1|Page
AAPD Guidelines & Relevant Pediatric Dentistry Readings Questions with
100% Correct Answers 2025 | 2026
diminution or elimination of pain and anxiety in a conscious
patient. The patient responds normally to verbal commands. All
vital signs are stable, there is no significant risk of losing
protective reflexes, and the patient is able to return to
preprocedure mobility. - ANSWER analgesia/ anxiolysis (AAPD
204)
What affect does nitrous oxide have on the CNS? - ANSWER
causes depression and euphoria (AAPD 204)
Nitrous oxide has two mechanisms of action. Describe MOA
that creates the analgesic effect and the MOA that creates the
anxiolytic effect. - ANSWER Analgesic effect: "appears to be
initiated by neuronal release of endogeneous opioid peptides
with subsequent activation of opioid receptors and descending
Gamma-amniobutyric acid type A (GABBA) receptors and
noradrenergic pathways that modulate nociceptive processing
at the spinal level"
,2|Page
Anxiolytic effect: "activation of the GABAA receptor either
directly or indirectly through the benzodiazepine binding site"
(AAPD 204)
Describe the solubility of nitrous oxide - ANSWER Although the
AAPD describes nitrous as 34 times more soluble than nitrogen;
nitrous is relatively insoluble which is the reason it can quickly
diffuse in and out of the human body/blood. (AAPD 204)
Describe the effect of nitrous on the cardiovascular system?
(Include effect on cardiac output, peripheral resistance and
blood pressure) - ANSWER Nitrous oxide causes minor
depression in cardiac output while peripheral resistance is
slightly increased, thereby maintaining the blood pressure.
(AAPD 204)
How rapid is Nitrous Oxide recovery - ANSWER two to three
minutes (AAPD 204)
What is the effect of Nitrous Oxide on the cough reflex? -
ANSWER Minimal impairment to any reflex including the cough
reflex (cough reflex is preserved) (AAPD 204)
,3|Page
The most common adverse effects of nitrous oxide are nausea
and vomiting which occur in what percentage of patients? -
ANSWER 0.5 percent; a higher incidence is noted with longer
administration of nitrous oxide/oxygen, fluctuation sin nitrous
oxide levels, and increased concentrations of nitrous oxide
(AAPD 206)
According to the study by Leelataweewud in 2000, what were
the relevant effects of incorporating N2O/O2 to a conscious
sedation of 1.5 mg/kg meperidine (demerol) (narcotic sedative),
50 mg/kg chloral hydrate and 25 mg hydroxyzine pamoate vs.
that same triple cocktail with just O2? - ANSWER 1) No
differences in pulse rate, oxyhemoglobin saturation (did find
small increase in respiratory rate in N2O/O2 group)
2) N2O/O2 did not increase risk of desaturation but did increase
frequency of desaturation events
3) N2O/O2 deepened level of sedation (so can deepen when
added to a narcotic sedation regimen)
4) if you are going to include N2O/O2 - must monitor with
heightened vigilance
What is the nonselective, competitive, alpha-adrenergic
antagonist used to reverse the effects of adrenergic agonists like
epinephrine? - ANSWER phentolamine mesylate
, 4|Page
What is the proposed mechanism of action for phentolamine
mesylate with respect to local anesthesia reversal - ANSWER
phentolamine mesylate is a vasodilator and the increased local
blood flow accelerates the clearance of local anesthetic from
the submucosal tissue to the bloodstream
T/F Injection of phentolamine mesylate at the same site as the
local anesthetic was injected can cut the time to return of
normal lip sensation and normal tongue sensation in half -
ANSWER true: "We observed a 55.6 percent reduction in
median time to return of normal lip sensation and a 60 percent
reduction in median time to return of normal tongue sensation
(Tavares JADA 2008)
Which are better at suppressing awareness? A) Potent inhaled
vapors, midazolam (versed), propofol
B) nitrous oxide and opioids - ANSWER A) Potent inhaled
vapors, midazolam (versed), propofol
In the study by Watts et al. what was the effect of giving local
anesthesia during a general anesthesia case on vital signs vs. no
local anesthesia - ANSWER "Patients who were not given
intraoperative local anesthesia were more likely to experience
