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 Table of Contents  
Year : 2022  |  Volume : 14  |  Issue : 1  |  Page : 84-88

Ozone therapy in dentistry: A literature review

1 Department of Conservative Dentistry and Endodontics, Sudha Rustagi College of Dental Sciences and Research, Faridabad, Haryana, India
2 Conservative Dentistry and Endodontics, Private Practitioner, Gurugram, Haryana, India

Date of Submission27-May-2021
Date of Decision27-Oct-2021
Date of Acceptance10-Nov-2021
Date of Web Publication04-Jan-2022

Correspondence Address:
Akshat Sachdeva
Department of Conservative Dentistry and Endodontics, Sudha Rustagi College of Dental Sciences and Research, Faridabad, Haryana
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jorr.jorr_39_21

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Ozone is a form of oxygen which has shown to be fruitful in the management of various diseases for many years now. Ozone therapy is slowly emerging as an alternative treatment modality for many dental pathologies catering to all age groups. It has proven to be beneficial than conventional strategies with applications to dental treatment. The present article aims to discuss the role of ozone in the management of certain conditions in the oral cavity and its possible clinical applications in the future.

Keywords: Dental applications, dental, dentistry, oral cavity, ozone

How to cite this article:
Vats V, Dhall S, Sachdeva A. Ozone therapy in dentistry: A literature review. J Oral Res Rev 2022;14:84-8

How to cite this URL:
Vats V, Dhall S, Sachdeva A. Ozone therapy in dentistry: A literature review. J Oral Res Rev [serial online] 2022 [cited 2023 Jun 1];14:84-8. Available from: https://www.jorr.org/text.asp?2022/14/1/84/334829

  Introduction Top

The word ozone emanates from the Greek word “ozein” which implies smell and was first utilized in 1840 by German scientist Christian Friedrich Schönbein, who is also regarded as “The father of ozone therapy.”[1] Ozone (O3) is a characteristic gaseous particle comprising three oxygen atoms. The stratosphere layer of the atmosphere contains plenitude of ozone, and it has an important role of shielding the living creatures from harmful ultraviolet rays. Ozone is present as a colorless gas and has a sharp smell that is distinguishable even at smaller concentrations.[1]

Ozone has been utilized in the clinical field since long owing to its incredibly solid oxidant property that oxidizes about all surfaces to the most noteworthy stage.[2] Ozone being a gas enters even into such tissues and spaces that are not easily accessible. It is utilized for circulatory enhancement and incitement of oxygen metabolism, disturbance of tumor metabolism, and to kill disease-causing microorganisms.[3]

  Mechanism Of Action Of Ozone Top

Ozone treatment has unique properties ranging from antimicrobial, immunostimulant, analgesic, and antihypnotic to detoxicating, bioenergetic, and biosynthetic activities.

Antimicrobial effect

Ozone disturbs the integrity of bacterial cell envelope by oxidation of phospholipids and lipoproteins. A low concentration of even 0.1 ppm is adequate to inactivate bacterial cells including spores.[4] Ozone also inhibits fungal cell growth at certain stages.

Anti-inflammatory and analgesic action

Ozone aids in the synthesis of biologically active materials such as interleukins, leukotrienes, and prostaglandins, which are valuable in diminishing inflammation and agony.[5]

Anti-hypoxic action

Ozone induces the ascent of PO2 in tissues and ameliorates transport of oxygen in the blood, which brings about a difference in cell metabolism of aerobic procedures.[5]

Bioenergetic and biosynthetic action

Ozone activates systems of protein synthesis, builds the measure of ribosomes and mitochondria in cells, hoisting functional movement, and recovery capability of tissues and organs.[6]

Immunostimulating action

Ozone impacts cellular and humoral immune framework. It stimulates the multiplication of immunocompetent cells and synthesis of immunoglobulins. It likewise activates the capacity of macrophages and expands the affectability of microorganisms to phagocytosis.[7]

Applications of ozone in dentistry

Ozone therapy offers advantages when used for conventional treatments and is indicated for use in a wide range of dental problems.

