Ozone Information For Clinicians

Frequently Asked Questions - 1

Dr Julian Holmes

Ozone Information

Frequently Asked Questions - 1

Frequently Asked Questions - 1

Author; Dr Julian Holmes, 2002-2011.
Frequently Asked Questions - 1

What is Ozone
Ozone is a form or oxygen. All oxygen is a gas; that fresh, clean smell that you find at high altitudes and after thunderstorms is ozone. It is an atmospheric protection against harmful sunlight and present all around us in the air we breathe. Ozone is named after the Greek word Ozein, to smell.

What is Ozone used for?
Apart from the protection it gives us against harmful UV light, without which life would cease on the planet, ozone is a powerful oxidizing agent, which has been widely used over the past 100 years to purify water systems. It has been used for many years to purify the water that you drink.

Ozone is a natural biocide, which effectively kills bacteria, viruses and fungi within seconds. It is used in various areas including hospitals and public places to control infections and smells.

Due to it's bactericidal, fungicidal and virostatic properties ozone is used widely in disinfecting wounds and killing diseases caused by bacteria, fungi and viruses.

The technology utilises the direct application of ozone to the decayed tooth surface in a controlled manner through use of the HealOzone System and is capable of potentially reversing caries. Ozone kills the bacteria arresting the further development of caries.

Tooth decay is the process where teeth rot and crumble away due to an attack of acid. The acid strips away the hard out layer of the tooth (enamel) and penetrates the softer inner layer (dentine). If this is allowed to proceed it results in dental decay.

The acid is a product of naturally occurring bacteria that is carried in the saliva which use sugars in our diet as food.

How does ozone work?
Ozone works by identifying and breaking up the cell walls of bacteria, viruses and fungi, and breaking up sulphur compounds into non-smelling compounds.

What are the advantages?

  • No need for anaesthetic by injection
  • No annoying drilling
  • No long treatment sessions

    How can Ozone help my teeth?
    With the use of a small laser, called the Diagnodent, we can look at the surface of your teeth to identify caries. The Diagnodent, detects areas of bacteria that cause decay, and gives us an idea of how much decay is present. A special handpiece, with a soft plastic cup, is then used to put ozone onto the decayed area. It is a short, simple and painless procedure. There is no drilling, fillings, injections or damage to your tooth.

    Ozone kills the acid-producing bacteria that grow out of control and cause decay. Once these bacteria have been eliminated from the local area a special liquid mineral is put on the cleaned area of decay. This encourages the tooth's remineralising process. We also recommend a special toothpaste and mouth rinse to encourage the tooth to continue healing. These products contain all the essential minerals that your body needs to repair decay. Regular use of the home kit encourages the success of your Ozone treatment.

    How do I know that the treatment has worked?
    You will need to return after 3 months to check that the lesion is healing. The research shows that in over 80% of cases, the decay has stopped or reversed.

    Do I feel anything?
    This treatment is entirely painless, with no invasive treatment required.

    What are the alternatives?
    The alternatives to ozone are traditional treatment methods, some of which may have been offered to you in the past. These are:

  • Fissure sealant and air abrasion that is the least invasive of the traditional treatments.
  • Doing nothing and risking the further decay and pain which is inevitable.
  • Having the tooth removed completely, rarely a recommended option.

    Clinical considerations and Discussions amongst the Dental Referencing
    Due to the recent developments in ozone technology we think that it is most important that the general public have access to current thinking amongst the dental profession.
    Whilst some of the questions and answers may be difficult to follow, the overall concepts are well illustrated. Further information is available on the
    www.the-o-zone website.

    Special thanks to Dr. Julian Holmes for all his hard work in informing the public and profession in this exciting new development.

    Questions and Answers on Technique/Treatment Queries
    Is there a protocol for the use of the Diagnodent within the HealOzone studies, i.e. the levels of the Diagnodent reading and at what level ozone will be effective?
    Yes, this is available from Prof Lynch or Julian Holmes

    What is the best way of accurately establishing efficacy of this treatment in practice, as the Diagnodent is excellent at diagnosing, but appears to be less useful in; monitoring?
    Use with clinical observation,
    e.g. CSI. The primary outcome variable must be 'clinical reversal' of caries.

