Research

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MRSA

Management of Aggressive Periodontitis

General Research Review Papers

Maslennikov O, Budilin S, Filatov D. Ozone Therapy in Clinical Practice.

Diseases of the Mouth - Caries & Dental Infections

Abu-Salem O, Marashdeh M, Holmes J, Lynch E. Clinical management of deciduous caries using ozone. In: Lynch E, ed. Ozone: the revolution in dentistry. Copenhagen: Quintessence Publishing, 2004:155–164, ISBN 18-5097-08-82.

Baysan A, Lynch E. Clinical management of root caries using ozone. In: Lynch E, ed. Ozone: the revolution in dentistry. Copenhagen: Quintessence Publishing, 2004:173–180, ISBN 18-5097-08-82.

Brauner A. Clinical studies of therapeutic results from ozonized water for gingivitis and periodontitis. Zahnärztl Prax 1991; 42:48–50.

Hamid A. Clinical reversal of occlusal pit and fissure caries using ozone. J Dent Res 2004; 83:B-3470.

Holmes J, Lynch E. Modern Dental Care; Published 2005.

IADR Abstracts

1. Ozone in Dentistry
   0165 Ozone in Dentistry E.F. REICH, Biberach, Germany Ozone is a very powerful oxidizer, which is used for disinfection in the food industry, medicine and water treatment. For a few years it is used in dentistry to treat caries in a more causal way than with the use of operative procedures. Besides...
2. The effect of ozone on tooth colour in vitro
   0134 The effect of ozone on tooth colour in vitro K. GUJRAL, B.J. MILLAR, and C. LOUCA, King's College London, United Kingdom Objectives: It has been suggested that when ozone breaks down to release a free oxygen radical this may be able to whiten teeth. The aim of this study is to measure any change...
3. Ozone, An Effective Treatment For Dental Unit Water Lines
   0711 Ozone, An Effective Treatment For Dental Unit Water Lines H.M. AL SHORMAN, L. ABU-NABA'A, W.A. COULTER, and E. LYNCH, Queens University Belfast, United Kingdom Ozone (O 3) has been used for purification of water due to its efficiency and lack of side effects. Objectives: The aim of this study was...
4. The Use of Ozone in Dentistry - Antimicrobial and Cellular Aspects
   The Use of Ozone in Dentistry - Antimicrobial and Cellular Aspects K.C. HUTH 1, K. KAMERECK 2, K. BRAND 2, and R. HICKEL 1, 1 University of Munich, Germany, 2 Technische Universität München, Munich, Germany Recently, the use of ozone as an antiseptic agent has become a relevant topic in dentistry. ...
5. Remineralization of Occlusal Pit and Fissure Caries After Using Ozone
   0680 Remineralization of Occlusal Pit and Fissure Caries After Using Ozone R. MORRISON, Harbour Dental Practice, Donaghadee, United Kingdom, and E. LYNCH, Queen's University, Belfast, United Kingdom Ozone has been shown to clinically reverse primary root carious lesions and early occlusal pit and fissure...
6. Evaluation of Antibacterial Effects of Different Root Canal Disinfection Methods
   .... Objectives: To assess the antimicrobial effect of 17% EDTA, TopClear, Sodium Hypochlorite (NaOCl), Sterilox, STEDS, Hydrogen Peroxide (H 2O 2), Ozone Gas, and Chlorhexidine (CHX) on Enterococcus faecalis in root canals. Methods: Root canals of 27 single rooted teeth were prepared with ProTaper files...

Additional Research

1. Den Besten and Berkowitz (Den Besten PK, Berkowitz RJ Early childhood caries: an overview with reference to our experience in California. J Cal Dent Assoc 31(2):139-143, 2003)
2. Anderson et al (Anderson MH, Bales DJ, Omnell KA. Modern management of dental caries: The cutting edge is not the dental burr. JADA 1993; 126: 727-743) Young (Young DA New caries detection technologies and modern caries management: merging the strategies. Gen Dent. 2002 Jul-Aug;50(4):320-31)
   • all argue that preventative management is better than drilling - that means the use of accepted scientific evidence-based research, as well as the use of new technologies to find decay BEFORE it has a chance to make a hole.
   • at the moment, the DIAGNOdent is the only real-time detection device that fits this niche.
3. Featherstone JD. The caries balance: the basis for caries management by risk assessment. Oral Health Prev Dent. 2004;2 Suppl 1:259-64.
   • ...minimally invasive dentistry aims at the least possible removal of enamel or dentin, including reducing pathological factors and enhancing remineralization to avoid any removal of hard tissues.
   • ...structured caries risk assessment should be carried out based upon the concept of the caries balance.
   • ...the key to improved dental health for all is now for the dental profession to embrace this knowledge and put it into practice in the real world, to inhibit caries formation and progression, and to enhance the natural repair process.
   • ...a change in how we manage caries is long over due. The days of drilln’fill are numbered.
4. Diagnosis & Evaluation
   Visual Inspection 49%
   
