Ozone Information For Clinicians - Dental

Evidenced Based Research into Ozone Treatment in Dentistry – An Overview.

© Dr Julian Holmes
2015


Ozone Information

  • Evidenced Based Research into Ozone Treatment in Dentistry – An Overview.

  • Introduction ~ Dental Disease Today.
  • Conventional Treatment.
  • Minimal Invasive Dentistry (MID).
  • Diagnosis of Demineralisation – A New Paradigm Shift.
  • Patient acceptance of Ozone treatment.
  • Ozone and Caries Management.
  • Integration of Ozone into the Dental Surgery.
  • Root Canal Therapy.
  • Dental Unit Water Lines.
  • OHManagement Software for Patient Management
  • 1H NMR Studies on Ozonated Oils.
  • 1H NMR Studies on Tooth Whitening Tooth whitening.
  • In Conclusion.
  • References.


  • Evidenced Based Research into Ozone Treatment in Dentistry – An Overview

    Evidenced Based Research into Ozone Treatment in Dentistry – An Overview

    Authors; Dr Julian Holmes and Professor Edward Lynch, 2004.

    (Please note; all references are indexed below; the full reference, the year the study was carried out, the number of subjects and lesions taken into the study, the time of treatment with ozone, the type of cavity treated if applicable, a brief resume of the results & the study period. Every study reported no adverse events.)

    Introduction ~ Dental Disease Today.

    The beginning of the 21st Century has seen a quiet revolution in the technology available to detect and arrest dental caries. Research from early 2000 – 2001 started to look at the chemistry of a gas that had been used in medicine for the previous 150 years. 1H MNR and microbiological studies confirmed that this gas could eliminate entire tooth micro-organism ecological systems in seconds, leaving a virtually sterile surface and dentine structure that would predictably remineralise. At last, it seemed that the dental profession has discovered the magic bullet that it had sought for many years that could arrest and reverse the carious process. It would go without saying that the patient and the GDP would undoubtedly prefer this option. There would be no fear, injections, drilling, filling, failed restorations or entry into the cyclic pathway of ever destructive and increasingly costly restorative dental care. The technology that has made this possible uses the well-documented properties of ozone gas. There are a number of portable ozone generators designed especially for dental use, and the treatment of intra-oral lesions of the hard and soft tissues. Ozone has been in use in dental hospitals and general dental practice for several years now. This paper will list some of the published studies using Ozone.

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    Conventional Treatment.

    The generally perceived wisdom has always been that dental caries is an infective process and the only real ‘treatment’ option was the cutting away, or ‘amputation’, of all diseased tissue and its replacement with some form of restorative material. This is the teaching that most dental students still receive at dental schools around the world today, and is practiced like a religion by the majority of dentist’s world-wide. Once entry into this religion is gained, the individual is condemned to a cycle of restorative care that becomes more expensive and complex as it fails and has to be replaced. Some individuals may attain a state of oral health that sees them achieve stability for many years, but the vast majority will continue within this cycle of restorative destruction and replacement.

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    Minimal Invasive Dentistry (MID).

    There has been a move towards cutting smaller preparations, towards an approach of minimally invasive dentistry, with the associated benefits to both the GDP and the patient. Many techniques however still involve the physical removal of tissue before the final restoration is placed. The ideal treatment solution is the simple removal of the disease process with no associated loss of sound tissue and no associated physical discomfort for the patient. This is now available with recent advances in the field of ozone treatment. For the first time, the GDP can break the ongoing circle of restorative dentistry, as it would appear that it is no longer necessary to place the initial restoration, which will require eventual replacement and subsequent re-treatment.

    The first record of ozone use in dental care was by a Swiss dentist, E.A. Fisch, who used ozone in dentistry before 1932, and introduced it to the German surgeon Erwin Payr who used it from that time. However, ozone seems to have disappeared from usage in dental care until 2001 when the first scientific studies were published examining the biomolecules found in dental caries, before and after treatment with ozone. 1H NMR Studies on Caries Biomolecules were published in 2001-2003 (1-5 in References). These studies showed that acids produced by bacteria were oxidised to less acidic products. These oxidative by-products adjusted the lesion pH to being more alkaline, so allowing a net gain of minerals by the lesion. This remineralisation process is the fundamental by-product of ozone treatment that leads to predictable mineral uptake by a treated surface. By eliminating the acid niche environment, the lesion can undergo a natural mineral uptake, so healing itself. Many studies have shown that caries reversal is possible, but it is impossible to predict which lesions will, and those which will not, reverse. Ozone treatment, combined with added oral hygiene products that increase the oral fluid concentration of bio-available minerals, makes this remineralisation process predictable (19 in References).

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    Diagnosis of Demineralisation – A New Paradigm Shift.

    Integration of ozone treatment unit into the surgery environment will totally change the GDP’s approach to the treatment of his or her patients. GDP’s have to completely reassess their diagnostic criteria when applied to dental caries and potential treatment of the carious lesion. The dental probe is no longer of any significant use for caries diagnosis and hence examination is based on the use of a digital intra oral camera combined with selective use of the DIAGNOdent. This new diagnostic tool has been extensively tested against the Electric Caries Monitor (Lode, Belgium) and against conventional diagnostic criteria. Caries can be considered to be a failure of prevention and maintenance. As such, looking for holes is a concept that cannot be part of modern dental care, where the dental profession is looking towards prevention. Thus the detection of demineralisation within the enamel layer is of paramount importance, before the carious process has an opportunity to penetrate through into the dentine below (6-9 in References). The studies show that ozone in its oxidative pathways has a profound effect on the diagnostic reporting of these new scientific instruments; the DIAGNOdent (KaVo GmbH, Germany) shows decreased values after ozone treatment of a carious lesion of statistical significance.

