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The miraculous healing therapy Ozone

therapy in dentistry
ARTICLE JULY 2012
DOI: 10.1016/j.ijd.2012.04.004

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1 AUTHOR:
Sumit Bhateja
Vyas Dental College and Hospital
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Indian Journal of Dentistry 2012 JulyeSeptember

Volume 3, Number 3; pp. 150e155

Review Article

The miraculous healing therapy e Ozone therapy in dentistry

Sumit Bhateja*

ABSTRACT
Atmospheric air is made up of nitrogen (71%), oxygen (28%) and other gasses (1%) including ozone, which could be
altered by various processes related to altitude, temperature and air pollution. Recently many researchers have
indicated that ozone can be utilized for therapeutic purposes & it has long been used in complementary and alternative medicine (CAM) & probably one of the most miraculous healing therapies available on our planet at this time.
Its use is based on the known anti-microbial, antihypoxic, analgesic, immunostimulating properties of ozone (O3) on
biological systems. These mechanisms of action supported with a lot of case reports and scientic studies allow using
it in different elds of medicine. Claims have been made that the oxidizing properties of ozone may in fact be
therapeutic for a variety of ailments; including many chronic infections for which few other treatments are available
and efcacious. This review is another attempt to summarize different modalities of ozone applications in dentistry.
Further studies are necessary to standardize indications and treatment protocols of this promising medical agent.
Keywords: Dentistry, Ozone, Ozone application, Ozone therapy

INTRODUCTION
Ozone (O3) is a triatomic molecule, consisting of three
oxygen atoms. Its molecular weight is 4798 g/mol.1 It is
produced in the upper atmosphere when UV light strikes
the oxygen rising from plants, plankton and algae in our
forests and seas. It then falls back through the atmosphere,
as it is heavier than air, combining with pollutants and
water, cleaning the air and forming peroxides that benet
plants.2 Ultraviolet light breaking down pollutants and
nitrous oxides also can produce ozone at the ground level,
which is the eye and lung irritant in smog. Ozone is an
unstable gas and it quickly gives up nascent oxygen molecule to form oxygen gas. The release of nascent oxygen
has benecial effects on every part and organ.1 It has
been used in medical eld since long back due to its
extremely strong oxidant property that oxidizes nearly
all surfaces to the highest oxidation stage. It is used in

circulatory enhancement and stimulation of oxygen

metabolism, disruption of tumor metabolism and to kill
pathogens.1,3 O3 is a powerful oxidant capable of
interacting as metabolic & immune modulator as well as
anti-microbial agent. Multiple microbiological & the
biochemical studies justied that there are no doubts about
the effectiveness of ozone in bacterial reduction.4 Ozone
can also be used to purify drinking water and water in
dental equipment and for sterilizing instruments for
medical & dental use.5 Medical ozone, is a mixture of
the purest oxygen and purest ozone & is being used to
disinfect and in treatment of diseases. It is made when
medical grade oxygen is electrically activated (using an
Ozone Generator). The ozone therapist determines the
complete dosage according to the medical/dental indication and the patients condition. According to its application, the ozone concentration may vary between 1 and
100 g/ml (0.05e5%).6,7

Senior Lecturer, Department of Oral Medicine Diagnosis & Radiology, Dr. D.Y. Patil Dental College & Hospital, Pune (Maharashtra), India.
*
A-3, Flat no. 204, Dwarka Lords, Shivar Chowk, Pimple Saudagar, Pune, Maharashtra 27, India. Tel.: 91 9561334497, email: bhateja.sumit@
gmail.com
Received: 21.12.2011; Accepted: 16.4.2012
2012 Indian Journal of Dentistry. All rights reserved.
http://dx.doi.org/10.1016/j.ijd.2012.04.004

Ozone therapy in dentistry

HISTORICAL BACKGROUND

Review Article

Table 1 Uses of ozone in medicine with mechanism of action.

