A landmark decommissioning project at St Bartholomew’s Hospital has cut nitrous oxide wastage from 98.5% to just 5%, offering a blueprint for dentistry.
In 2023, the London hospital was the UK’s highest user of nitrous oxide per operation, generating 44kg of CO₂ per procedure against a national average of 17kg. A subsequent investigation revealed the cause was systemic leakage, gas was venting into the atmosphere before reaching patients.
By decommissioning its piped infrastructure and switching to individual cylinders, the hospital secured annual savings of £11,000, funded by an initial £15,000 NHS England investment.
What the UCL research adds
Research from the University College London (UCL) Eastman Dental Institute, published in the British Dental Journal in February, quantifies the same nitrous oxide problem in dentistry.
Analysing 891 sedation episodes across 128 UK sites, researchers found the average carbon footprint per dental sedation appointment is 28.6kg CO₂ equivalent roughly a 73-mile car journey.
Nitrous oxide wastage at sites using piped supplies ran 30% higher than those using individual cylinders, directly mirroring the Barts Hospital findings.
The research also found significant variation in clinical practice, with weekly nitrous oxide footprints ranging from 38.9kg to 1,849kg CO₂ equivalent across sites. Flow rates varied from one to 13 litres per minute with no clear link to patient outcomes, suggesting many patients may be receiving more gas than clinically necessary.
The implication of nitrous oxide wastage for dentistry
Despite the environmental cost, inhalation sedation remains highly effective, with the UCL study recorded a 92% success rate. However, how efficiently is it being delivered?
For those practices running ageing piped systems, the Barts model offers a practical and financially compelling case for change.
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