   • The reliability of carious lesion diagnosis by sharp explorer compared to diagnosis of carious lesion by histological cross section was 25%. A seemingly intact occlusal enamel surface may conceal an extensive lesion of the dentin...
     
     AL-SEHAIBANY, WHITE & RAINEY
     J Clin Pediatr Dent 20(4):293-298 1996.

Further Research/Conclusions

(al, 2003; Domingo et al, 2004). The effects of O3 reduce tooth destruction in routine preparation (Clifford, 2004; Holmes, 2004; Holmes and Lynch, 2004) and O₃ reduces the time and the cost of dental care.

Bocci V (Bocci 1994) has emphasized that the potential toxicity of O3 should not preclude its employment for medical, dental & veterinary purposes. This statement has been echoed by thousands of health professionals who use ozone in clinical practices around the world, and millions of patients that have been treated. The results of these studies show... (Domingo and Holmes, 2004; Johnson et al, 2003)

In Endodontics, O₃ is effective against Enterococcus faecalis (Chang et al, 2003) which is implicated in endodontic treatment failure.

Lynch E, Swift Jr EJ. Evidence based efficacy of ozone for root canal irrigation. Ask the Experts (Publication of Department of Operative Dentistry, University of North Carolina) Journal Compilation. 2008;20(5): 287-293. Int Endod J. 2009 Jan;42(1):3-13.

Effectiveness of ozone against endodontopathogenic microorganisms in a root canal biofilm model. Huth KC, Quirling M, Maier S, Kamereck K, Alkhayer M, Paschos E, Welsch U, Miethke T, Brand K, Hickel R. Department of Restorative Dentistry & Periodontology, Ludwig-Maximilians University, Munich, Germany. khuth@dent.med.uni-muenchen.de

AIM: To assess the antimicrobial efficacy of aqueous (1.25-20 microg mL(-1)) and gaseous ozone (1-53 g m(-3)) as an alternative antiseptic against endodontic pathogens in suspension and a biofilm model. METHODOLOGY: Enterococcus faecalis, Candida albicans, Peptostreptococcus micros and Pseudomonas aeruginosa were grown in planctonic culture or in mono-species biofilms in root canals for 3 weeks. Cultures were exposed to ozone, sodium hypochlorite (NaOCl; 5.25%, 2.25%), chlorhexidine digluconate (CHX; 2%), hydrogen peroxide (H(2)O(2); 3%) and phosphate buffered saline (control) for 1 min and the remaining colony forming units counted. Ozone gas was applied to the biofilms in two experimental settings, resembling canal areas either difficult (setting 1) or easy (setting 2) to reach. Time-course experiments up to 10 min were included. To compare the tested samples, data were analysed by one-way anova. RESULTS: Concentrations of gaseous ozone down to 1 g m(-3) almost and aqueous ozone down to 5 microg mL(-1) completely eliminated the suspended microorganisms as did NaOCl and CHX. Hydrogen peroxide and lower aqueous ozone concentrations were less effective. Aqueous and gaseous ozone were dose- and strain-dependently effective against the biofilm microorganisms. Total elimination was achieved by high-concentrated ozone gas (setting 2) and by NaOCl after 1 min or a lower gas concentration (4 g m(-3)) after at least 2.5 min. High-concentrated aqueous ozone (20 microg mL(-1)) and CHX almost completely eliminated the biofilm cells, whilst H(2)O(2) was less effective. CONCLUSION: High-concentrated gaseous and aqueous ozone was dose-, strain- and time-dependently effective against the tested microorganisms in suspension and the biofilm test model.
PMID: 19125975 [PubMed - indexed for MEDLINE]

Quintessence Int. 2006 May;37(5):353-9. The use of ozone in dentistry and maxillofacial surgery: a review. Stübinger S, Sader R, Filippi A. University Clinic for Reconstructive Surgery, Department of Cranio- and Maxillofacial Surgery, University Hospital Basel, Switzerland. sstuebinger@uhbs.ch