Indications of ozone

The German chemist Christian Friedrich Schonbein

(1840) of the University of Basel in Switzerland who rst
used the term OZONE (derived from the Greek word
ozein which means odor), is regarded as the Father of
ozone therapy.6 He subjected oxygen to electrical
discharges and noted the odor of electrical matter. Joachim Hansler (1857), a German physicist and physician,
along with German physician, Hans Wolff, developed
the rst ozone generator for medical use. Dr. C. Lender
(1870), for the rst time applied O3 into medical eld.
He puried blood in test tubes by using O3. In 1893, Ousbaden, Holland became the rst city to utilize a water
treatment plant using ozone. In World War I and II it
was used to treat wounded soldiers in the trenches. In
early 20th century Food and Drug Act, revised its use
and effect in the eld of medicine. Dr. E.A. Fisch
(1950), a German dentist, was the rst dentist to use
ozone on regular basis in his dental practice in Zurich, Switzerland and published numerous papers on its application in
dentistry. Numerous researchers since that time
have worked to elucidate the nature and actions of ozone.
Mariniak and Delarive showed that it is an allotropic
form of oxygen, and Mulliken and Dewar claried its
molecular structure.2,3,6

MECHANISMS OF THERAPEUTIC ACTIONS

OF OZONE
There are several known actions of ozone on human body,
such as anti-microbial. immunostimulating, antihypoxic,
analgesic, detoxicating, bioenergetic and biosynthetic (activation of the metabolism of carbohydrates, proteins &
lipids) etc. Table 1 summarizes various medical indications
of ozone therapy along with mechanism of actions of each
use.
1. Anti-microbial action - The anti-microbial effect of
ozone as a result of its action on cells by damaging its
cytoplasmic membrane due to ozonolysis of dual bonds
and also ozone-induced modication of intracellular
contents because of secondary oxidants effects. This
action is non-specic and selective to microbial cells;
it does not damage human body cells because of their
major antioxidative ability. Ozone is very efcient in
antibiotics resistant strains. Its anti-microbial activity
increases in liquid environment of the acidic pH. In viral
infections the ozone action lies in the intolerance of
infected cells to peroxides and change of activity of
reverse transcriptase, which takes part in synthesis of
viral proteins.8

151

External ulcers and skin

disorders
Arterial circulatory
disorders

Immunodeciency and
immunodysbalance:
d Chronic forms of
hepatitis B and C
d Supportive therapy
in cancer patients
d Supportive therapy
in rheumatoid arthritis
Inammatory condition
such as:
d Knee arthrosis
d Gonarthrosis
d Traumatic
knee disorders

Mechanisms
Disinfection, wound cleansing
and improved wound healing
Activation of RBC metabolism
with an improvement of
oxygen release.
Activation of ROS
(reactive oxygen species) and
radical scavengers
Activation of immunocompetent
cells with release of cytokines
such as interferons and interleukins.
Modulation of immune system
Increase of antioxidative capacity
by activation of biological
anti-oxidants
Antiinammatory effect
Activation of antioxidative enzymes
as radical scavangers
Activation of immunocompetent
and cartilage cells with
release of TGF-b

2. Immunostimulating action - Ozone inuences cellular

and humoral immune system. It stimulates proliferation
of immunocompetent cells and synthesis of immunoglobulins. It also activates function of macrophages
and increases sensitivity of micro-organisms to phagocytosis. When administered at low concentrations, the
organisms own resistance is mobilized, i.e. ozone (re)
activates the immune system. As a response to this activation through ozone, the bodys immune cells produce
special messengers called cytokines. These molecules in
turn activate other immune cells, setting off a cascade of
positive change throughout the immune system, which is
stimulated to resist diseases. This means that the application of medical ozone is extremely useful for immune
activation in patients with a low immune status and/or
immune decit. Ozone causes the synthesis of biologically active substances such as interleukins, leukotrienes
and prostaglandins which is benecial in reducing
inammation and wound healing.8
3 Antihypoxic action - Ozone brings about the rise of pO2
in tissues and improves transportation of oxygen in
blood, which results in change of cellular metabolism e
activation of aerobic processes (glycolysis, Krebs cycle,
b-oxidation of fatty acids) and use of energetic
resources. It also prevents formation of erythrocytes

