Ozone: A new face of dentistry

Abstract

Most of people possess a fear towards dentistry. On account of this fear, they avoid the dental treatment. Infact, 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. Incorporation of ozone in dental clinic set-ups would eradicate the feeling of pain during dental treatment and also cut off the treatment time, significantly. Ozone has been shown to stimulate remineralization of recent caries-affected teeth after a period of about six to eight weeks. 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.

Full text

The Internet Journal of Dental Science 2009 : Volume 7 Number 2
Ozone: A new face of dentistry
Rajeev Kumar Garg
Dental surgeon
Dental surgery clinic
Jaipur Rajasthan India
Sandeep Tandon
Professor & Head
Dept. of Paedodontics
Govt. Dental College & Hospital
Jaipur Rajasthan India
Citation: R. Garg & S. Tandon : Ozone: A new face of dentistry. The Internet Journal of Dental Science.
2009 Volume 7 Number 2
Keywords: Caries | bleaching | ozone | ozone oils

Abstract
Most of people possess a fear towards dentistry. On account of this fear, they avoid the
dental treatment. Infact, 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. Incorporation of ozone in dental clinic set-ups
would eradicate the feeling of pain during dental treatment and also cut off the
treatment time, significantly. Ozone has been shown to stimulate remineralization of
recent caries-affected teeth after a period of about six to eight weeks. 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.
Introduction
Until now, dentists have been convinced that caries can only be eliminated by the
removal of the carious part of the tooth followed by replacement of that deceased
substance with a suitable restorative material. Also, surgical treatment for caries
involved usually the removal of healthy tooth substance, with occasionally ensuing
pulpitic disorders. And, very oftenly, sooner or later, secondary caries appeared and
filling needed replacing. But, all that has changed now. The treatment and prevention of
tooth decay, it only takes seconds, has minimal physical intervention and is completely
pain-free. This has become possible only because now, dentists have in their

armamentarium, ozone. Ozone is a gas composed of three atoms of oxygen and is the
most powerful oxidant. It is one of the most important gases in the stratosphere due 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 twentieth
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, now a days, 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.1 This is very much true for the cases of incipient caries. But, still for the
cases of open cavitations, scientists will have to go a long way. But definitely one day,
ozone would be the single only answer to all types of caries.
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 ultra-
violet 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 ultra-
violet 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 gasses (1%) including ozone which is altered by
processes related to altitude, temperature, and air pollution.
There are three different systems for generating ozone gas2:
• Ultraviolet System: produces low concentrations of ozone, used in esthetics, saunas,
and for air purification.
• Cold Plasma System: used in air and water purification.
• Corona Discharge System: produces high concentrations of ozone. It is the most
common system used in the medical/ dental field. It is easy to handle and it has a
controlled ozone production rate.
Brief History
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. At the time, ozone therapy was difficult and limited due to the lack of
ozone-resistant materials, such as Nylon, Dacron, and Teflon, until 1950 when ozone-
resistant materials were manufactured. At that time Joachim Hänsler, a German
physicist and physician, joined another German physician, Hans Wolff, to develop the
first ozone generator for medical use. Their design continues to be the basis for modern
equipment.

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.
Dental ozone generators
Recent studies have proven the effectiveness of applying ozone in both the medical and
dental fields and its indications for use in a wide range of specialties.3 Application of
ozone gas has been advocated in dentistry for sterilization of cavities,4,5,6 root canals,7,8
periodontal pockets,9 and herpetic lesions.10 CurOzone USA Inc. (Ontario, Canada)
developed the HealOzone, which is now distributed by KaVo Dental (KaVo, Biberach,
Germany), for use in dentistry.
Millar and Hodson11 compared the safety of two ozone generating systems. These are the
Ozicure device (which is no longer available and is not licensed for use in Europe) and
HealOzone developed by CurOzone USA Inc., now distributed by KaVo Dental,
Biberach, Germany, for use in dentistry. The two were compared based on the amount
of ozone that escaped during gas application. The investigators found the Ozi-cure
device, when used without adequate suction, allowed ozone to reach concentrations
above the permitted levels and, therefore, should not be used. The HealOzone generator
was found to be safe to use following the manufacturer’s recommendations. After the
treatment, a special filter in the generator turns the residual ozone back into oxygen.12