Ozone has been successfully used in medicine because of its microbiologic properties for more than 100 years. Its bactericide, virucide, and fungicide effects are based on its strong oxidation effect with the formation of free radicals as well as its direct destruction of almost all microorganisms. In addition, ozone has a therapeutic effect that facilitates wound healing and improves the supply of blood. For medical purposes, ozone may be applied as a gas or dissolved in water. Despite the advantages that the therapeutic use of ozone offers, reservations remain in terms of its application in the oral and maxillofacial area. Particularly, the gaseous application of ozone is critically evaluated because of its possible side effects on the respiratory system. The objective of this article is to provide an overview of the current applications of ozone in dentistry and oral surgery. Research was based on peer-reviewed sources found through a Medline/PubMed search and other textbooks, reviews, and journals.
PMID: 16683682 [PubMed - indexed for MEDLINE]

Shanghai Kou Qiang Yi Xue. 2008 Feb;17(1):92-5. Ozone Sterilization[The disinfecting effect of ozone on four kinds of bacteria].[Article in Chinese] Wang RR, Shang GW, Hu LF, Wang XP, Huang W, Li MY, Zhu CL. Department of Dentistry, The 10th People's Hospital of Shanghai, Shanghai 200072, China.

PURPOSE: To evaluate the disinfecting effect of ozone on 4 kinds of bacteria: Staphylococcus aureus, Streptococcus mutans, Staphylococcus epidermidis and Streptococcus pneumoniae. METHODS: The concentration of ozone that was transmitted by ozone generator at different time was determined by using iodine titrimetric method. According to the bactericidal assay of quantitative vehicle, the bacteria on the ozonized vehicles and unozonized vehicles was washed, 50 microl eluant was seeded on the TSA plates. The TSA plates were put into the anaerobiotic incubator (90% N(2),10% CO(2),37 degrees centigrade). After 24 to 48 hours, the CFU on the plate was counted.The data was analyzed by one-way ANOVA with SAS 6.12 software package. RESULTS: The sterilization effect depended on the ozone concentration and the treatment time. When the 4 kinds of bacteria were treated with 2.73 mg/L ozone for 45 minutes, there was no bacteria alive. CONCLUSIONS: Ozone has obvious disinfecting effect on the 4 kinds of bacteria and the effect is correlated with the concentration of ozone.
PMID: 18360678 [PubMed - in process]

Biofactors. 2006;27(1-4):5-18. High resolution 1H NMR investigations of the oxidative consumption of salivary biomolecules by ozone: relevance to the therapeutic applications of this agent in clinical dentistry. Grootveld M, Silwood CJ, Lynch E. Department of Applied Science, London South Bank University, 103 Borough Road, London, UK. grootvm@lsbu.ac.uk

High resolution proton (1H) nuclear magnetic resonance (NMR) spectroscopy was employed to simultaneously evaluate the oxidising actions of ozone (O3) towards a wide range of salivary biomolecules in view of its applications in dental practices, which may serve as a viable and convenient means for the treatment of dental caries. Treatment of supernatants derived from unstimulated human saliva specimens (n=12) with O3 (4.48 mmol) revealed that this reactive oxygen species gave rise to the oxidative consumption of pyruvate (generating acetate and CO2 as products), lactate (to pyruvate and sequentially acetate and CO2), carbohydrates in general (a process generating formate), methionine (giving rise to its corresponding sulphoxide), and urate (to allantoin). Further, minor O3-induced modifications included the oxidation of trimethylamine and 3-D-hydroxybutyrate, the fragmentation of salivary glycosaminoglycans to NMR-detectable saccharide fragments, and the conversion of polyunsaturated fatty acids to their ozonides. Moreover, evidence for the ability of O3 to induce the release of selected low-molecular-mass salivary biomolecules from macromolecular binding-sites was also obtained. Since many of the oxidation products detectable in O3-treated samples are identical to those arising from the attack of *OH radical on biofluid components, it appears that at least some of the modifications observed here are attributable to the latter oxidant (derived from O3*- generated from the single electron reduction of O3).
PMID: 17012760 [PubMed - indexed for MEDLINE

J Dent Res. 2007 May;86(5):451-6. Effect of aqueous ozone on the NF-kappaB system. Huth KC, Saugel B, Jakob FM, Cappello C, Quirling M, Paschos E, Ern K, Hickel R, Brand K. Department of Restorative Dentistry & Periodontology Ludwig-Maximilians-University, Goethe Street 70, 80336 Munich, Germany. khuth@dent.med.uni-muenchen.de