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Indian Journal of Dentistry 2012 JulyeSeptember; Vol. 3, No. 3

aggregates and increases their contact surface for oxygen

transportation. Its ability to stimulate the circulation is
used in the treatment of circulatory disorders and makes
it valuable in the revitalizing organic functions.8
4. Analgesic & detoxicating action - Ozone causes secretion of vasodilators such as NO which is responsible
for dilatation of arterioles and venules.8
5. Bioenergetic & biosynthetic action - It activates mechanisms of protein synthesis, increases amount of ribosomes and mitochondria in cells. These changes on the
cellular level explain elevation of functional activity
and regeneration potential of tissues and organs.8
Miscellaneous actions of ozone are circulatory enhancement, disruption of tumor metabolism and stimulation of
oxygen metabolism.

Bhateja

8. Hemorrhage from any organ.

9. Ozone allergy.

FORMS OF APPLICATION3,8,10
Systemic forms of application
d

d
d

Major Auto Hemo Therapy (MAH) as extracorporeal

blood treatment with O3 and reinfusion of activated
blood
Rectal insufation of O3eO2 mixture
Minor auto hemo therapy as intramuscular injection of
activated blood.

Topical forms of application

RATIONALE OF OZONE THERAPY

Setting the standard-of-care and therapeutic goals are based
on sound evidence-based science is critical. Therapeutic
goals are inclusive and not exclusive of standard-of-care.
The goals of oxygen/ozone therapy9
1.
2.
3.
4.
5.
6.

Elimination of pathogens.
Restoration of proper oxygen metabolism.
Induction of a friendly ecologic environment.
Increased circulation.
Immune activation.
Stimulation of the humoral anti-oxidant system.

Indications of ozone therapy

3,8,10

1. Arterial circulatory disorders

2. Immunodeciency and immunodysbalance
d Additive therapy in carcinoma patients
d Diseases caused by viruses (eg. Hepatitis)
3. Inammatory conditions
4. Rheumatic diseases
5. External ulcers and skin lesions
6. Dentistry
3,8,10

Contraindications of ozone therapy

1. Pregnancy.
2. Glucose-6-phosphate-dehydrogenase deciency
(favism).
3. Hyperthyroidism.
4. Severe anemia.
5. Severe myasthenia.
6. Acute alcohol intoxication.
7. Recent myocardial infarction.

d
d
d
d
d

Transcutaneous ozone gas application in gas-tight and

ozone-resistent plastic covers
Ozonized water in the form of spray or compresses
Rectal O3eO2 insufation
Intraarticular injections
Intramuscular injections
Ozonized olive oil.

SYSTEMS FOR GENERATING OZONE GAS3,10

1. Ultraviolet system: Produces low concentrations of
ozone, used in aesthetics and for air purication.
2. Cold plasma system: used in air and water purication.
3. Corona discharge system: produces high concentrations
of ozone. It is the most common system used in the
medical/dental eld. It is easy to handle and it has
a controlled ozone production rate.

OZONE THERAPY IN DENTISTRY

Dentistry is changing as we are now using modern science
to practice dentistry. The ozone therapy has been more
benecial than present conventional therapeutic modalities.
This state of the art technology allows us to take a minimally invasive and conservative approach to dental treatment. The main use of ozone in dentistry is relays on its
anti-microbial properties. It is proved to be effective against
both Gram positive, Gram negative bacteria, viruses and
fungi. In dentistry, ozone has got its role in various dental
treatment modalities. Ozone therapy presents great advantages when used as a support for conventional treatments-

Ozone therapy in dentistry

1. Prophylaxis and prevention of dental caries.

2. Remineralisation of pit and ssure, root and smooth
surface caries.
3. Restoration of open cavitations along with conventional
conservative measures.
4. Bleaching of discolored root canal treated teeth.
5. Endodontic treatment.
6. Desensitization of extremely sensitive tooth.
7. Soft tissue pathoses.
8. The treatment of infected, badly healing wounds and
inammatory process.

