of both nostrils.

Trial locations and contacts

1 site in 1 country.

Ayala Y Rubin, BA DDS contact

(1)-647-988-5202

ayala.rubin@utoronto.ca

Canada1 site
  • University of Toronto, Faculty of Dentistry

    Toronto, Ontario, M5G 1G6

    Ayala Y Rubin, BA DDS, 6479885202, ayala.rubin@utoronto.ca

    Carilynne Yarascavitch, BSc DDS MSc, 416-864-8252, C.Yarascavitch@dentistry.utoronto.ca

Other trials in Canada

About this study

Official title: Feasibility and Comfort of a Nasal Demand-Driven Method for Gas Delivery in a Dental Setting

This study compares two methods of gas delivery in a dental setting: 1) demand-driven (DD) and 2) free-flow (FF).

Nitrous oxide and oxygen sedation (NOS) is a common form of minimal sedation for adult and paediatric patients undergoing dental procedures. In order for NOS devices to be utilized during dental treatment, dentists must be able to provide gas flow to the patient, and subsequently scavenge used and unused gasses. Gas delivery is via a nasal mask, since the oral cavity must be accessible to the dentist throughout treatment.

Read more

Current devices for NOS in the dental setting utilize a free-flow gas method, where nitrous oxide and oxygen are released continuously from their tanks. The flow rate is set by the dentist according to the patient's minute ventilation needs, and unused and exhaled gasses are scavenged via the nasal mask. The demand-driven gas flow method, where inspiration triggers gas flow, has been used successfully in other medical settings, such as in obstetrics, medical emergencies, and for patients with chronic obstructive pulmonary disease. However, in these settings the mask used covers both the nose and mouth, and patients can trigger the demand-driven method through inspiration of the nose or mouth. The demand-driven gas flow method has a significant gas-sparing advantage over the free-flow method. With a demand-driven method, the patient dictates the flow rate and gas is only delivered when they are inspiring, compared to the free-flow method which provide gas flow throughout inspiration and expiration. However, the demand-driven method have not been studied in a dental setting where flow can only be triggered through the nose. It is therefore unknown whether it is feasible or comfortable for patients to trigger a demand-driven method nasally when their mouth is open during dental treatment.

This study will aim to assess the feasibility and comfort of a nasal demand-driven gas delivery method utilizing 100% oxygen in healthy, adult participants in a simulated dental setting. If the device is feasible and comfortable with 100% oxygen in a simulated dental setting, future research can be conducted to assess its use for NOS for dental treatment.

Read the detailed description

The study design is a within-subjects, single-blinded, randomized control trial. Participants will be randomzied to inspire 100% oxygen through their nose utilizing a demand-driven (DD) gas delivery method and a free-flow (FF) gas delivery method for 2 minutes each in a simulated dental setting.

The study will take place at the University of Toronto's Faculty of Dentistry Children's Clinic. Participants will be positioned supine in the dental chair. A child size, rubber bite block will be inserted with an attached capnography device to measure end-tidal carbon dioxide at the mouth. A double-mask nasal hood with disposable insert will be placed on the participant's nose. The participant will be instructed to breathe through their mouth for 1 minute. Baseline respiratory rate and presence/absence of end tidal carbon dioxide at the mouth will be obtained through the capnograph and recorded. The presence of carbon dioxide at baseline during mouth breathing will confirm that the capnograph is able to measure end-tidal carbon dioxide at the mouth.

