IJOCR
10.5005/jp-journals-10051-0050
Ozone
Therapy: A Revolution in Dentistry
Case Report
Ozone Therapy: A Revolution in Dentistry
1
Trisha Rastogi, 2Sugandha Sharma, 3Anurupa Singh, 4Anies Ahmed
ABSTRACT
Most people possess a fear toward dentistry. On account of this
fear, they avoid the dental treatment. In fact, people fear injections and drills that are used in dental clinics. But in recent time,
dentistry has been experiencing a period of dynamic changes
and growth, perhaps like no other time before. The use of ozone
in dental treatment is the result of this dynamics and growth.
Ozone (O3) gas discovered in the mid-19th century is a molecule
consisting of three atoms of oxygen in a dynamically unstable
structure due to the presence of mesomeric states. Although
O3 has dangerous effects, yet researchers believe it has many
therapeutic effects. Ozonized water, whose use is particularly
known in dental medicine, is optimally applied as a spray or
compress. Incorporation of ozone in dental clinic setup would
eradicate the feeling of pain during dental treatment and also
cut off the treatment time significantly. Scientific support, as
suggested by demonstrated studies, for ozone therapy presents
a potential for an atraumatic, biologically based treatment for
conditions encountered in dental practice.
Keywords: Bleaching, Caries, Dentistry, Ozonated oil, Ozone.
How to cite this article: Rastogi T, Sharma S, Singh A,
Ahmed A. Ozone Therapy: A Revolution in Dentistry. Int J Oral
Care Res 2016;4(3):227-230.
Source of support: Nil
Conflict of interest: None
INTRODUCTION
Ozone (O3), a natural gas discovered in the mid-19th
century, is a molecule consisting of three atoms of oxygen
in a dynamically unstable structure due to the presence
of mesomeric states. The gas is colorless, acrid in odor,
and explosive in liquid or solid form. It has a half-life
of 40 minutes at 20°C and about 140 minutes at 0°C.1-3
The word ozone originates from the Greek word ozein,
which means odor and was first used by German chemist
Christian Friedrich Schonbein, father of ozone therapy
(1799–1868) in 1840 when, working with a voltaic pile
1,2
Senior Lecturer, 3,4Postgraduate Student
1-4
Department of Oral Medicine and Radiology, D.J. College
of Dental Sciences and Research, Ghaziabad, Uttar Pradesh
India
Corresponding Author: Trisha Rastogi, Senior Lecturer
Department of Oral Medicine and Radiology, D.J. College of
Dental Sciences and Research, Ghaziabad, Uttar Pradesh
India, Phone: +918527514760, e-mail: trishrastogi@rediffmail.
com
in the presence of oxygen, he noticed the emergence of a
gas with an “electric and pungent smell” that could be a
sort of “super-active oxygen.”4 Industrial ozone generators are used for industrial application and disinfection
of water, after it was shown the potent and broad bactericidal activity of ozone. The first medical application
seems to have been the use of ozone for treating gaseous,
posttraumatic gangrene in German soldiers during the
First World War.5 However, a big step forward was
the invention of a reliable ozonizer for medical use by
the physicist Joachim Hansler (1908–1981). The idea to
use ozone in medicine developed slowly during the last
century and it was stimulated by the lack of antibiotics
and the disinfectant properties of ozone. Ozone, which
is used for medical purposes, is a gas mixture comprising 95 to 99.95% oxygen and 0.05 to 5% pure ozone.5 Its
basic function is to protect humans from harmful effects
of UV radiation.2 It is one of the most important gases in
the stratosphere due to its ability to filter UV rays which
is critical for the maintenance of biological balance in the
biosphere. It has been used in human medicine since the
beginning of 20th century. Today, ozone is used not only
to disinfect wounds and improve blood circulation, but
also as a treatment for carcinomas, leukemia, rheumatism,
and multiple sclerosis. In dentistry, nowadays, ozone has
got its own role. It is used in a safe and controlled manner
to remove caries painlessly followed by remineralization
of that demineralized tooth structure.6
WHAT IS OZONE
Ozone is a gas composed of three atoms of oxygen and
present naturally in the upper layer of atmosphere in
abundance. It has got the capacity to absorb the harmful
ultraviolet rays present in the light spectrum from the
Sun. Thus ozone filters the light spectrum high up in
the atmosphere and protects the living creatures from the
ultraviolet rays. Ozone is an unstable gas and it quickly
gives up nascent oxygen molecule to form oxygen gas.
Due to the property of releasing nascent oxygen, it has
been used in human medicine since long back to kill
bacteria, fungi, to inactivate viruses, and to control hemorrhages. Medical grade ozone is made from pure medical
oxygen because oxygen concentration in the atmospheric
air is variable. Atmospheric air is made up of nitrogen
(71%), oxygen (28%), and other gases (1%) including
ozone which is altered by processes related to altitude,
temperature, and air pollution.7
International Journal of Oral Care and Research, July-September 2016;4(3):227-230
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Trisha Rastogi et al
There are three different systems for generating
ozone gas8:
1. Ultraviolet system: Produces low concentrations of
ozone, used in esthetics, saunas, and for air purification.
