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FDA issues shortage notice for nitrous oxide

January 19, 2017

By Michelle Manchir and Jennifer Garvin

There is a shortage of nitrous oxide cylinder gas, the Food and Drug Administration said Jan. 19, but the supply is anticipated to return to normal levels in 30 days.

Meanwhile, bulk liquid nitrous oxide is currently available, the agency said.

Nitrous oxide was in the news last year following an August 2016 explosion at a production facility in Cantonment, Florida, that was operated by Nitrous Oxide Corp., an Airgas company.

Until the Jan. 19 notice, the FDA said it had been monitoring the supply of nitrous oxide medical gas and that there was no shortage, though Airgas and at least one retailer acknowledged limitations in providing the gas to medical offices.

In a Jan. 10 statement, Airgas said the explosion "impacted production at the facility indefinitely as well as Airgas Nitrous Oxide's supply of nitrous oxide in the short-term."

Furthermore, state dental associations in California, Texas and South Carolina, as well as the ADA, have received calls from member dentists regarding their concerns about a potential national shortage.

Dr. Rocky Napier, president of the South Carolina Dental Association, said he and his office staff scrambled to open a new account with a supplier other than his regular one after a delivery man in December told him to anticipate a shortage, which Dr. Napier attributes in part to his office in Aiken, South Carolina, being located at the end of a supply chain.

Dr. Napier said that, after several suppliers in his area said they could not fulfill his nitrous oxide order, he was able to open a new account in mid-January, and that his office has not been disrupted by the August explosion.

One distributor of nitrous oxide, Grace Medical Gas and Equipment, based in Katy, Texas, told its customers in a January email to use nitrous oxide only when absolutely necessary.

John Greer, founder and president of Grace Medical Gas and Equipment, said in the past month he has sometimes received dozens of calls per day from his medical office companies concerned about the shortened supply.

Normally, he said he receives 100 large cylinders per month to distribute to his customers. In December, he got around 65, he said.

Still, Mr. Greer said most of his clients have expressed understanding when he explains the manufacturing of the gas is out of his control. He said the manufacturer he works with has indicated full production would begin again in February.

"Everybody understands it's like trying to have the whole country drink water out of one faucet," he said.   

In its statement, Airgas said its impacted customers have been notified directly, and that "serving our medical customers is our first priority in this situation."

The ADA urges dental offices unable to order nitrous oxide from their usual vendor to contact other vendors.  

Meanwhile, the ADA and the FDA encourage dental offices to report any shortages by emailing the agency at drugshortages@fda.hhs.gov.

Dentists can look for other shortage notices, safety alerts and product recalls on the ADA Safety Alerts website by visiting ADA.org/SafetyAlerts.

For more information on all drug shortages or supply issues, visit the FDA's website.