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    Patient acceptance of Ozone treatment.

    In the past number of years continual advances in both materials science and treatment methods have brought outstanding benefits for our patients in terms of simplicity of treatment. Successful dentine bonding systems have obviated the need for the design of a retentive cavity in most cases and hence dramatically reduced the use of the air turbine to design what may be termed as classical cavities. These bonding systems have allowed GDP’s to concentrate almost exclusively on the removal of carious tissue whilst retaining as much sound hard tissue as is possible, a first step towards the minimally invasive approach now advocated. However, this carious tissue has still to be removed whether by use of the handpiece, air abrasion, or with hand instruments (ART) when used in conjunction with caries removing liquids and gels (e.g. Carisolv). Ozone treatment of dental caries removes the requirement for physical removal of diseased tissue as the dental profession is now promoting remineralisation and not amputation of carious dentine.

    The benefits to patients are therefore obvious. Most patients fear and apprehension arises from their perception that the use of the handpiece may be an unpleasant and possibly traumatic experience. This, combined with the requirement for local anaesthesia, the fear of which is virtually universal, has lead to the widespread view that the visit to the dental surgery is an unpleasant one. In the employment of ozone treatment GDP’s now have the capability to alleviate those concerns and change the public perception of dental treatment as a whole. Of course, there are still situations where treatment will follow more classical lines. However, these instances are becoming increasingly rare. Patient acceptance is therefore universal. GDP’s can offer treatment of a wide variety of carious lesions where there is no need for local anaesthesia, no need for drilling, and treat many lesions in a very short space of time, totally painlessly and totally atraumatically. Patients are delighted after treatment and are particularly motivated towards oral hygiene and dietary control when they realize that in improving and concentrating on these areas they can effectively avoid the local anaesthesia / drill approach (10-15 in References). One area that has not been looked at in past papers was anxiety by parents and carers for those they brought for dental treatment and care. Ozone treatment has been shown that not only patients but also their parents and carers can benefit from this non-invasive treatment modality (10, 14 in References).

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    Uses of Ozone in the General Dental Practice.

    Ozone and Caries Management

    According to “The Niche Environment Theory”, a “bacterial niche” is established within a carious lesion. Bacteria are far from the ‘simple bugs’ as they are often referred to. They have survived for billions of years, where as humans have a minute time frame of existence in comparison. The dental profession should not be surprised to learn that bacteria set up complex interactions with other bugs, ‘talk’ to neighbouring colonies when times are good, and call for help from others when their host attempts to change their environment. Protein coatings, plaque and debris are known to protect these colonies by reducing the effect of pharmaceutical agents designed to eliminate these bacterial colonies.

    Progression of the carious lesion occurs when conditions are suitable for acidogenic bacteria to release acid as a metabolic by-product. The acid produced may lead to a breakdown of mineralized tooth structure. At times, an equilibrium situation may occur when the rate of re-mineralisation equals the rate of de-mineralisation. Ozone has the effect, through its powerful oxidising properties, of not only removing the protein protection and being bactericidal, but also oxidising the biomolecules that allow the niche to survive and expand (1, 3-5 in References). This has a severely disruptive effect on the bacterial population in the carious lesion and obliterates the cariogenic bacteria and their ecological niche, thereby swinging the equilibrium in favour of re-mineralisation. No more acid can be produced within the lesion when the acid-producing bacteria are eliminated. For example, the acid Pyruvate, one of the strongest naturally occurring acids manufactured by bacteria, and implicated in the progression of caries, is oxidated by ozone to acetate acid and carbon di-oxide. Acetate acid is less acidic than pyruvate, and this de-carboxylation reaction leads to mineral uptake due to the more alkaline conditions in a carious lesion. The lesion will become populated with normal mouth commensals, which do not produce acid, after ozone therapy.

    Ozone has been show clinically to be effective in the management of root caries lesions (16-22 in References). These lesions often present in the elderly who may have associated medical problems, which complicate their dental management. Using ozone therapy, such lesions are easily treated. The portability of ozone units facilitates its use in the domiciliary setting and treatment is also simplified because the clinician does not need to carry a range of restorative materials on such visits. Dentists using ozone units for caries management, encourage their patients to regularly use a fluoride-containing mouthwash, that will enhance the efficacy of ozone by promoting re-mineralisation and to reduce the frequency of consumption of fermentable carbohydrates.

    Treatment of permanent teeth lesions.

    Ozone is used instead of fissure sealants at the eruption of permanent dentition and as prophylaxis in population at risk of rampant carious lesions. It is possible that the current fissure sealant technique needs to be re-examined. Current protocols for fissure sealants are the use of a bristle brush and pumice to clean the occlusal surfaces of teeth prior to sealing. However, it is know that food debris and bacteria will remain impacted at the depths of the fissures. Subsequent micro-leakage will allow the acid-niche to resume its activity, so that over a period of time, the surface will collapse into a large carious cavity.

    Alternative preparation systems, such as the KaVo ProphyFlex or similar, or air abrasion (PrepStart, Danville Engineering) ( 42, 43, 44 in References)could be used. Bristles used in manufacture of bristle brushes are often larger than the fissures being cleaned. However, air abrasion powders (average particle size 27microns) will flush out the debris, prepare the fissure for acid etching, and produce a more reliable sealing along the fissure edges.

    Treatment of primary pits and fissure carious lesions (PFCLs).