AAPD Guidelines & Relevant Pediatric Dentistry Readings Questions with
100% Correct Answers 2025 | 2026
diminution or elimination of pain and anxiety in a conscious
patient. The patient responds normally to verbal commands. All
vital signs are stable, there is no significant risk of losing
protective reflexes, and the patient is able to return to
preprocedure mobility. - ANSWER analgesia/ anxiolysis (AAPD
204)
What affect does nitrous oxide have on the CNS? - ANSWER
causes depression and euphoria (AAPD 204)
Nitrous oxide has two mechanisms of action. Describe MOA
that creates the analgesic effect and the MOA that creates the
anxiolytic effect. - ANSWER Analgesic effect: "appears to be
initiated by neuronal release of endogeneous opioid peptides
with subsequent activation of opioid receptors and descending
Gamma-amniobutyric acid type A (GABBA) receptors and
noradrenergic pathways that modulate nociceptive processing
at the spinal level"
,2|Page
Anxiolytic effect: "activation of the GABAA receptor either
directly or indirectly through the benzodiazepine binding site"
(AAPD 204)
Describe the solubility of nitrous oxide - ANSWER Although the
AAPD describes nitrous as 34 times more soluble than nitrogen;
nitrous is relatively insoluble which is the reason it can quickly
diffuse in and out of the human body/blood. (AAPD 204)
Describe the effect of nitrous on the cardiovascular system?
(Include effect on cardiac output, peripheral resistance and
blood pressure) - ANSWER Nitrous oxide causes minor
depression in cardiac output while peripheral resistance is
slightly increased, thereby maintaining the blood pressure.
(AAPD 204)
How rapid is Nitrous Oxide recovery - ANSWER two to three
minutes (AAPD 204)
What is the effect of Nitrous Oxide on the cough reflex? -
ANSWER Minimal impairment to any reflex including the cough
reflex (cough reflex is preserved) (AAPD 204)
,3|Page
The most common adverse effects of nitrous oxide are nausea
and vomiting which occur in what percentage of patients? -
ANSWER 0.5 percent; a higher incidence is noted with longer
administration of nitrous oxide/oxygen, fluctuation sin nitrous
oxide levels, and increased concentrations of nitrous oxide
(AAPD 206)
According to the study by Leelataweewud in 2000, what were
the relevant effects of incorporating N2O/O2 to a conscious
sedation of 1.5 mg/kg meperidine (demerol) (narcotic sedative),
50 mg/kg chloral hydrate and 25 mg hydroxyzine pamoate vs.
that same triple cocktail with just O2? - ANSWER 1) No
differences in pulse rate, oxyhemoglobin saturation (did find
small increase in respiratory rate in N2O/O2 group)
2) N2O/O2 did not increase risk of desaturation but did increase
frequency of desaturation events
3) N2O/O2 deepened level of sedation (so can deepen when
added to a narcotic sedation regimen)
4) if you are going to include N2O/O2 - must monitor with
heightened vigilance
What is the nonselective, competitive, alpha-adrenergic
antagonist used to reverse the effects of adrenergic agonists like
epinephrine? - ANSWER phentolamine mesylate
, 4|Page
What is the proposed mechanism of action for phentolamine
mesylate with respect to local anesthesia reversal - ANSWER
phentolamine mesylate is a vasodilator and the increased local
blood flow accelerates the clearance of local anesthetic from
the submucosal tissue to the bloodstream
T/F Injection of phentolamine mesylate at the same site as the
local anesthetic was injected can cut the time to return of
normal lip sensation and normal tongue sensation in half -
ANSWER true: "We observed a 55.6 percent reduction in
median time to return of normal lip sensation and a 60 percent
reduction in median time to return of normal tongue sensation
(Tavares JADA 2008)
Which are better at suppressing awareness? A) Potent inhaled
vapors, midazolam (versed), propofol
B) nitrous oxide and opioids - ANSWER A) Potent inhaled
vapors, midazolam (versed), propofol
In the study by Watts et al. what was the effect of giving local
anesthesia during a general anesthesia case on vital signs vs. no
local anesthesia - ANSWER "Patients who were not given
intraoperative local anesthesia were more likely to experience