The researcher will then open the envelope with the randomization plan for the participant and will indicate whether they will receive the FF or DD gas delivery method first. The gas delivery device will be attached to the nasal hood, and set to either DD or FF gas delivery method. Once the device is connected, the participant will be instructed to breathe through their nose for 2 minutes. During this time, respiratory rate, presence/absence of end tidal carbon dioxide at the mouth, and oxygen flow rate per minute will be observed and recorded. The absence of end-tidal carbon dioxide at the mouth during this testing phase will provide a verifiable measure that patients are breathing through their nose. After 2 minutes, the flow will be stopped and the bite block removed. The participant will be instructed to breathe through their mouth. The participant will then complete the VAS on comfort of breathing through their nose during the first gas flow delivery method. The bite block will then be reinserted, and the flow resumed using the second gas flow delivery method for 2 minutes. During this time, respiratory rate, presence/absence of end tidal carbon dioxide at the mouth, and oxygen flow rate per minute will be observed and recorded. After 2 minutes, the gas flow will once again be stopped and the bite block removed. The participant will be instructed to complete the VAS on comfort of breathing through their nose. The nasal hood will be removed. The participant will be debriefed to the order of gas flow received (DD or FF first) and the participant will then be dismissed.

Being tested
Demand-driven delivery method, Free-flow delivery method
Medical subject headings
Respiratory Aspiration

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Demand-driven delivery methodDevice

    The gas delivery device is set to the demand-driven setting. Patients must inspire through their nose to trigger the flow of gas.

  • Free-flow delivery methodDevice

    The gas delivery device is set to a free-flow setting. Gas flows through the system at a rate determined by the operator. Standard flow rate is 6 liters per minute. Patients do not need to inspire through their nose to trigger the flow of gas.

Study groups in NCT04305990
Study groupRoleWhat they receive
Demand-driven delivery followed by free-flow deliveryExperimentalParticipants will inspire 100% oxygen through their nose with the gas delivery device set to a demand-driven delivery setting through a nasal hood for 2 minutes followed by inspiration of 100% oxygen through their nose with the gas delivery device set to a free-flow delivery setting through a nasal hood for 2 minutes.
Receives: Device: Demand-driven delivery method; Device: Free-flow delivery method
Free-flow delivery followed by demand-driven deliveryExperimentalParticipants will inspire 100% oxygen through their nose with the gas delivery device set to a free-flow delivery setting through a nasal hood for 2 minutes followed by inspiration of 100% oxygen through their nose with the gas delivery device set to a free-flow delivery setting through a nasal hood for 2 minutes.
Receives: Device: Demand-driven delivery method; Device: Free-flow delivery method

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Comfort of the demand-driven gas delivery mechanism

    To assess patient comfort of breathing through their nose with the demand-driven gas delivery method vs the free-flow method. In order to assess comfort, the patient will report perceived comfort on a 100mm visual analog scale immediately after each device is turned on. We will test for non-inferiority in comfort of the demand-driven as compared to the free-flow delivery method.

    Measured: Assessed immediately after breathing through each mechanism for 2 minutes

  2. Feasibility of the demand-driven gas delivery mechanism

    To assess whether it is feasible for participants to inspire 100% oxygen through a nasal hood when utilizing a demand-driven gas delivery mechanism when their mouth is open, in a simulated dental setting. In order to assess feasibility, we will monitor for the presence or absence end-tidal carbon dioxide at the mouth to confirm whether the patient is breathing through their nose or mouth. Absence of carbon dioxide at the mouth indicates the patient was able to trigger the mechanism and breathe through their nose.

    Measured: Procedure (Assessed for the duration of time when the patient is breathing from either delivery system)

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted12 Mar 2020
  2. Study startMar 2020 (estimated)
  3. Primary completionOct 2020 (estimated)
  4. Study completionOct 2020 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Other
Allocation
Randomised
Intervention model
Crossover
Model description
The study design is a within-subjects, single-blinded, randomized controlled trial. Each participant will receive both the free-flow (FF) and demand-driven (DD) gas delivery methods in a randomized sequence.
Masking
Single blind
Who is masked
Participant
Enrolment
100 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04305990
Sponsor's protocol ID
00038876
Status last verified
Mar 2020
First submitted
10 Mar 2020
Last updated
12 Mar 2020
Results posted
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Wilson S, Gosnell ES. Survey of American Academy of Pediatric Dentistry on Nitrous Oxide and Sedation: 20 Years Later. Pediatr Dent. 2016 Oct 15;38(5):385-392.