    Early diagnosis of primary pits and fissure caries is of great importance in children and adults because of the rise of a new model of the carious lesion, which is difficult to diagnose with the traditional methods as oral radiographs and probe. Low sensitivity of visual, probing and bitewing examination leads to a significant number of teeth with dentinal caries being undetected. Lesions have a natural history of deepening into dentine leaving a macroscopically undamaged enamel surface. Minimal mineral loss prevents x-rays to show evidence of decay, and no macroscopic cavitation shows any probe stickiness. Systems using indirect light fluorescence have been demonstrated effective in the clinical diagnosis of decays in permanent and in deciduous dentition.

    Published studies (23-37 in References) have shown a reversal rate of from 84% to 99%, depending on which protocol is followed. Where only one variable is used, for example ozone or no-ozone, the reversal range is from 84%-92%. Compare this to where periodic ozone treatment is combined with oral hygiene instruction, strict usage of remineralisation products, where reversal rates of 99% can be achieved (31 in References). This would point to the development of a treatment protocol that starts with changes in oral hygiene and care, ozone treatment on a regular basis and the use of remineralising washes and pastes. In this way, the treatment outcome becomes more predictable.

    Ozone treated non-cavitated pit and fissure caries lesions had no adverse effects when followed for 12 months. Remineralisation in the ozone treated group had already occurred at the first month recall visit (23-25 in References). Fissure sealants applied over ozone treated lesions had not affected short-term or 1 year retention rates (27 in References).

    Clinical indices showed significant remineralisation changes that can be detected by the clinician in the general practice (24, 25, 27 in References). Significantly, more lesions became arrested in the ozone treated teeth and this translated to less dental procedure requirements being required for the treated teeth. Therefore, ozone treatment is a clinically proven alternative treatment for non-cavitated occlusal pit and fissure caries.

    The combination of ozone treatment with fissure sealants, both carried out on the same patient visit, did not reduce sealant retention. A therapeutic approach for initial lesions to allow more remineralisation to occur after the ozone treatment and before the sealant is applied, can be achieved by fissure sealing on a second visit. Other combinations of treatments, along with ozone, can include fluoride applications and smart filling materials. These are being tested now with longer ozone application time periods and with removal of the outer soft caries for the treatment of more extensive lesions.

    Treatment of deciduous teeth lesions.

    Dental treatment of young people can have long lasting effects (10 in References). If dental care is painful and unpleasant, as these patients grow into adults, they will tend to only attend when if pain. As all dentists know, at this stage, restorative care tends to be more difficult and more extensive. The use of ozone (38-39 in References) and mineral releasing glass ionomers can play a significant role in the dental management of these patients. As confidence in the treatment by the patient and parents or guardians is gained, so the compliance with important oral hygiene message will be increased.

    Where caries is found, it is simple to treat and the application of, for example, FujiVII (GC Japan) will supply long-term fluorine and mineral release, as well as preventing ingress of food debris and re-establishment of the acid-niche environment. Treatment is simple, fast (the average ozone time for practitioners using ozone is 30 seconds) and involves little preparatory work. The loose debris is first cleaned away, until a leathery base is reached. This can be done with air abrasion (44 in References) or hand instruments (45 in References). Ozone is applied, the lesion wetted with a remineralising wash and then the glass ionomer can be applied. This modified ART technique has been reported by Holmes (44-45 in References).

    Treatment of the larger carious lesion.

    Where caries has penetrated into the deeper dentinal tissue, ozone still has a role to play. In these cases, the loose debris is first removed to the leathery subsurface, ozone is applied, and then remineralising solutions and glass ionomers can be applied (40-41 in References).

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    Integration of Ozone into the Dental Surgery.

    Most preparation and restorative systems are not used in isolation, and are integrated into dental practice restorative routines. Filling materials fail at alarming rates. Costs can be measured in terms of pain, discomfort, and in financial terms such as lost productivity. In England and Wales, restorations carried out in the NHS dentistry cost a total of £1.25 billion in 2001. This does not include private treatment, which is currently estimated to be 50% of dentists’ income. The total costs of all dental treatment in England and Wales probably exceeded £3.26 billion in 2001 (General Dental Council UK, Annual Statistics, 2001).
    Studies have shown that the use of ozone combined with air abrasion and ART (42-45 in References) can have significant effects in reducing the duration of treatment, the cost, and preservation of natural tooth tissue when compared to traditional ‘drilling and filling’. When ozone is integrated fully into treatment modalities, there are significant cost benefits; ozone usage combined with air abrasion or ART shows significant cost benefits in terms of reduction in treatment time, predictable outcome and income into the practice (46, 48-49 in References). Nor are single teeth usually treated. The majority of the first dental practitioners who invested into ozone technology now routinely ozone treat lesions, while other restorative treatment is being carried out. Thus the potential of ozone to be a ‘profit-centre’ in a dental practice is unlimited. Put another way, the way this technology is integrated into dental care is limited solely by the vision of the dental practitioner.

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    Root Canal Therapy.

    The aim of conventional root canal therapy is to provide a clean, shaped, root canal that facilitates the placement of root filling systems. As practitioners adopt some of the newer obturation systems, the need for shaping decreases. In the apical area multiple canals linked by a “web” of accessory canals may be found. This is the so-called “apical delta” and the common lateral canals. Until recently, the dental profession relied on irrigants reaching these areas to disinfect and dissolve organic debris where it is impossible to instrument mechanically. In cases where previous root canal treatment has failed, Enterococcus faecalis seems particularly prominent and especially difficult to eradicate. Ozone will eliminate this bacterial type (47 in References). It is also postulated that ozone will penetrate through the apical foramen, and enter into the surrounding and supportive bone tissue. The effect of ozone on these tissues will be to encourage healing and regeneration (56 in References).

