Many students, when asked by a teacher or professor to volunteer in front of the class, shy away, avoid eye contact, and try to seem as plain and unremarkable as possible. The same is true in dental school – unless it comes to laughing gas.
As a fourth year dental student, I’ve had times where I’ve tried to avoid professors’ questions about anatomical variants of nerves, or the correct way to drill a cavity, or what type of tooth infection has symptoms of hot and cold sensitivity. There are other times where you cannot escape having to volunteer. These include being the first “patient” to receive an injection from one of your classmate’s unsteady and tentative hands. Or having an impression taken with too much alginate so that all of your teeth (along with your uvula and tonsils) are poured up in a stone model.
But volunteering in the nitrous oxide lab … that’s a different story. The lab day is about putting ourselves in our patients’ shoes, to be able to empathize with them when they need to be sedated. For me, the nitrous oxide lab might have been the most enjoyable 5 minutes of my entire dental education.
In today’s dental practice, nitrous oxide is a readily available, well-researched, incredibly safe method of reducing patient anxiety with little to no undesired side effects. But this was not always the case.
The Oxford Textbook of Anaesthesia for Oral and Maxillofacial Surgery argues that “with increasingly refined diets [in the mid-nineteenth century] and the use of copious amounts of sugar, tooth decay, and so dentistry, were on the increase.” Prior to the modern day local anesthesia armamentarium, extractions and dental procedures were completed with no anesthesia. Patients self-medicated with alcohol or other drugs, but there was no predictable or controllable way to prevent patients from experiencing excruciating pain.
That is until Horace Wells, a dentist from Hartford, Connecticut started taking an interest in nitrous oxide as a method of numbing patients to pain.
Wells became convinced of the analgesic properties of nitrous oxide on 11 December 1844 after observing a public display in Hartford of a man inhaling the gas and subsequently hitting his shin on a bench. After the gas wore off, the man miraculously felt no pain. With inspiration from this demonstration and a strong belief in the analgesic (and possibly the amnestic) qualities of nitrous oxide, on 12 December, Wells proceeded to inhale a bag of the nitrous oxide and have his associate John Riggs extract one of his own teeth. It was risky—and a huge success. With this realization that dental work could be pain free, Wells proceeded to test his new anesthesia method on over a dozen patients in the following weeks. He was proud of his achievement, but he chose not to patent his method because he felt pain relief should be “as free as the air.”
This discovery brought Wells to the Ether Dome at the Massachusetts General Hospital in Boston. Before an audience of Harvard Medical School faculty and students, Wells convinced a volunteer from the audience to have their tooth extracted after inhaling nitrous oxide. Wells’ success came to an abrupt halt when this volunteer screamed out in pain during the extraction. Looking back on this event, it is very likely that the volunteer did not inhale enough of the gas to achieve the appropriate anesthetic effect. But the reason didn’t matter—Wells was horrified by his volunteer’s reaction, his own apparent failure, and was laughed out of the Ether Dome as a fraud.
The following year, William Morton successfully demonstrated the use of ether as an anesthetic for dental and medical surgery. He patented the discovery of ether as a dental anesthetic and sold the rights to it. To this day, most credit the success of dental anesthesia to Morton, not Wells.
After giving up dentistry, Horace Wells worked unsuccessfully as a salesman and traveled to Paris to see a presentation on updated anesthesia techniques. But his ego had been broken. After returning the United States, he developed a dangerous addiction to chloroform (perhaps another risky experiment for patient sedation, gone awry) that left him mentally unstable. In 1848, he assaulted a streetwalker under the influence. He was sent to prison and in the end, took his own life.
This is the sad story of a man whose discovery revolutionized dentists’ ability to effectively care for patients while keeping them calm and out of pain. As a student at the University of Connecticut School of Dental Medicine, it is a point of pride knowing that Dr. Wells made this discovery just a few miles from where I have learned about the incredible effects of nitrous oxide. My education has taught me to use it effectively for patients who are nervous about a procedure and to improve the safety of care for patients with high blood pressure. This is a day we can remember a brave man who risked his own livelihood in the name of patient care.
Featured image credit: Laughing gas, by Rumford Davy. Public domain via Wikimedia Commons.