Indications of Ozone in dental
problems
Very recently, in dentistry, ozone has got its role in various dental treatment modalities.
Interest in ozone use in dentistry is due to the infectious diseases associated with the
oral cavity. Ozone therapy presents great advantages when used as a support for
conventional treatments, for example, to dental caries, periodontal procedures, and
endodontic treatment.13
Prophylaxis and prevention of cariesRemineralization of pit and fissure
cariesRemineralization of root and smooth surface cariesRestoration of open cavitations
along with conventional conservative measuresBleaching of discoloured root canal
treated teethEndodontic treatmentDesensitization of extremely sensitive tooth
necksSoft tissue pathoses
Caries prevention and remineralization
Ozone can be used to kill bacteria present in carious lesion, painlessly and even without
anaesthetic. 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 then, can be remineralized
using a special remineralization kit, containing Calcium, Fluorine, Phosphorus and
Sodium, all in their ionic forms.1,14

Bleaching
In root canal treated teeth, crown discolouration is a major aesthetic problem, especially
in anterior teeth. Conventional walking bleaching requires much more time and results
are not oftenly satisfactory. Also, capping the tooth with ceramic crown is not always a
good idea. But, now, ozone has the answer to all these questions.
After removing the root canal filler material from the pulp chamber, the canal is sealed
tight at the level of cementoenamel junction. Then, the chamber is cleansed with sodium
peroxide solution to remove any debris, cement particles and the smear layer, leaving
the dentinal tubules opened-up. Now, a bleaching paste or a cotton pellet moistened in
bleaching solution is packed in the chamber and the orifice is sealed with the Glass-
inomer cement. After placing the bleaching agent in to the inner of the tooth, the crown
is irradiated with ozone for minimum of 3-4 minutes. This ozone treatment bleaches the
tooth within minutes and gives the patient a happy and healthier-looking smile.
Endodontic treatment
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.
Desensitization of sensitive root necks
Quick and prompt relief from root sensitivity has been documented after ozone spray for
60 seconds followed by mineral wash onto the exposed dentine in a repetitive manner.

This desensitization of dentine 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, preventing the fluid exchange
through these tubules. Thus, ozone can effectively terminate the root sensitivity problem
within seconds and also results last longer than those by conventional methods.
Soft tissue pathoses
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 post-
extraction healing time by forming a pseudo-membrane over the socket, so protecting it
from any physical and mechanical insults.
Ozone therapy contraindications
The following are contraindications for use of ozone therapy:13
Pregnancy Glucose-6-phosphate-dehydrogenase deficiency (favism) Hyperthyroidism
Severe anaemia Severe myasthenia Active hemorrhage
Conclusion
Most people suffer anxieties about being treated for tooth decay or more precisely; they
fear the injections and drills. But, now, with ozone treatment, this is all the thing of past.
Studies have shown that 99 percent of all the bacteria causing tooth decay have been
eliminated after 10 seconds of ozone exposure and even 99.9 percent bacteria after 20

seconds exposure. Thus, treating patients with ozone cuts off the treatment time with a
great deal of difference, it eliminates the bacterial count more precisely and moreover, it
is completely painless, so increasing the patients’ acceptability and compliance.11,15,16
Ozone can now be incorporated in various other treatment modalities also, like
bleaching of discoloured teeth, root canal treatment, desensitization and treatment of
some soft tissue infections. Ozone, definitely, seems to be a promising treatment
modality for various dental problems, in future.
Correspondence to
Dr. Rajeev Kumar Garg
Dental Surgery
35 Kishanpole
Jaipur 302001 (Rajasthan)
INDIA
Phone: +91 9414216475
Email: dr_gargrazz@yahoo.co.in
drazule@gmail.com

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