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    Dental Unit Water Lines.

    Dental unit water lines (DUWL’s) have been shown to be heavily contaminated with biofilm and high bacterial counts have been recorded in the water from dental units. This does not seem to have any serious effects in the general dental practice setting but may be more worrying where immuno-compromised patients are concerned. Biofilm contamination plays havoc with dental units, often causing annoying blockages in couplings, hand pieces and 3:1 syringes.
    Initial research on the use of low concentrations of ozone in water was disappointing (50 in References). However, when higher ozone dosage concentrations were applied to water lines via the dental unit water supply, the studies showed greatly reduced numbers of bacteria present and also a significant reduction in the biofilm present (51-52 in References). It is interesting to note that ozone units may be adapted to allow ozone to be applied to the water lines via the “clean water system” water bottle. Significant savings may be made by the resulting reduction in blockages of hand pieces and couplings. As the pool of immuno-compromised patients increases, it would reasonably be expected that there could be an increase in the incidence of cross infection leading to death of members of this patient group. The introduction of new cleaning and sterilisation techniques with the use of ozone should minimise the potential for cross infection.

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    OHManagement Software for Patient Management

    The introduction of new diagnosis instruments and a new treatment modality requires a new practice management system to successfully implement the new treatment strategies and patient management. OHManagement Software (55 in References) is a computerised management system. After the programme has been set up, patients can be entered into the database. As various diagnostic criteria are entered, the programme computes a risk assessment for every patient, and it determines the ideal treatment plan and protocol. Recall queries can be setup; for instance, the programme can search the data base for all patients who smoke and admit to above average alcohol consumption, print out personalised letters to let them know a new treatment is available for their treatment. This form of targeted letter allows the dental practice to target specific patients’ profiles for specific treatment protocols.

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    1H NMR Studies on Ozonated Oils

    Ozone gas is a lung irritant, and ozone units for use in a dental setting are manufactured to a design that makes it impossible for free ozone to be released into the oral cavity and oro-nasal complex. In the same way that some antibiotics have various delivery systems (for example a liquid, capsule and cream presentation) practice has shown that an alternative delivery system for ozone would be an advantage. Ozonated oils are not new, and have been manufactured for a number of years. A 2002/2003 study published in 2003 showed that the purest oil substrate that was cheap and easily to source was sunflower oil (58 in References). Unlike olive oils that can contain a number of impurities, depending on the country, region, locality, and chemicals used to recover the oils, sunflower oil showed to be the purest, irrespective of source and re-seller. It is notable that sunflower oil has been the oil of choice for the Cuban National Ozone Clinic for the last 20 years. Studies on this product are continuing.

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    1H NMR Studies on Tooth Whitening Tooth whitening.

    Teeth may be whitened using ozone gas, due its strong oxidising properties, and ozone oil has been used in some Cuban studies in root-filled teeth to lighten them. A 2003 study (59 in References) showed that ozone could oxidise the components responsible for tooth discolouration. Studies in Spain and the UK with a full mouth-tray delivery system show spectacular results within a short treatment time. And of course the full mouth tray system would solve a number of issues for the treatment of interstitial caries, and mesial or distal lesions where a seal with a round cup delivery system is difficult to use. It would make the treatment of the elderly, infirm and disabled potentially easy and predictable in terms of oral hygiene care and reduction in the incidence of caries in the physically impaired. Lastly, the full-tray system can be used for periodic preventative ozone treatment for every patient.

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    In Conclusion.

    In conclusion, ozone therapy provides a treatment modality with considerable benefits for dental patients of all ages. It is applicable to a wide range of conditions of the intra-oral hard and soft tissues. The current published research shows that treatment of carious lesions is effective and made much more acceptable for the patient. This makes it especially relevant to the younger patient, who may find conventional treatment unacceptable and also for the elderly, who may have medical problems, which may complicate conventional dental treatment. The treatment is simple, completely safe to provide and often renders the need to introduce potentially toxic restorative materials unnecessary.

    Despite advances in clinical and laboratory research there is a huge potential for a cost-effective way to prevent and reverse caries. In the ageing population, and those with reduced manual dexterity, a preventative and early intervention strategy needs to be found. In this respect, the use of ozone should be also considered for medically compromised patients, domiciliary care patients and homebound elderly people. The equipment required is limited and essentially portable compared to that required for conventional drill & fill. Therefore elderly patients who have limited access to the dental services can benefit from this treatment. In many poor, developing and highly populated countries, equipment, dental supplies, and dental services are inadequate due to high costs and lack of dentally trained personnel.

    Even if ozone therapies could save just 50% of all the fillings placed, the cost savings are huge. The research shows us that over 90% of fillings could be saved. In the modern world, where centralised welfare is being reduced to contain finances, the implications are enormous.

    From a dental public health point of view, with dental caries being such a problem in large areas of the country and with such a shortage of clinicians here in some parts of the UK and Europe, the ozone therapy has potentially a major part to play in the prevention and treatment of dental caries. Ozone units and the DIAGNOdent are totally portable and it is possible to envisage units being used with great effect in dental practices and community clinics. It takes such little time to treat several teeth that it may be possible to help many more patients compared with conventional treatment. Being so simple to use, dental hygienists and therapists are ideally suited to providing the treatment for all categories of patient.