Forms of application in dentistry6,7

i. As an infusion into infected jaw bone (cavitation).
ii. As an infusion into the temporomandibular joint for
the treatment of pain and inammation.
iii. As an irrigant during new root canal therapy to
disinfect the involved tooth.
iv. Adjunctive therapy with the use of Ozonated olive
oil for periodontal disease.

Ozone therapy in prosthodontics

Microbial plaque accumulating on the dentures is
composed of several oral micro-organisms, mainly C. albicans. Denture plaque control is essential for the prevention
of denture stomatitis. In an attempt to solve this problem
Arita et al assessed the effect of ozonated water in combination with ultrasonication on C. albicans. Following exposure to owing ozonated water (2 or 4 mg/l) for one minute
they found no viable C. albicans suggesting the application
of ozonated water might be useful in reducing the number
of C. albicans on denture bases.11

Ozone therapy in restorative dentistry &

endodontics
Conventional drill and ll dentistry involves the amputation
of a considerable volume of diseased tissue. With ozone
therapy and re-mineralization, only minimal quantities of
dental tissue need be removed to facilitate a restoration of
the tooth. This makes the restorative treatment much
simpler, less time consuming and much more cost-effective.
For the patient, it is far more comfortable than drilling and
lling.12e18
Ozone treatment takes a mere 10e40 s per tooth, and
requires a minimum set of disposable items, such as cotton
rolls and so on. Conventional drill and ll treatment can
take at least 20 min or much longer & also requires expensive restorative materials. Conventional llings weaken the

Review Article

153

structure of the teeth and the future often brings the need for
repeating the restoration as the structure of the tooth/lling
break down. The vitality of the dental pulp may also be
compromised and endodontic therapy is often required,
signicantly adding to the cost. Patients are astonished by
the comfortable nature and the simplicity of the ozone
therapy. No local anesthetic injection, no drills and an
appointment time measured in a few minutes. The implications for this new treatment to a general dental practitioner
are profound.
The principle line of study has evolved using the ozone
to determine its effect on several kinds of caries (pit and
ssure, noncavity, and primary root caries). The oxidative
impact on this microbiota has been recognized in several
studies; however, there is a divergence of opinion regarding
the amount of time that ozone gas should be applied. One
study suggests application of ozone gas for a period of
10e20 s resulted in 99% of the micro-organisms being
destroyed. Another report states 40 s of application was
insufcient to decontaminate the area and failed to act on
underlying infected dentin. Interesting data shows ozone
does not affect the sealing ability of the bonding-system.
Ozone therapy was also used in prevention of dental caries
in pit & ssures in children.
In root canal treated teeth, crown discoloration is a major
aesthetic problem, especially in anterior teeth. After placing
the bleaching agent into the inner of the tooth, the crown is
irradiated with ozone for minimum of 3e4 min. This ozone
treatment bleaches the tooth within minutes and gives the
patient a happy and healthier-looking smile.
Quick and prompt relief from root sensitivity has been
documented after ozone spray for 60 s 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 exposed 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 ow into the tubules easily, deeply
and effectively to plug the dentinal tubules, preventing the
uid exchange through these tubules. Thus, ozone can effectively terminate the root sensitivity problem within seconds
and also lasts longer than those by conventional methods.

Ozone therapy in periodontics

The application of ozone therapy in periodontics showed
promising results. Both gaseous and aqueous ozone are
used as a substitute to mechanical debridement. Ozonated
water (4 mg/l) strongly inhibited the formation of dental
plaque and reduced the number of sub gingival

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Indian Journal of Dentistry 2012 JulyeSeptember; Vol. 3, No. 3

pathogens. Gram negative bacteria, such as P. endodontalis

and P. gingivalis were substantially more sensitive to
ozonated water than gram positive oral streptococci and
C. albicans in pure culture. Ozone gas found to be toxic
to the human oral epithelial and gingival broblast cells
and aqueous ozone is more biocompatible than gaseous
ozone. The application of ozone therapy in chronic
gingival and periodontal diseases, showed subjective and
objective improvement of their status, as well as
patients with periodontal abscess, with no exudation was
observed.19,20

Bhateja

Clavo et al25 in their study concluded that the ozone

therapy can produce an improvement in blood ow and
oxygenation in some tissues & appears to have had some
positive effect during the treatment of patients with
advanced head & neck tumors.
The use of topical ozone for the treatment of recurrent
aphthous ulceration requires further investigation before it
can be advocated as a valid treatment option for these
lesions.

