So What is RA?

A warm welcome to visitors interested to find out more about "R.A." or "Happy Air" sedation.

Whether you are already a patient, a potential patient or an on-line friend from Twitter, Facebook, my dental practice website or if you found you're way here via Google or another search engine. You may even have come here from a link that do not even exist as I write this.


So welcome to this overview about "RA" or "R.A." pronounced "Are eh”!
So what is it and why do I keep harping on about it?
Declaration
Firstly I should declare that I have no direct business connection with any company involved in the supply of RA equipment.
I am a member of SAAD (Society for the Advancement of Anaesthesia in Dentistry) though RA IS NOT ANAESTHESIA and the DSTG (Dental Sedation Teachers Group) and I am on the mentors list for both.

RA is short for Relative Analgesia, a term coined in the 1960s for a technique of conscious sedation that was being written about in the dental literature in the USA in 1932! These days it may be called Inhalation Sedation (IS or IHS).

I have been offering this to anxious patients since 1977. It has transformed many people's experience of dental treatment and in doing so has in some ways transformed their lives as well as their smiles.

So isn't it old-fashioned?
Certainly not. In my onion it is under-used in the UK and misunderstood by most new dental graduates who may have had little or no experience of using it or seeing it used.

We refer to it as "Happy Air" which is an apt description. It is one of several types of conscious sedation which a dentist may offer. The others most commonly are Intravenous Sedation (IV), usually with a drug called Midazolam which has an excellent safety record when used by dentists or oral sedation using a tablet of liquid medication is also possible. This has a less predictable effect and a prolonged after effect.
RA is a technique for producing sedation in a patient with mild to moderate dental anxiety, who remains fully conscious and cooperative. It is, if you like a mind-altering drug having very similar, but not identical effects to alcohol but without the hangover!

The RA technique uses a mix of Nitrous Oxide and Oxygen, breathed through a soft nasal "hood”. The amount of Nitrous Oxide is carefully adjusted (titrated) to the response of the patient. Thus some adults need a small dose of nitrous oxide and some children much more to achieve the same level of calm, relaxation and detachment from the dental processes. Everyone is different.

Q and As

Q1 Is it the same as the gas and air used in labour?

A Well yes and no.
1) Yes it is the same drug - two mixed gases, nitrous oxide and oxygen BUT...
2) In labour, the purpose is to use the ANALGESIC (Pain-killing) effect nitrous oxide to reduce the level of pain during contractions. Paramedics also use the same idea for pain relief, e.g. broken bones. It is give as a 50/50 pre-mixed gas called Entonox.
In dentistry we DO NOT use Entonox or RA for pain relief. A patient would still require a local anaesthetic for most procedures as well BUT only once relaxed and sedated, as Entonox alone is not sufficient for most dental procedures.
3) In labour the expectant mother waits until the pain comes and then uses the gas mix herself for as long as needed. perhaps a few minutes. No need for trained staff.
4) In dentistry the patient begins the sedation process which takes a few minutes BEFORE any further treatment or local anaesthetics are given AND continues to breathe the "Happy Air" mix for the entire time that treatment continues.

Q2 I hear some women say it was great during childbirth, others say they didn't like it and yet others say it did nothing for them. Why is that?

A As I mentioned before everyone is different. As everyone gets the same dose with Entonox in childbirth then, like baby bear's porridge, it is just right for some but too strong for others and just not strong enough for a few more.
Q3 How long does it take to come round?
A Only when all the dental treatment is finished is the "Happy Air" switched off. Within 2-3 minutes of breathing neat oxygen, the patient is ready to return to the patient lounge and to leave the practice shortly after. We advice against driving for at least 30 mins. but we would advise each individual.
Q4 Will I remember anything?
A The chances are you will remember almost everything but will not care about it!
Q5 What else does RA help?
A If gagging or fear of choking is your main concern, RA is a huge help. It will transform your previous experiences in most cases.

My Courses

Since 2003 I have been running Hands-on training courses for Dental teams usually from my own dental pratice in Newbury. When demand is higher I have the the course from Precision Dental Studio's Education Suite, in Thatcham. By Invitation the courses ahve been run in Wexford ( twice) and Dublin. On December 5th the course is being hosted by "Twitter buddy" @richfretwell at the Guidepost Dental practice in Morpeth.


I have also had articles published on the subject. In 2001 two short pieces appeared in Smile-on.com. In 2004, I was commissioned by Dr. Ellis Paul, Editor of FMC’s Private Dentistry magazine to write a 2-part article. In 2007 an article was published in Dental Nursing Magazine- a team view and recently again on-line by invitation of Dental Angels Dental recruitment Agency.

What to do next...
For new dental clients...  Thinking about joining our dental practice to enjoy the revelation that is RA?

What to do next or please call us on 01635 47757 to arrange a free consultation with our Treatment Co-ordinator Chris Charon

More resources:
Patients own stories
Patient testimonials (not all are about RA though!)
For dentists:
Meet me at The Dental Showcase in Birmingham and
Next Hands-on Course for dentists
Case histories