    However, perhaps the dental profession needs to return to the basic concepts of a preventative approach. The diagnosis of caries is a prevention failure in this context. Ozone certainly has a major role to play in a preventative-orientated dental practice.

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    Referenced Published Research

    1H NMR Studies on Caries Biomolecules

    Study Title;Study Date;Subjects Number;Teeth Number;Ozone Time(Seconds);Caries Type; % Success;Follow-up Period;Adverse Reactions
    1 Lynch E, Smith E, Baysan A, Silwood C J, Mills B, Grootveld M. Salivary Oxidising Activity of a Novel Anti-bacterial Ozone-generating Device. Journal of Dental Research 2001; 80:132001n/an/an/an/an/an/an/a
    2 C.J.L. Silwood and M. Grootveld. Surface Analysis of Novel Hydroxyapatite Bioceramics Containing Titanium (IV) and Fluoride. IADR Abstract 20022002n/an/an/an/an/an/an/a
    3 Lynch E, Silwood CJL, Smith C, Grootveld M. Oxidising actions of an Anti-Bacterial Ozone-Generating Device towards Root Caries Biomolecules. IADR Abstract 20022002n/an/a5 SecondsPrimary Root Caries Biomoleculespyruvate oxidised to acetate and CO2n/an/a
    4 Claxson AWD, Smith C, Turner MD, Silwood CJL, Lynch E, Grootveld M. Oxidative Modification of Salivary Biomolecules with Therapeutic Levels of Ozone. IADR Abstract 2002n/an/an/a10 SecondsMultiComponent Analysis shows chemical pathways of ozoneshows oxidation of VSC's, & Pyruvaten/an/a
    5 Lynch E, Silwood CJ, Abu-Naba'A L, Al Shorman H, Baysan A, Holmes J and Grootveld M. Oxidative Consumption of Root Caries Biomolecules using Ozone. IADR Abstract 2003.2003303030 SecondsMulticomponent analysis of root caries by high field 1H -NMR spectroscopy provides useful information regarding the oxidation of PRCL biomolecules by O3.shows oxidation of VSC's, & Pyruvaten/an/a

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    Comparison of Diagnostic Techniques

    Study Title;Study Date;Subjects Number;Teeth Number;Ozone Time(Seconds);Caries Type; % Success;Follow-up Period;Adverse Reactions
    6 Abu-Naba'a L, Al Shorman H, Lynch E. The Effect of Ozone Application on Fissure Caries QLF Readings. IADR Abstract 2002.20020242 QLF readings20 SecondsOcclusal Fissure Caries on extracted teethQLF readings correlated with histological examn/aNone
    7 Megighian GD, Bertolini L. In vivo Treatment of Occlusal Caries with Ozone: One and Two Months' Effect with Light-induced Fluorescence (QLF) as Diagnostic Methods. IADR Abstract 2003.20038030020,30 & 40 secondsPrimary Occlusal Fissure Carious Lesions80% reduction of QLF at 1 month, and 90% reduction at 2 months2 monthsNone
    8 Marashdeh MM, Abu-Salem OT, Lynch E. Ozone Treatment of Occlusal Caries in Primary Teeth: Immediate Effects and Correlation of Diagnostic Methods. IADR Abstract 2003.2003175010 SecondsOcclusal Caries Primary TeethReduced DIAGNOdent Readings after ozone treatmentn/aNone
    9 Abu-Naba'a L, Al Shorman H, Lynch E. Immediate Effect of Ozone Application In-vivo on DIAGNOdent Readings. IADR Abstract 2004.20049039410 SecondsPrimary Occlusal Pit & Fissure CariesOzone immediately reduced Diagnodent vales (p<0.05)n/aNone

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    Assessment of Anxiety & Fear with Ozone Treatment v Traditional Dental Amputation Therapy

    Study Title;Study Date;Subjects Number;Teeth Number;Ozone Time(Seconds);Caries Type;% Success;Follow-up Period;Adverse Reactions
    10 Dahnhardt JE, Jaeggi T, Scheidegger N, Kellerhoff N, Francescut P, Lussi A. Treating Caries in Anxious Children with Ozone: Parents' Attitudes after the First Session. IADR Abstract 2003.200320n/an/an/aozone + ART. 75% afraid of dental care before ozone treatment, 75% would recommend to relative/friend. 80% willing to pay more v. drill&filln/aNone
    11 Johnson N, Johnson J, Johnson K, Abu-Naba'a L, Al Shorman H, Freeman R, Lynch E. Patients’ Attitudes to Dental Treatment Using Ozone vs. Conventional Treatment. IADR Abstract 2003.2003100n/aozone treatment v drill&fillAll Lesionsozone reduces anxiety and fear of dental treatmentn/aNone
    12 Domingo H, Abu-Naba'a L, Al Shorman H, Holmes J, Marshdeh MM, Abu-Salem AT, Smith C, Freeman R, Lynch E. Reducing Barriers to Care in Patients Managed with Ozone. IADR 2003.2003377n/a20 secondsall lesions99% happy with ozone treatment, 97% happy with the time taken, 100% would like ozone treatment again, 99% were not anxious after ozone treatment3 monthsNone
    13 Megighian GD, Dal Vera M. Reducing Barriers to Care in Patients Managed with Ozone in a General Dental practice in Italy. IADR Abstract 2003.2003250n/an/aall lesion types100% happy with ozone treatment, 100% would recommend, 80% reduced anxiety6 monthsNone
    14 Domingo H, Abu-Naba'a L, Al Shorman H, Holmes J, Marshdeh MM, Abu-Salem AT, Freeman R, Lynch E. Reducing Barriers to Care in Patients Managed with Ozone. IADR Abstract 2004.200420 studiesn/an/an/a83% - 99% Caries Reversaln/aNone
    15 Abu-Naba'a L, Al Shorman H, Lynch E. Patient's Attitude to Treatment of Pit and Fissure Caries with Ozone. IADR Abstract 2004.200449n/an/aPit and Fissure Caries98% happy with treatment, 94% happy with time, 94% would choose ozone even if higher fee. 100% would choose ozone treatment again, and 100% not anxious after ozone treatment6 monthsNone