OZONE SAFETY & TOXICITY

Ozone therapy in oral surgery
The inuence of ozonized water on the epithelial wound
healing process in the oral cavity was observed by Filippi.
It was found that ozonized water applied on the daily basis
can accelerate the healing rate in oral mucosa. This effect
can be seen in the rst two postoperative days. The comparison with wounds without treatment shows that daily treatment with ozonized water accelerates the physiological
healing rate. Patients treated with ozone got healed more
quickly without the need for systemic medication when
compared to the control group. This nding suggested ozonated oil might be effective in the treatment of alveolitis.
Application of ozone therapy after tooth extraction and in
case of post-extraction complications like dry socket was
found quite useful.21

Ozone therapy in oral medicine

Thanomsub et al22 tested the effects of ozone treatment on
cell growth and ultrastructural changes in bacteria (Escherichia coli, Salmonella sp., Staphylococcus aureus and
Bacillus subtilis). It was discovered that ozone at
0.167 mg/min/l can be used to sterilize water, which is
contaminated with up to 105 cfu s/ml bacteria within
30 min. Destroying of bacterial cell membrane was
observed, subsequently producing intercellular leakage
and eventually causing cell lysis. Nevertheless, these ozone
concentrations have no signicant effect on the cell
viability in bacterial cultures at higher concentrations of
106 and 107 cfu/ml. Sechi et al23 evaluated the effect of
ozonized sunower oil on different bacterial species isolated from different sites. Ozone proved to be effective
against all bacteria when tested, while mycobacteria were
shown to be the most susceptible to the oil. Macedo and
Cardoso24 described a case report of the application of ozonated oil on herpes labialis and mandibular osteomyelitis
and demonstrated faster healing time than conventional
protocols.

There has been a reported case of death due to air embolism

during the use of ozone in the treatment of psoriasis (Marchetti & Monaca, 2000). Apart from this, it has been reported that a 45-year-old woman complained of acute
bilateral visual loss after intra-discal and peri-ganglionic
injection of ozone-oxygen gas mixture for lumbar disk
herniation (Lo Giudice, 2004). Corea (2004) also reported
a case of vertebrobasilar stroke after treatement with
ozone-oxygen for lumbar disc herniation. Ozone inhalation
can be toxic to the pulmonary system and other organs.
Complications caused by ozone therapy are infrequent at
0.0007 per application. Known side-effects are epiphora,
upper respiratory irritation, rhinitis, cough, headache, occasional nausea, vomiting, shortness of breath, blood vessel
swelling, poor circulation, heart problems and at a times
stroke. Because of ozones high oxidative power, all materials that come in contact with the gas must be ozone resistant, such as glass, silicon, and Teon. However, in the
event of ozone intoxication the patient must be placed in
the supine position, and treated with vitamin E and n-acetylcysteine. Hepatitis C and HIV infections have also
been reported following ozone autohaemotherapy.3

CONCLUSION
Considered an alternative therapy, Ozone has been increasingly used in recent decades and has been found useful in
various diseases. Medical reports on successful application
of ozone in therapy of different diseases and studies on its
effects caused a rapid growing interest in it. Some factors
are responsible for its wide spreading, such as simplicity
of performance, good tolerance by patients, absence of
side-effects or adverse reactions and high medico-social
and economic efciency. Even though ozone therapy is still
being ignored by most of medical establishment because of
facts that gaseous ozone is quite toxic and has strong oxidative properties. Further research is needed to standardise
indications and treatment procedures of ozone therapy.

Ozone therapy in dentistry

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