    PubMed 28206894
  • Malamed SF, Clark MS. Nitrous oxide-oxygen: a new look at a very old technique. J Calif Dent Assoc. 2003 May;31(5):397-403.

    PubMed 12839232
  • Becker DE, Rosenberg M. Nitrous oxide and the inhalation anesthetics. Anesth Prog. 2008 Winter;55(4):124-30; quiz 131-2. doi: 10.2344/0003-3006-55.4.124.

    PubMed 19108597
  • Clark MS, Brunick A. Handbook of Nitrous Oxide and Oxygen Sedation. 5th Edition ed: Elsevier Health Sciences; 2019.

  • Tiep BL, Nicotra MB, Carter R, Phillips R, Otsap B. Low-concentration oxygen therapy via a demand oxygen delivery system. Chest. 1985 May;87(5):636-8. doi: 10.1378/chest.87.5.636.

    PubMed 3921316
  • van der Kooy J, De Graaf JP, Kolder ZM, Witters KD, Fitzpatrick E, Duvekot JJ, Dons-Sinke IJ, Steegers EA, Bonsel GJ. A newly developed scavenging system for administration of nitrous oxide during labour: safe occupational use. Acta Anaesthesiol Scand. 2012 Aug;56(7):920-5. doi: 10.1111/j.1399-6576.2012.02668.x. Epub 2012 Mar 7.

    PubMed 22404276
  • Dallal GD. Randomization.com [updated July 15, 2008. Available from: ⟨http://www.randomization.com/⟩.

  • Doig GS, Simpson F. Randomization and allocation concealment: a practical guide for researchers. J Crit Care. 2005 Jun;20(2):187-91; discussion 191-3. doi: 10.1016/j.jcrc.2005.04.005.

    PubMed 16139163
  • Humphris GM, Morrison T, Lindsay SJ. The Modified Dental Anxiety Scale: validation and United Kingdom norms. Community Dent Health. 1995 Sep;12(3):143-50.

    PubMed 7584581
  • Humphris GM, Dyer TA, Robinson PG. The modified dental anxiety scale: UK general public population norms in 2008 with further psychometrics and effects of age. BMC Oral Health. 2009 Aug 26;9:20. doi: 10.1186/1472-6831-9-20.

    PubMed 19709436
  • Humphris G, Crawford JR, Hill K, Gilbert A, Freeman R. UK population norms for the modified dental anxiety scale with percentile calculator: adult dental health survey 2009 results. BMC Oral Health. 2013 Jun 24;13:29. doi: 10.1186/1472-6831-13-29.

    PubMed 23799962
  • King K, Humphris G. Evidence to confirm the cut-off for screening dental phobia using the Modified Dental Anxiety Scale. Soc sci dent. 2010;1(1):21-8.

  • Hendrix JM, Garmon EH. American Society of Anesthesiologists Physical Status Classification System. 2025 Feb 11. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Available from http://www.ncbi.nlm.nih.gov/books/NBK441940/

    PubMed 28722969

Questions about this trial

What is this clinical trial studying?

A study testing Demand-driven delivery method and Free-flow delivery method in people with Nitrous Oxide and Dentistry, run by University of Toronto at 1 site in Canada.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 2 inclusion and 3 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: status not confirmed, as of the sponsor's last update on 12 Mar 2020. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Canada. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Results are not available in the source record.

How can a doctor refer a patient or contact the research team?

Contact Ayala Y Rubin, BA DDS ((1)-647-988-5202, ayala.rubin@utoronto.ca), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Comfort of the demand-driven gas delivery mechanism (time frame: Assessed immediately after breathing through each mechanism for 2 minutes). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT04305990, which also lists 13 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 12 Mar 2020.

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