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    Treatment of Primary Root Carious lesions

    Study Title;Study Date;Subjects Number;Teeth Number;Ozone Time(Seconds);Caries Type;% Success;Follow-up Period;Adverse Reactions
    16 Baysan A & Lynch E. Treatment of Primary Root Carious Lesions using Ozone for either 10 or 20 Seconds In Vivo. IADR Abstract 2001.2001267010 or 20 SecondsRoot caries10 seconds reduced CFU's from 7.0 to 4.35 Log10. 20 seconds reduced 6.0 to 0.46 Log10n/aNone
    17 Baysan A & Lynch E. Treatment of Primary Root Carious Lesions using Ozone for either 10 or 20 Seconds In Vivo. IADR Abstract 2001.2001267010 or 20 SecondsRoot caries10 or 20 seconds treatment time showed significant changesn/aNone
    18 Baysan A, Lynch E. Management of root caries using ozone in-vivo. Journal of Dental Research 2001; 80:3720018021410 secondsRoot caries30.9% S2 to S0, 34% S2 to S13 monthsNone
    19a Holmes J. Clinical reversal of root caries using ozone, double-blind, randomised, controlled 18-month trial. Gerodontol 2003: 20 (2): 106-14 200220028917840 secondsRoot caries100% reversal of treated Lesions 18 months18 monthsNone
    19b Holmes J. Ozone Treatment of Root Caries after 21-Months. IADR Abstract 2004.20048917840 secondsRoot caries100% reversal of treated Lesions 21 months21 monthsNone
    20 Baysan A & Lynch E. Clinical Assessment of Ozone on Root Caries. IADR Abstract 2004.20048022620 secondsRoot Caries47% S1 to S0, 52% S2 to S112 monthsNone
    21 Baysan A. Management of Primary Root Caries using Ozone Therapies. PhD Thesis, University of London, 2002.2002n/an/an/an/an/an/an/a
    22 Baysan A, Lynch E. Safety of an ozone delivery system during caries treatment in-vivo. Journal of Dental Research 2001; 80: 1159-1159. 20012001n/an/an/an/an/an/an/a

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    Treatment of Pit and Fissure Carious Lesions

    Study Title;Study Date;Subjects Number;Teeth Number;Ozone Time(Seconds);Caries Type;% Success;Follow-up Period;Adverse Reactions
    23 Abu-Naba'a L, Al Shorman H, Lynch E. Ozone Efficacy in the Treatment of Pit and Fissure Caries. J. Dent Res. 2002; abstract.2002n/an/an/an/an/an/aNone
    24 Abu-Naba'a L, Al Shorman H, Stevenson M, Lynch E. Ozone Treatment of Pit and Fissure Caries: 6-month Results. IADR Abstract 2003.20037824010 secondsPit & Fissure Caries100% successful remineralisation6 monthsNone
    25 Abu-Naba'a L, Al Shorman H, Lynch E. Ozone Treatment of Primary Occlusal Pit and Fissure Caries (POPFC): 12-Months Clinical Severity Changes. IADR Abstract 2003.200312925810 secondsPrimary Occlusal Pit and Fissure CariesTreated lesions got better 0.018±0.05, 0.216±0.06* and 0.283±0.06*, while control lesions got worse 0.079±0.04*, 0.294±0.07 and 0.443±0.0712 monthsNone
    26 Holmes J, Lynch E. Arresting Occlusal Fissure Caries Using Ozone. IADR Abstract 2003.2003278127510, 20, 30 or 40 SecondsPrimary Occlusal Pit & Fissure Caries93% clinical reversal of treated lesion, control lesions did not change or got worse12 monthsNone
    27 Abu-Naba'a L, Al Shorman H, Lynch E. Ozone Treatment of Primary Occlusal Pit and Fissure Caries: 12-month ECM results and Clinical implications. IADR Abstract 2003.203 12925810 secondsTrt ECM change ranged from 0.02 to 0.62 (average 0.30 ±0.009) and Ctrl ranged from 0.07 to -0.27 (-0.13±.009).Difference between groups ranged from 0.22 to 0.56 (p<0.05 at 4 recalls).12 monthsNone

    28 Reaney D, Lynch E. Clinical Reversal of Pit and Fissure Caries After Using Ozone. IADR Abstract 2003.

    2003227830 secondsPrimary Pit & Fissure Carious Lesion74.4% ozone treated teeth clinically reversed 100% stable or reversed. 82% control lesions got worse1 monthsNone

    29 Daly T, Lynch E. Reversal of Occlusal Pit and Fissure Caries by Ozone. IADR Abstract 2003.

    2003585830 secondsPrimary Occlusal Fissure Carious Lesions62% lesion reversal (p=<0.05)10 weeksNone

    30 Stinson P. Clinical Reversal of Occlusal Pit and Fissure Caries after Using Ozone IADR Abstract 2003.

    2039827930 secondsPrimary Occlusal Fissure Carious Lesions84% lesion reversal with ozone (p<0.05)3 monthsNone
    31 Holmes J. Clinical Reversal of Occlusal Pit and Fissure Caries Using Ozone. IADR Abstract 2003.2003376236410,20,30, or 40 secondsPrimary Occlusal Fissure Carious Lesions99% reversal12 monthsNone

