OZONE: THE BIOLOGIC ANSWER TO THE OROFACIAL/SYSTEMIC INFECTION PROBLEM
The Center for Advanced Dental Disciplines
Robert E. Harris, Jr. D.M.D.
E. Griffin Cole, D.D.S.

ABSTRACT

Oxygen/Ozone therapy in dental medicine is an emerging technology that will enhance the current standard of care in dental medicine in various practical applications. The current challenge that is confronting dental medicine is the increasing recognition of the cause-and-effect relationship of orofacial infections to serious systemic infections that may contribute to the dysfunction of the human immune system.1
“Collaboration between dentists who practice oral-systemic health and medical providers who understand that high-risk periodontal pathogens are causal of arterial disease is essential for heart attack and stroke prevention…. Arterial inflammation due to high-risk periodontal pathogens is a potentially lethal medical problem, and the solution rests in the hands of dental providers”

Bradley Bale, MD
AGD Impact February 2018
This paper will discuss the proper professional use of ozonated water and oxygen/ozone gas as treatment modalities for orofacial infections that can result in oral-systemic health issues.

INTRODUCTION

The disinfectant properties of ozone were first documented in Germany in the 1850s by Werner Von Siemens. The first recorded use of oxygen/ozone in a dental practice was in the dental office of Dr. E.A. Fisch in 1932.1
Oxygen/Ozone therapy was one of the treatments of choice for infections until the introduction of antibiotic therapy. Antibiotics became the treatment of choice for bacterial infections due to their portability and shelf life. Oxygen/Ozone, by contrast, must be produced by a medical/dental ozone generator using only medical grade oxygen and used rapidly due to its short shelf life. 2
Orofacial infections include:

  • Dental Caries 3,4
  • Periodontal Infections 4,5,22,23
  • Endodontic Infections 6,7
  • Osteonecrotic/Alveolar Osteitis Infections 8,9
  • Bisphosphonate Related Osteonecrotic Infections 10
  • Post-Surgical Soft Tissue Infections 4
  • Peri-implantitis 11

The primary cause of an orofacial infection can be bacterial, but it is usually not solely bacterial in origin. The more common cause is some combination of bacteria, viruses, fungi and parasites. These mixed infections form a “biofilm”24,25 on the affected area and when present as a “biofilm” they exhibit increased resistance to antibiotic therapy. The Journal of the American Dental Association, Vol. 140, No.8, 978-986 states, “Periodontitis like other biofilm infections, is refractory to antibiotic agents and host defenses because the causative microbes live in complex communities that persist despite challenges that range from targeted antibiotic agents to phagocytosis.” The article concluded that “The regular delivery of non-targeted antibiofilm agents may be an effective strategy for treating biofilms, especially if these agents include oxidative agents that dissolve the “biofilm matrix.” Oxidizing agents include ozone, hydrogen peroxide, chlorine, chlorine dioxide and iodine solutions. 12,13,14

There are several critical factors that must be adhered to when producing ozonated water and oxygen/ozone gas for treating orofacial infections.

  • The ozone molecule used for orofacial procedures must be produced from a pure medical grade oxygen source that is both the source of the ozone molecule and the solvent for the delivery of the ozone gas. The use of ambient air to produce medical/dental ozone is totally unacceptable.15
  • Ozone is a strong oxidant. Healthy human cells have adequate endogenous antioxidant enzymes in their cell membranes to protect them from ozone. Microbial cell membranes do not contain adequate levels of antioxidants for protection from ozone. 16,17
  • The ozone generator must be manufactured from approved ozone resistant materials. i.e. glass, PTFE, silicone, etc. 15
  • The ozone generator must be manufactured to safely produce oxygen/ozone gas for dental use. 15
  • All excess ozone produced must be converted back to oxygen by a catalytic converter to avoid eye and lung irritation. Activated charcoal is not acceptable for this application. 15
  • The amount of ozone used for therapeutic purposes occurs in a range of 95-99.95% oxygen to 0.05-5% ozone 15,20

By following proper ozone production guidelines and using the specific treatment protocols developed by German, Italian, Russian, and Cuban clinicians and refined for practical patient care by American clinicians, ozone can be delivered in therapeutic doses to the orofacial structures. The biofilm is oxidized and the associated bacteria, viruses, fungi and parasites are destroyed because they lack sufficient antioxidant enzymes in their cell membranes. 16,17 With the exception of the eyes and lungs, all human cells are protected from ozone oxidation by endogenous antioxidant enzymes in their cell membranes.

CLINICAL APPLICATIONS

A. Ozonated water is used to eliminate aerosol contamination in the dental office by using it as: 21

  1. A pretreatment patient rinse
  2. In the dental unit water supply bottles
  3. In ultrasonic and piezo scalers
  4. In irrigation syringes
  5. As a hard surface disinfectant

Pretreatment microscopic examination of periodontal pocket fluid and tissue samples revealed large numbers of diverse microbes. Following treatment with ozonated water and oxygen/ozone gas, the microbial population was eliminated. Ozonated water is also used to irrigate all dental tissues during operative dentistry procedures, endodontic procedures and oral surgical procedures.

B. OXYGEN/OZONE GAS IS USED TO COMPLETE THE STERILIZATION OF THE TISSUES BY ITS APPLICATION TO:

  1. cavity preparations
  2. crown preparations
  3. periodontal pockets
  4. root canal system of teeth
  5. oral surgical sites

The visual result of the application to tooth structure is an apparent oxidation of the organic components of the enamel, cementum, dentin and dentinal tubules. The use of oxygen/ozone gas in the above procedures produced little or no post-operative sensitivity for the patient when the ozonated water and oxygen/ozone gas were appropriately applied during the treatment. One-hundred studies conducted by Lynch, et. al. validated caries reversal in multiple applications. 19

CONCLUSION

The increase in the number of patients with antibiotic resistant infections, such as, MRSA, VRSA, etc., has resulted in the re-emergence of medical/dental oxygen/ozone therapy as a safe and effective procedure to eliminate these infections. Dental oxygen/ozone therapy is poised to create a significant paradigm shift in the practice of Oral Systemic Health and Dental Medicine. When produced correctly and administered according to proper protocols, dental oxygen/ozone can eliminate orofacial infections. This therapy will be the key component to reducing debilitating systemic infections that arise from orofacial sources.

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