    How can you accurately confirm that a lesion has been arrested?
    Use CSI and DV

    How long do you need to wait before finding evidence that lesions are arresting/reversing?
    About 4-8 weeks, depending on lesion type, and degree of openness

    When is it safe to assume that no further treatment is required?
    When the DV falls. Covering with Fuji7 is also advantageous.

    What applications can ozone be used for?
    Still discovering this but its recommended uses are for pit, fissure and root caries.

    What cavity types are being treated with Ozone?
    Some users are treating lesions of all types and sizes.

    Which of these applications already has clinical research to support it?
    Single surface (root and occlusal)

    Why does ozone treatment affect sensitivity?
    It opens the channels, allowing minerals to flood into channels, blocking pores, so sensitivity ceases

    What pulpal changes are evident after ozone treatment?
    See Bocci auto-haematology studies

    If dentine has been literally denatured, how can one get remineralistion?
    Mineral will penetrate the organic component

    Is there any evidence to show the success rates of treatment on large open carious lesions?
    Yes, see Julian Holmes' recent study

    Is there any evidence to show the success rates on interproximal lesions?
    Yes, see Julian Holmes' recent study

    What techniques if any are being used for treatment of interproximal lesions?
    Tunnel / open using air abrasion or direct access

    How can one tell whether the enamel porosity above lesions is sufficient to allow ozone penetration?
    You should be able to tell by the Diagnodent reading.

    What, if any, possible future health risks are there to patients, which may be caused by ozone treatment?
    None, provided equipment is well maintained, which includes 12 monthly services, to ensure ozone is being produced at the correct levels.

    Should ozone cavities be temporised? If so does this slow down healing.
    Use Fuji7 from GC UK; Remineralisation takes up to 4 months

    Are you using HealOzone as part of endodontic treatment, including root canals? If so, is it a benefit?
    Julian Holmes is using ozone both as gas and ozonated oil. Reducing pain is useful in controlling infective cases which seem to re-infect and then fail

    What beneficial effects have been found for the use of ozone on ulcers, if it is a benefit what type of ulcer can be treated?
    All ulcers seem to get better when treated with ozone gas or an ozonated oil/fluid.

    How do you feel about the use of Ozone for the possible reversal of pulpitis?
    In most cases it can be used to reverse pulpitis

    Are there any studies supporting the use of Ozone to reduce sensitivity?
    There are studies available from Canada, but these have not been published yet, but see Julian Holmes paper

    What findings if any are there relating to periodontic treatment?
    See current studies

    Could fizzy drink consumption cause the tooth not to remineralise?
    It is more likely to delay, rather than prevent remineralisation. As ozone treatment also changes the pH of a lesion from acidic to alkaline, and drinks that contact phosphoric acid or sugars would be expected not to support dental treatment

    Does ozonation work 100% of the time?
    No, there are many reasons why ozone treatment may not work in some cases.

    Is there a guide to the required ozone administration levels?
    Yes, see EL/JH study

    How quickly will acidogenic plaque re-form and would any kind of provisional filling be useful?
    It will take more than 6-8 (approx 14-18 weeks for a mature lesion to re-establish) weeks, but the use of Fuji 7 has been found to be very successful by some of the Pathfinders.

    What use does ozone have for the treatment of dry sockets?
    Dry socket is a bio-film problem and therefore there is no reason why it should not be treated by ozone. Ozonated fluids could be used as an alternative medium

    When treating open cavities, how important is the patient plaque control?
    Very, although the use of Fuji 7 is advantageous.

    How important is the homecare kit?
    Very! It not only gives the an enhanced mineral intake which aids remineralisation, but also encourages a new improved oral hygiene routine.

    What areas of treatment do not appear to be successful?
    Lesions with DV>98. These very large lesion need either/and multiple treatments, or/and longer treatment times (2+ minutes of ozone).