Ozone in the management of dental caries

Dental caries is defined as an irreversible microbial disease of the calcified tissues of the teeth, characterized by demineralization of the inorganic portion and destruction of the organic substance of the tooth, which often leads to cavitations.[8] It is a complex and dynamic process where a multitude of factors initiate and influence the progression of disease. Dental caries is a preventable, chronic, and biofilm-interceded disease regulated by diet. This multifactorial oral ailment is caused fundamentally by an unevenness of the oral verdure (biofilm) because of the presence of fermentable dietary carbohydrates on the tooth surface over time.

Ozone therapy can be an alternative treatment strategy replacing conventional drilling and filling for noncavitated carious lesions. The utilization of ozone therapy in the management of dental caries has been widely considered and numerous studies have demonstrated its adequacy in the treatment of pit and fissure caries, root caries, and interproximal caries. Ozone is conveyed through a handpiece, which is furnished with a silicon cup. The cup is applied straightforwardly to the tooth with the goal that it forms a tight seal at the application site. The mechanism of action is because of its microbiological properties and its capacity to oxidize the bacterial cell wall.[9]

A study conducted in 2004 demonstrated that applying ozone for 40 s is adequate to kill various groupings of Streptococcus mutans, and the use of 60 s had totally wiped out S. mutans, Lacticaseibacillus Casei, and Actinomyces naeslundii.[10] The imbuement of ozone into noncarious dentin forestalled biofilm arrangement in vitro from S. mutans and Lactobacillus acidophilus over a multi-week time span.[11]

Ozone application in cases of deep pits and fissures has been seen as exceptionally successful, which otherwise are difficult to clean. Purging the fissures preceding ozone treatment is suggested. This allows ozone to promptly get to the carious lesion. After treatment, the use of remineralizing agents and fixing of the spotless fissures is energized.[12] Ozone expels the smear layer deserting the exposed dentin that is blocked by the remineralizing agent applied subsequently.

Removal of root caries by customary techniques involving caries expulsion and restoration is somewhat troublesome. Reversal and arrest of shallow noncavitated root carious lesions have been seen observed ozone treatment. Ozone application either for 10 or 20 s drastically diminished the greater part of the miniaturized scale creatures in essential root caries with no side effects recorded at review spans in the range of 3–5.5 months.[10] The utilization of ozone has demonstrated great outcomes in shallow lesions because of its enhanced infiltration. Baysan et al.[13] assessed the antimicrobial impact of ozone on primary root carious sores and the adequacy on S. mutans and Streptococcus sobrinus. A huge decrease in microorganisms was seen after ozone introduction for either 10 or 20 s in essential root carious lesions. Moreover, the use of ozone for 10 s had the option to diminish the tally of S. mutans and S. sobrinus on saliva-covered glass beads. The authors of the study inferred that ozone might be a successful option in contrast to traditional drilling and filling for the treatment of primary root caries.

Ozone in endodontics

A successful endodontic treatment is based on the principles of debridement, disinfection, and obturation which can be achieved by thorough cleaning and shaping of the root canal to provide an environment conducive to periradicular healing. Ozone can be utilized as an antimicrobial in endodontics. Ozone is efficacious when recommended in sufficient concentration, time and conveyed accurately into root canals after conventional cleaning, shaping, and irrigation has been accomplished.[1] At the point, when a root canal was disinfected using ozone water with sonification, the antimicrobial adequacy was similar to 2.5% NaOCl.[12] A study conducted earlier exhibited the antimicrobial activity of ozone in the root canal treatment with no tissue poisonousness. The examination likewise appeared that there was high metabolic movement of the related fibroblasts indicating a rapid healing procedure.[14] Ozone was seen as viable against disease-causing microorganisms such as Enterococcus faecalis, Candida albicans, Peptostreptococcus, and Pseudomonas aeruginosa.[5] Ozone likewise kills the particular anaerobic odor related to some incessantly tainted teeth.