Ozone has been proposed as an alternative oral antiseptic in dentistry, due to its antimicrobial power reported for gaseous and aqueous forms, the latter showing a high biocompatibility with mammalian cells. New therapeutic strategies for the treatment of periodontal disease and apical periodontitis should consider not only antibacterial effects, but also their influence on the host immune response. Therefore, our aim was to investigate the effect of aqueous ozone on the NF-kappaB system, a paradigm for inflammation-associated signaling/transcription. We showed that NF-kappaB activity in oral cells stimulated with TNF, and in periodontal ligament tissue from root surfaces of periodontally damaged teeth, was inhibited following incubation with ozonized medium. Under this treatment, IkappaBalpha proteolysis, cytokine expression, and kappaB-dependent transcription were prevented. Specific ozonized amino acids were shown to represent major inhibitory components of ozonized medium. In summary, our study establishes a condition under which aqueous ozone exerts inhibitory effects on the NF-kappaB system, suggesting that it has an anti-inflammatory capacity.
PMID: 17452567 [PubMed - indexed for MEDLINE]

J Appl Microbiol. 2004;96(5):1133-42. Mechanisms of Bacillus subtilis spore resistance to and killing by aqueous ozone. Young SB, Setlow P. Department of Molecular, Microbial and Structural Biology, University of Connecticut Health Center, Farmington, CT 06032-3305, USA.

AIMS: To determine the mechanisms of Bacillus subtilis spore killing by and resistance to aqueous ozone. METHODS AND RESULTS: Killing of B. subtilis spores by aqueous ozone was not due to damage to the spore's DNA, as wild-type spores were not mutagenized by ozone and wild-type and recA spores exhibited very similar ozone sensitivity. Spores (termed alpha-beta-) lacking the two major DNA protective alpha/beta-type small, acid-soluble spore proteins exhibited decreased ozone resistance but were also not mutagenized by ozone, and alpha-beta- and alpha-beta-recA spores exhibited identical ozone sensitivity. Killing of spores by ozone was greatly increased if spores were chemically decoated or carried a mutation in a gene encoding a protein essential for assembly of the spore coat. Ozone killing did not cause release of the spore core's large depot of dipicolinic acid (DPA), but these killed spores released all of their DPA after a subsequent normally sublethal heat treatment and also released DPA much more readily when germinated in dodecylamine than did untreated spores. However, ozone-killed spores did not germinate with either nutrients or Ca(2+)-DPA and could not be recovered by lysozyme treatment. CONCLUSIONS: Ozone does not kill spores by DNA damage, and the major factor in spore resistance to this agent appears to be the spore coat. Spore killing by ozone seems to render the spores defective in germination, perhaps because of damage to the spore's inner membrane. SIGNIFICANCE AND IMPACT OF THE STUDY: These results provide information on the mechanisms of spore killing by and resistance to ozone.
PMID: 15078531 [PubMed - indexed for MEDLINE]

Prim Dent Care. 2006 Jan;13(1):37-41. The use of ozone in dentistry and medicine. Part 2. Ozone and root caries. Baysan A, Lynch E. Department of Fixed and Removable Prosthodontics, GKT Dental Institute, Guy's Tower Floor 25, King's College London, Guy's Hospital, London SE1 9RT, UK. aylin.baysan@kcl.ac.uk

A previous paper, recently published in Primary Dental Care, gave an overview of the medical uses of ozone and outlined some of its uses in dentistry. The current paper focuses on a description of use of ozone in the management of root caries and considers recent studies in this area. There has been relatively limited research into the non-invasive (pharmaceutical) management of root caries. The best management strategy still remains to be developed. Initial studies have indicated that an application of ozone for a period of either 10 or 20 seconds is capable of clinically reversing leathery root carious lesions. It is suggested that, subject to confirmation from extensive trials, this simple and non-invasive technique may benefit many patients with root caries throughout the world since this approach to treat root caries can easily be employed in primary care clinics and in the domiciliary treatment of home-bound elderly people and immobile patients in hospices and hospitals.
PMID: 16393498 [PubMed - indexed for MEDLINE]

Wound/Ulcer Healing with Ozone Abstracts: Ozonated Oil, Br J Dermatol. 2005 Dec;153(6):1096-100.