    What is the average ozone application time?
    The average ozone application time being used should be 40- 60 seconds

    What are the typical results i.e. % of successes versus failure?
    About 10% failures with only one ozone session, now more predictable with multiple treatment sessions, longer ozone exposure times, and the use of Fuji7

    The following suggestions were put forward to show that ozone is working - would it be possible to develop a colour change liquid which changes colour when ozonated?
    At this time, the best means of showing that ozone is being generated is to ozonate a latex glove for 5 seconds, if ozone is being generated the glove will disintegrate. Note this will not work on non-latex gloves!

    Is there a device available that can read ozone output?
    Yes, there is a specialist piece of equipment that can read ozone output but it is a very high investment.

    Could an elongated silicone tip be designed to reach cavity box?
    In the case of the O3 Ozi-cure, the probe allows easy access to the lesion. For the HealOzone user, various work-arounds have been suggested. It is possible although in most cases it is advised that the box is opened up a little to allow treatment.

    All the following areas for research will be looked at in due course. There are 4 further research studies running in UK Dental Schools that will cover some of these areas.

  • Root canal sterilisation and delivery hardware ;
  • Periodontal disease treatment
  • Bleaching
  • Full mouth delivery system
  • Interproximal application methods
  • Prevention with Ozone
  • The effects of using a high fluoride containing mouthwash and/or toothpaste as an alternative to the kit.

    Questions for Fellow Ozone Users

    How do you feel the results of HealOzone treatment within your practice compare with the Clinical trials?
    On average the results are better than those found in the clinical trials.

    There have been a number of requests that the users instruction manual be improved, please suggest any desired improvements. All manufacturers of medical and dental equipment have a duty to provide this.
    A full Clinical Guide is avaialable from Dr Julian Holmes and O3.working on this.

    Taking into account the feedback that shows that the KaVo HealOzone handpiece is not user friendly, how can it be improved for easier more efficient use?
    See below

    A foot control has been suggested, is this a good alternative?
    It appears that many users feel that this is a good idea.

    Would it be helpful to be able to select ozone application times?
    It is generally agreed that this would be helpful.

    What improvements would you like to see made to the HealOzone rubber cups for easier use?
    Design for wet teeth, rather than dry! This is not an issue for the users of the Ozi-cure unit

    Apart from the Diagnodent, what other processes are you using to effectively monitor progress after the ozone application?
    The CSI

    What tips are there for achieving a good seal on teeth?
    Dry, gentle squeeze of cup in grooved areas, change position of hand piece orientation

    How can variable penetration of ozone be controlled and what studies are there to support this.
    There is no current data to confirm that this is possible or desirable.

    Research Questions What statistical information is there to show the length of time it takes for lesions to arrest/reverse.
    Statistics show that it takes an average of 6-8 weeks for reversal.

    Are there any radiographic studies to show evidence that lesions are arresting/reversing.
    Julian Holmes and other Pathfinders have patient studies of this kind.

    Patient Reaction - Treatment Success
    What adverse reactions to treatment are occurring, if any?

    How are you managing the situation when treatment does not appear to have worked? DV>98,
    aggressive multiple 60-second ozone Tx until DV <90 - or better until the CSI changes towards a 'healing' or remineralising lesion.

    Are any of your patients experiencing pain after ozone treatment?

    Commercial Elements
    What is the average fee scale?
    Approximately 35.00/tooth, maximum 295.00 for full mouth. Many Pathfinders appear to be charging the same price as a standard composite.

    Patient Information and Kits
    KaVo and O3 have been asked to produce patient information with evidence-based results, would this be helpful to you?

    Should you give every patient a patient kit?
    Yes it increases the success levels of the treatment.

    If so, is a patient kit included in the price in the fee or charge separately?
    The uptake is better when the kit is included within the price of the treatment.

    How good is acceptance of the kit?
    Very good, if explained to the patients.

    Is this hindered by the flavour?
    The flavour has been a problem but in which case use alternative application. It has been suggested that the paste can be smeared onto tooth surface and the mouth rinse applied with a cotton wool bud directly into the lesion area


    January 2015
    The-O-Zone Dr Julian Holmes