Ozone in periodontics

Periodontal disease refers to the one influencing the supporting structures of the teeth. It generally starts as a gum disease and in a little proportion of cases, advances to periodontitis. Microorganisms, particularly bacteria are the prime causative factors in periodontal disease. It is assessed that more than 500 distinctive bacterial species are fit for colonizing the oral cavity, and the injuries immensely affect the personal quality of life of the patient.[15] Periodontitis is suggested to have an etiological or modulating job in cardiovascular and cerebrovascular ailments, diabetes, and respiratory disorders.[16]

Ozonated water (4 mg/L) was discovered viable for slaughtering Gram-positive and Gram-negative oral microorganisms and oral C. albicans in unadulterated culture just as microbes in plaque biofilm and helpful to control oral disease-causing microorganisms in dental plaque.[17] Ozonated water can be utilized as a pretreatment mouth rinse before performing scaling and root planing and pockets can be irrigated in nonsurgical curettage step. This procedure will decrease the underlying pathogenic burden on the patient both locally and systemically. On treatment completion, each pocket and sulcus is insufflated with ozone gas which straightforwardly reaches the tissues, disinfecting the region. The patient can likewise be administered ozonated oil for the purpose of applying topically at the soft delicate tissue.[5]

Ozone in prosthodontics

It has been reported that ozone can be applied for cleaning the surface of removable partial denture alloys without compromising the physical properties of the alloy.[1] Denture stomatitis, which is mainly caused due to C. albicans can be controlled by topical application of ozonated oil over the tissue surface and denture surface.[5] Ozone therapy in the field of implantology has shown to aid in bone regeneration.[5] The socket is prepared conventionally, then ozone is bubbled into the socket for about 40 s. This is followed by the placement of the implant into the socket. It has shown to prevent infection and enhance bone regeneration.[5]

Ozone in oral surgery

Ozone has been found to enhance wound healing. A study in 2014 evaluated the effect of ozone therapy on pain, swelling, and trismus following third molar surgery and concluded that ozone application effectively reduced postoperative pain.[1] In addition, ozone therapy has been found to be beneficial for the management of refractory osteomyelitis in the head-and-neck as an adjunct to treatment with antibiotic, surgery, and hyperbaric oxygen.[5] Studies have shown that intra-articular ozone gas injection can be used in the treatment of internal derangement of the temporomandibular joint.[18]

Ozone in oral medicine

Soft tissue lesions such as aphthous ulcers and herpes labialis have been reported to be effectively treated with the aid of ozone therapy. This property can be credited to the accelerated healing properties of ozone.[1] The application of gaseous ozone has shown to be effective in cases of oral lichen planus by increasing wound healing following high-dose radiotherapy. Results have shown success in the resolution of symptoms, thus strengthening its potential to replace steroid treatment.[18]

Ozone toxicity

Even though ozone has certain benefits, the inhalation of ozone at times can be toxic to the pulmonary system and other organs. The European cooperation of Medical Ozone Societies prohibited the intravenous injections of ozone gas due to the risk of air embolism.[19] Complications caused by ozone therapy have not been very frequently reported. Few known side-effects include:[19]

  • Upper respiratory irritation
  • Rhinitis
  • Cough
  • Headache
  • Occasional nausea, vomiting
  • Shortness of breath
  • Poor circulation
  • Heart problems.