2. Cold plasma system: Used in air and water purification.
3. Corona discharge system: Produces high concentrations of ozone. It is the most common system used in
the medical/dental field.
CASE REPORT
Christian Friedrich Schönbein, a German chemist, is
considered to be the father of ozone therapy (1840).
When he passed an electrical discharge through water,
a strange smell was produced, which he called ozon,
from the Greek word ozein (odor). Edward Fisch was the
first dentist to use ozone in 1950. He used ozone to treat
Austrian surgeon Ernst Payr who then became an ozone
enthusiast and began a line of research dedicated to its
use in healthcare.7 Ozone therapy has been in use since
the 1800s and in 1896 the genius Nikola Tesla patented the
first O3 generator in the United States, later forming
the “Tesla Ozone Company.”9 During the First World
War (1914–1918) doctors familiar with O3’s antibacterial
properties and with few other medical resources available to them applied it topically to infected wounds and
discovered O3 not only remedied infection, but also had
hemodynamic and anti-inflammatory properties.10 In the
late 1980s, reports had emerged that German physicians
were successfully treating HIV patients with 03-AHT
(Autohemotherapy).11,12 Medical grade ozone is a mixture
of pure oxygen and pure ozone in the ratio of 0.05 to 5%
of O3 and 95 to 99.95% of O2. Due to the instability of
the O3 molecule, medical grade ozone must be prepared
immediately before use. Within less than an hour after
preparation, only half of the mixture is still ozone while
the other half is transformed into oxygen. As a result, it
is impossible to store ozone over long periods of time. In
order to control the decomposition of O3 into oxygen, it
can be associated with a vehicle with aqueous properties
to promote the conversion more quickly or with a vehicle
with more viscous properties to retard the conversion.7
MECHANISM OF ACTION
Inactivation of bacteria, viruses, fungi, yeast, and protozoa:
Ozone therapy disrupts the integrity of the bacterial cell
envelope through oxidation of the phospholipids and
lipoproteins. In fungi, O3 inhibits cell growth at certain
stages. With viruses, O3 damages the viral capsid and
upsets the reproductive cycle by disrupting the virusto-cell contact with peroxidation. The weak enzyme
coatings on cells which make them vulnerable to invasion by viruses make them susceptible to oxidation and
elimination from the body.13
228
Stimulation of oxygen metabolism: Ozone therapy causes
an increase in the red blood cell glycolysis rate. This
leads to the stimulation of 2,3-diphosphoglycerate which
leads to an increase in the amount of oxygen released to
the tissues. Ozone activates the Krebs cycle by enhancing oxidative carboxylation of pyruvate, stimulating
production of ATP. There is a stimulation of production
of enzymes which act as free radical scavengers and cellwall protectors.14
Activation of the immune system: Ozone administered at a
concentration between 30 and 55 μg/cc causes the greatest
increase in the production of interferon, tumor necrosis
factor, and interleukin-2. The production of interleukin-2
produces subsequent immunological reactions.15
MODES OF OZONE ADMINISTRATION16
Ozone therapy in dentistry contains a multiplicity of
protocols to deal with dental infection. The three fundamental forms of application of ozone to oral tissue are:
Ozonated Water
It is commonly used in root canal therapy. The following
properties of ozone are used in this case:
• Hemostatic effect
• Disinfectant and sterilization effect
• Accelerated wound healing, improved oxygen supply,
and support of metabolic process.
Ozonated Olive Oil
Mostly used in periodontal and surgical procedure for
healing. Also used for the treatment of dry sockets,
periapical sinus, denture sore mouth, lip herpes,
mouth, and tongue ulcer. Ozonated oils are pure plant
extracts, through which pure oxygen and ozone are
passed. The final products contain ozides. This method
of external application is harmless.
Ozone Gas
Ozone gas is generally used to treat dental caries and
aphthous ulcer. Ozone-generating equipment converts
oxygen to ozone. The ozone is then led to a handpiece
fitted with a silicon cup over the tooth for minimum of
10 seconds.
APPLICATIONS OF OZONE IN DENTISTRY
The use of ozone has been proposed in dentistry because
of its antimicrobial, disinfectant, biocompatibility, and
healing properties. Ozone has been applied for the
treatment of early carious lesions, sterilization of cavities, root canals, periodontal pockets, enhancing epithelial wound healing, such as ulcerations and herpetic
IJOCR
Ozone Therapy: A Revolution in Dentistry
lesions, bleaching of discolored root canal treated teeth,
desensitization of extremely sensitive teeth, treatment of
peri-implantitis and as a rinse for the avulsed teeth or as a
denture cleaner and decontamination of used toothbrush.
In Caries Prevention17,18
Ozone can be used to kill bacteria present in carious
lesion, painlessly and even without anesthetic. Ozone is
applied to the carious lesion in a controlled manner, safely
killing bacteria that have caused caries, thus requiring
minimal of physical intervention and just a few seconds.
In cases of incipient caries, ozone can kill bacteria in the
demineralized part and this demineralized tooth structure
can then be remineralized using a special remineralization kit, containing calcium, fluorine, phosphorus, and
sodium all in their ionic forms.