    32 Jackson P, Lynch E. Healing of Pit and Fissure Caries after Using Ozone. IADR Abstract 2003.

    2037813030 secondsPrimary Occlusal Fissure Carious Lesions68% reversal / stable3 monthsNone

    33 Johnson N, Johnson J, Johnson K, Lynch E. Healing of Pit and Fissure Caries after Using Ozone. IADR Abstract 2003.

    2003359020 secondsPrimary Occlusal Fissure Carious Lesions59% reversal, 41% stable, none got worse1 monthNone

    34 Johnson N, Johnson J, Johnson K, Lynch E. Effective Treatment of Occlusal Fissure Caries Using Ozone. IADR Abstract 2003.

    200310530020 secondsOcclusal Fissure Caries81% lesion reversal p<0.05). 17% remained stable1 monthNone

    35 Abu-Naba'a L, Al Shorman H, Lynch E. 6-month Clinical Indices Changes after Ozone Treatment of Pit and Fissure Caries (PFC). IADR Abstract 2003.

    200383440 secondsPrimary Occlusal Fissure Carious Lesionslesions reversed using clinical criteria indices (p<0.05)6 monthsNone

    36 Morrison R & Lynch E. Remineralisation of Occlusal Pit and Fissure Caries After Using Ozone. IADR Abstract 2003.

    200310818640 secondsPrimary Occlusal Fissure Carious Lesions80.5% lesion reversal, 100% stability, no progression in ozone treated group 13 weeksNone

    37 Hamid A. Clinical Reversal of Occlusal Pit and Fissure Caries Using Ozone. IADR Abstract 2004.

    2004929240 secondsPrimary Occlusal Fissure Carious Lesions86.6% reversal6 monthsNone

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    Treatment of Primary/Deciduous Teeth

    Study Title;Study Date;Subjects Number;Teeth Number;Ozone Time(Seconds);Caries Type;% Success;Follow-up Period;Adverse Reactions

    38 Abu-Salem OT, Marashdeh MM, Lynch E. Ozone Efficacy in Treatment of Occlusal Caries in Primary Teeth. IADR Abstract 2003.

    2003164210 secondsOcclusal Carious LesionsECM improved (p<0.05) and Diagnodent improved (p<0.05)6 monthsNone

    39 Abu-Salem OT, Marashdeh MM, Lynch E. Ozone Efficacy in Treatment of Occlusal Caries in Primary Teeth. IADR Abstract 2003.

    2003175010 secondsOcclusal Caries + Air AbrasionECM readings increased in test v control (p=<0.05)3 monthsNone

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    Treatment of Occlusal Caries with Ozone

    Study Title;Study Date;Subjects Number;Teeth Number;Ozone Time(Seconds);Caries Type;% Success;Follow-up Period;Adverse Reactions
    40 Morrison R, Lynch E. Efficacy of Ozone to Reverse Occlusal Caries. IADR Abstract 2003.200314524040 secondsPrimary Pit & Fissure Caries96% treated lesions reversed, none got worse13 weeksNone
    41 Cronshaw MA. Treatment of Primary Occlusal Pit and Fissure Caries with Ozone: Six-month Results. IADR Abstract 20042004184930 secondsPrimary Occlusal Fissure Carious Lesions89% clinical reversal of ozone treated lesions6 monthsNone

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    Combining Ozone Treatment with Other Preparation Systems

    Study Title;Study Date;Subjects Number;Teeth Number;Ozone Time(Seconds);Caries Type;% Success;Follow-up Period;Adverse Reactions
    42 Clifford C. Successful Use of Airbrasion in Conjunction with Ozone Treatment. IADR Abstract 2003.2003374840 secondsInterproximal Carious lesionsTreatment faster than drill&fill (p<0.05) and allows other cavity types to be treated3 monthsNone

    43 Clifford C. Reversal of Caries Using Airbrasion and Ozone- Nine Month Results. IADR Abstract 2004

    2004346840 secondsApproximal lesion100% reversal with hardened tissue9 monthsNone
    44 Holmes J & Lynch E. Reversal of Occlusal Caries using Air Abrasion, Ozone, and Sealing. IADR Abstract 20042004387640 secondsOcclusal Caries100% reversal3 monthsNone

    45 Holmes J. Restoration of ART and Ozone treated primary root carious lesions. IADR Abstract 2004.

    20046012020 secondsPrimary Root CariesART & Ozone lead to no pulp exposures, retained full vitality and strength of tooth. Drill&Fill lead to pulp exposures and further RCT was required before review period.6 monthsNone

    46 Domingo H, Holmes J. Reduction in treatment time with combined air abrasion and ozone compared to traditional ‘Drill & Fill’. IADR abstract 2004.

    20046412840 secondsPrimary Root CariesAA & Ozone was faster than Drill&Fill. AA was more profitable than D&F6 monthsNone

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    Ozone in Endodontics

    Study Title;Study Date;Subjects Number;Teeth Number;Ozone Time(Seconds);Caries Type; % Success;Follow-up Period;Adverse Reactions

    47 Chang H, Fulton C, Lynch E. Antimicrobial Efficacy of Ozone on Enterococcus faecalis. IADR Abstract 2003.

    2003n/an/a60, 30, 20, 10, 0 seconds108 solution E Faecalis 60= 0 cfu's, 30= 0 cfu's, 20= 0 cfu's, 10= 0 cfu's at 106 and 105 concentrations. Higher concentrations were markedly reducedn/aNone

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    Cost Benefits of Ozone Treatment

    Study Title;Study Date;Subjects Number;Teeth Number;Ozone Time(Seconds);Caries Type; % Success;Follow-up Period;Adverse Reactions

    48 Johnson N, Johnson J, Lynch E. Cost Benefit Assessment of a Novel Ozone Delivery System vs. Conventional Treatment. IADR Abstract 2003.