In the event of ozone intoxication, the patient must be placed in supine position, should be made to inhale humid oxygen, and administered ascorbic acid, Vitamin E, and n-acetylcysteine. Because of ozone's highly oxidative power, all materials that come in contact with the gas must be ozone resistant, such as glass, silicon, and teflon.[19]

  Conclusion Top

Ozone therapy has a wide range of applications in almost every field of dentistry. Its unique properties include immunostimulant, analgesic, antihypnotic, detoxicating, antimicrobial, bioenergetic, and biosynthetic actions. It is atraumatic, painless, and noninvasive in nature. The future vows to be energizing as it is believed that ozone therapy, owing to its wide variety of applications, will be established as a treatment modality worldwide.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Tiwari S, Avinash A, Katiyar S, Iyer A, Jain S. Dental applications of ozone therapy: A review of literature. Saudi J Dent Res 2017;8:105-11.  Back to cited text no. 1
Makkar S, Makkar M. Ozone-treating dental infection. Indian J Stomatol 2011;2:256-9.  Back to cited text no. 2
Meena A, Trivedi HP, Gupta M, Parvez S, Likhyani L. Therapeutic applications of ozonated products. Int J Dent Clin 2011;3:68-9.  Back to cited text no. 3
Broadwater WT, Hoehn RC, King PH. Sensitivity of three selected bacterial species to ozone. Appl Microbiol 1973;26:391-3.  Back to cited text no. 4
Kumar A, Bhagawati S, Tyagi P, Kumar P. Current interpretations and scientific rationale of the ozone usage in dentistry: A systematic review of literature. Eur J Gen Dent 2014;3:175-80.  Back to cited text no. 5
  [Full text]  
Baysan A, Lynch E. The use of ozone in dentistry and medicine. Part 2. Ozone and root caries. Prim Dent Care 2006;13:37-41.  Back to cited text no. 6
Singh T, Majumdar S, Ghosh AK, Pal SP, Waghle SR, Dakchiyani MB. Application of Ozone Therapy in Dentistry– AReview. J Adv Med Dent Scie Res 2014;2:44-47.  Back to cited text no. 7
Shafer's Textbook of Oral Pathology. 7th ed. India: Elsevier; 2012.  Back to cited text no. 8
Komali G. Ozone Therapy – A revolutionary noninvasive therapy in dentistry. Open Access Scientific Reports 2012;1:473.  Back to cited text no. 9
Baysan A, Lynch E. Effect of ozone on the oral microbiota and clinical severity of primary root caries. Am J Dent 2004;17:56-60.  Back to cited text no. 10
Holmes J. Clinical reversal of root caries using ozone, double-blind, randomised, controlled 18-month trial. Gerodontology 2003;20:106-14.  Back to cited text no. 11
Reddy SA, Reddy N, Dinapadu S, Reddy M, Pasari S. Role of ozone therapy in minimal intervention dentistry and endodontics – A review. J Int Oral Health 2013;5:102-8.  Back to cited text no. 12
Baysan A, Whiley RA, Lynch E. Antimicrobial effect of a novel ozone-generating device on micro-organisms associated with primary root carious lesions in vitro. Caries Res 2000;34:498-501.  Back to cited text no. 13
Estrela C, Estrela CR, Decurcio DA, Hollanda AC, Silva JA. Antimicrobial efficacy of ozonated water, gaseous ozone, sodium hypochlorite and chlorhexidine in infected human root canals. Int Endod J 2007;40:85-93.  Back to cited text no. 14
Saini R, Marawar P, Shete S, Saini S, Mani A. Dental expression and role in palliative treatment. Indian J Palliat Care 2009;15:26-9.  Back to cited text no. 15
[PUBMED]  [Full text]  
Saini R. Ozone therapy in dentistry: A strategic review. J Nat Sci Biol Med 2011;2:151-3.  Back to cited text no. 16
Abhishek GM. Ozone: An emerging prospect in dentistry. Indian J Dent Sci 2012;4:47-50.  Back to cited text no. 17
Suh Y, Patel S, Kaitlyn R, Gandhi J, Joshi G, Smith NL, et al. Clinical utility of ozone therapy in dental and oral medicine. Med Gas Res 2019;9:163-7.  Back to cited text no. 18
[PUBMED]  [Full text]  
Naik SV, Rajeshwari K, Kohli S, Zohabhasan S, Bhatia S. Ozone – A biological therapy in dentistry – Reality or Myth Open Dent J 2016;10:196-206.  Back to cited text no. 19


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