The dual action of ozone on the skin. Valacchi G, Fortino V, Bocci V. Department of Physiology, University of Siena, Siena 53100, Italy. gvalacchi@ucdavis.edu

The aim of this brief review is to summarize the recent literature on the effect of ozone (O3) on cutaneous tissues. Recently it has been reported that a chronic contact with O3 can be deleterious for the skin. Our group and others have shown a progressive depletion of antioxidant content in the stratum corneum and this can then lead to a cascade of effects resulting in an active cellular response in the deeper layers of the skin. Using an in vivo model we have shown an increase of proliferative, adaptive and proinflammatory cutaneous tissue responses. On the other hand the well known activity of O3 as a potent disinfectant and oxygen (O2) donor has been also studied for therapeutic use. Two approaches have been described. The first consists of a quasi-total body exposure in a thermostatically controlled cabin. This treatment has proved to be useful in patients with chronic limb ischaemia. The second approach is based on the topical application of ozonated olive oil in several kinds of skin infection (from soreness to diabetic ulcers, burns, traumatic and surgical wounds, abscesses and skin reactions after radiotherapy). We and other authors have observed a striking cleansing effect with improved oxygenation and enhanced healing of these conditions. It is now clear that, on the skin, O3, like other drugs, poisons and radiation, can display either a damaging effect from a long exposure or a beneficial effect after a brief exposure to O2 and O3 or to the application of ozonated oil to chronic wounds.
PMID: 16307642 [PubMed - indexed for MEDLINE]

Vnitr Lek. 2006 May;52(5):411-6. [Infections and diabetic foot syndrome in field practice] [Article in Czech]

Ozone Healing Zhonghua Shao Shang Za Zhi. 2000 Jun;16(3):163-5.

[The role of ozone solution on debridement and sterilization of burn wound] [Article in Chinese] Xie W, Zhang L, Yang R. Department of Burns, The Third Municipal Hospital of Wu Han, Wu Han 430037, P.R. China.

OBJECTIVE: To observe the role of ozone solution on debridement and sterilization of burn wound. METHODS: In vitro sterilizing effect on common isolated bacteria from burn wound and debridement and sterilization effects on burn wound of ozone disinfectant (ozone solution) were studied. RESULTS: All the bacteria tested were killed in vitro by ozone solution. In addition, when ozone solution was applied on burn wound, its clearance rate of bacteria was 94.5% and the clinical effective rate was 97.1%. CONCLUSION: Ozone is low in cost and high in effect which might be used as an agent for burn wound disinfection.
PMID: 11876864 [PubMed - indexed for MEDLINE]

Záhumenský E. Diabetologická ordinace, Zlín. zahumensky.emil@seznam.cz

In diabetic foot syndrome, the infection of diabetic ulceration is the critical parameter of classification, the most frequent reason of hospitalization and the main cause of amputations. Debridement and release of pressure are the critical steps of initial therapy of neuropathic ulceration showing no clinical signs of infection. Infection of neuroischemic foot is much more serious condition: in case of positive microbiological finding, antibiotic therapy is recommended even without any clinical signs of infection. Healing can be accelerated by ozone and Dermacyn therapy. Prevention of ulceration should be based on using appropriate shoes (with respect to risk factors) and PC plantography.
PMID: 16771079 [PubMed - indexed for MEDLINE]

Br J Biomed Sci. 2007;64(1):44-9. The case for oxygen-ozonetherapy. Bocci V. Department of Physiology, University of Siena, via Moro 2, 53100, Siena, Italy. bocci@unisi.it

Ozone is a very reactive gas that is toxic to the respiratory system. However, under controlled conditions, it can be therapeutically useful in several human diseases. An unfavourable combination of factors (ozone is one of the worst troposphere pollutants) and past misuse have led to misgivings about ozonetherapy. However, basic and clinical work developed over the past 10 years has clarified the fundamental mechanisms of action of ozone in biology and medicine. Interestingly, judicious doses of ozone dissolved in blood trigger a cascade of well-defined chemical compounds acting on multiple cellular targets according to well-known molecular, biochemical and pharmacological pathways. Ozonetherapy is proving to be very useful in age-related macular degeneration, ischaemic and infectious diseases, and in wound healing disorders, where conventional medicine has failed. Critical evaluation of the potential therapeutic utility of this simple, inexpensive medical application by national and international health authorities is warranted and may lead to clinical benefit for a large proportion of the world's population.