    2003 48n/an/aOcclusal and Root Carious LesionsOzone tooth 3 minutes max, conventional drill&fill 20 minutes minimum. Ozone treatment takes less time and cost (p<0.05)n/aNone

    49 Domingo H, Holmes J. Reduction in treatment time with combined air abrasion and ozone compared to traditional ‘Drill & Fill’ and cost comparison. IADR abstract 2004.

    200464 12840 SecondsPrimary Root CariesAA & Ozone was faster than Drill&Fill. AA was more profitable than D&F6 monthsNone

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    Treatment of Dental Unit Water Lines (DUWL)

    Study Title;Study Date;Subjects Number;Teeth Number;Ozone Time(Seconds);Caries Type; % Success;Follow-up Period;Adverse Reactions
    50 Cardon B, Eleazer P, Miller R, Staat R. Low concentration ozone treatment insufficient to control DUWL biofilm. IADR Abstract 2002.2002n/an/aOzone conc. 0.05ppm DUML samplesNo Effects Seen10 weeksNone
    51 Al Shorman, Abu-Naba'a, Coulter W, Lynch E. Ozone, An Effective Treatment For Dental Unit Water Lines. IADR Abstract 2002.2002n/an/a3 minutes, at 2100ppm ozone 615 ml/min DUWL flushed for 2 minutesOzone treatment showed reduction from 5.2*103 CFU/ml to 300 CFU/ml after first application, then 0 CFU/ml at seconds and subsequent application.8 daysNone
    52 Al Shorman, Abu-Naba'a, Coulter W, Lynch E. Primary Colonization of DUWL by P. aeruginosa and its Eradication by Ozone. IADR Abstract 2003.2003n/a n/a5 minutesDental Unit Water LinesReduced DUWL count <100 CFU's/ml at 2 weeksreduced to 0 CFU's/ml v2 weeksNone

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    Effects of Ozone on Dental Materials

    Study Title;Study Date;Subjects Number;Teeth Number;Ozone Time(Seconds);Caries Type; % Success;Follow-up Period;Adverse Reactions
    53 Campbell D, Hussey D, Cunningham L, Lynch E. Effect of Ozone on Surface Hardness of Restorative Materials. IADR Abstract 2003.200318310 SecondsRestorative MaterialsOzone has no effect on material hardness n/aNone
    54 Abu-Naba'a L, Al Shorman H, Lynch E. 6-months Fissure Sealant Retention Over Ozone- treated Occlusal Caries. IADR Abstract 2003.200353 6610 SecondsPrimary Occlusal Fissure Carious LesionsOzone treatment followed by immediate sealant placement was not detrimental to retention rate.6 monthsNone

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    OHManagement Software for Patient Management

    Study Title;Study Date;Subjects Number;Teeth Number;Ozone Time(Seconds);Caries Type; % Success;Follow-up Period;Adverse Reactions
    55 Scholz V. OHManagement Software for quality management in an ozone treatment practice. IADR Abstract 20042004n/a n/a10 clinics operating with new OHManagement Software, compared to no OHMn/aPatient recall attendance (53% v 44%) and compliance (84% v 75%) were better with the new OHMn/an/a

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    Other References

    Study Title;Study Date;Subjects Number;Teeth Number;Ozone Time(Seconds);Caries Type; % Success;Follow-up Period;Adverse Reactions
    56 Bocci V. Ozone as a bioregulator. Pharmacology and toxicology of ozone therapy today. J Biol Regul Homeost Agents 1996; 10: 31-53.1996n/an/an/an/an/an/an/a
    57 Baysan A, Lynch E, Grootveld M. The use of ozone for the management of primary root carious lesions. Tissue Preservation and Caries Treatment. Quintessence Book 2001, Chapter 3, 49-67.2001n/an/an/an/an/an/an/a

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    1H NMR Studies on Ozonated Oils

    Study Title;Study Date;Subjects Number;Teeth Number;Ozone Time(Seconds);Caries Type; % Success;Follow-up Period; Adverse Reactions

    58 Lynch E, Grootveld M, Holmes J, Silwood CJ, Claxson AWD, Prinz J, Toms HB. 1H NMR Analysis of Ozone-treated Grapeseed, Olive, and Sunflower Seed Oils. IADR Abstract 2003

    2003n/an/a10 MinutesOzonated Oils Comparisonozonides are likely to account for anti-microbial qualities of ozonated vegetable oilsn/aNone

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    1H NMR Studies on Tooth Whitening

    Study Title;Study Date;Subjects Number;Teeth Number;Ozone Time(Seconds);Caries Type; % Success;Follow-up Period; Adverse Reactions
    59 Holmes J, Grootveld M, Smith C, Claxson AWD, Lynch E. Bleaching of Components Responsible for Extrinsic Tooth Discoloration by Ozone. IADR Abstract 2003.2003n/an/a10,20 seconds, 10 & 20 minutestooth stain removal (Melanoidins) bleaching effect with ozonetreatment time None

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    January 2015
    The-O-Zone © Dr Julian Holmes