In Endodontic Treatment19
Ozone oils can be used to sterile the root canal systems
and to clear the canals of necrotic debris by virtue of
ozone’s bactericidal and effervescent properties. Ozone
oils are ozonated sunflower oil or olive oil or groundnut
oil. This ozone oil irrigation is more quick and efficient in
canal sterilization than that conventional irrigation by the
sodium hypochlorite and sodium peroxide combination.
In Periodontal Treatment20
Ozonated water strongly inhibited the accumulation of
dental plaque. Ozonated oil is used as a safe therapeutic
alternative in patients with acute necrotizing ulcerative
gingivitis. Healing and bactericidal properties make it
useful as a subgingival irrigant.
21
In Healing Wounds
Ozone has been reported to accelerate the healing of
soft tissue conditions, i.e., aphthous ulcers, herpes
labialis, ANUG, and other gum infections. It also reduces
the postextraction healing time by forming a pseudomembrane over the socket, so protecting it from any
physical and mechanical insults. Ozone therapy was
found to be beneficial for the treatment of refractory
osteomyelitis in the head and neck in addition to treatment with antibiotics, surgery, and hyperbaric oxygen.
In alveolitis, there is accelerated healing by irrigation
with ozonated water after removal of the necrotic pulp
and debris under antibiotic coverage.
22
In Bleaching
In root canal treated tooth, crown discoloration is a major
esthetic problem, especially in anterior teeth. Conventional walking bleaching requires much more time and
results are not satisfactory. Ozone can be successfully used
for lightening the yellowish tinge of tetracycline stain.
In Desensitization of Sensitive Root Necks23
Quick and prompt relief from root sensitivity has been
documented after ozone spray for 60 seconds, followed
by mineral wash onto the exposed dentin in a repetitive
manner. This desensitization of dentin lasts for longer
period of time. Smear layer present over the expose root
surface prevents the penetration of ionic calcium and
fluorine deep into the dentinal tubules. Ozone removes
this smear layer, opens up the dentinal tubules, broadens
their diameter, and then calcium and fluoride ions flow
into the tubules easily, deeply, and effectively to plug the
dentinal tubules. It prevents the fluid exchange through
these tubules. Thus ozone can effectively terminate the
root sensitivity problem within seconds.
In Prosthodontics23
Ozone gas can be applied as a prophylactic treatment
prior to etching and the placement of sealant with no
negative impact on sound enamel physical properties.
The longer exposure to ozone gas has a strong bactericidal
effect on microorganisms within the dentinal tubules of
deep cavities, which could result in increasing the clinical
success of restorations with no negative impact on dentin
and enamel shear bond strength to adhesive restoration. Ozonated oil can be applied topically in denture
stomatitis and also for cleaning the surface of removable
partial denture.
Decontamination of Toothbrush23
Ozone application was found to remove the toothbrushes
bristles micro biota following conventional brushing.
CONTRAINDICATIONS OF OZONE24,25
The following are the contraindications of ozone therapy:
• Pregnancy
• Glucose-6-phoshate dehydrogenase deficiency
• Hyperthyroidism
• Severe anemia
• Severe myasthenia
• Active hemorrhage
• Acute alcohol intoxication
• Ozone allergy.
ADVANTAGES OF OZONE THERAPY24
• Noninvasive or minimal intervention technique
• Induction of a friendly ecologic environment
• Improves metabolism of infected tissues by means of
its oxidizing effect.26
International Journal of Oral Care and Research, July-September 2016;4(3):227-230
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Trisha Rastogi et al
DISADVANTAGES OF OZONE THERAPY24
The problem of maintaining the ideal tightness between
the cap and the ozoned tooth.
• The device does not administer ozone when there is
a risk of untightness.
• More time (up to 10 minutes) needed for a proper
preparation of the cap.
RECENT DEVELOPMENT27,28
Ozone was effectively used as an antibacterial agent to
treat oral infections caused by Actinomyces naeslundii,
Lactobacilli casei, and Streptococcus mutans. Exposure of
about 60 seconds exhibited 99.9% killing efficiency, but
exposure for such a long period showed degradation of
salivary proteins. So, exposure of 10 to 30 seconds was
proved effective in killing significant number of bacteria.
O3 was also observed to regulate the expression of the
genes that play vital role in onset and maintenance of
allodynia.
CONCLUSION
In contrast with traditional medicine modalities, such
as antibiotics and disinfectants, ozone therapy is quite
economical; it will markedly reduce both medical cost
and invalidity. Dentistry is varying with induction of
modern science to practice dentistry. The ozone therapy
has been more beneficial than present conventional
therapeutic modalities that follow a minimally invasive
and conservative application to dental treatment. The
exposition of molecular mechanisms of ozone further
benefits practical function in dentistry. Treating patients
with ozone therapy lessens the treatment time with an
immense deal of variation and it eradicates the bacterial
count more specifically. The treatment is painless and
increases the patient’s tolerability and fulfilment with
minimal adverse effects. In future, the focus should be
on randomized clinical trial for routine use of ozone in
the treatment of various dental pathologies.
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