Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
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Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
Knowledge is treasure of a wise man. The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help ones reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journalsNo manuscriptsNo authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Reviews
Year : 2022 | Month : April | Volume : 16 | Issue : 4 | Page : ZE14 - ZE19 Full Version

Effectiveness of Ozone against Common Dental Problems: A Literature Review


Published: April 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/52741.16150
Surabhi Durgapal, Mamatha Shetty

1. Postgraduate Student, Department of Periodontics, AB Shetty Memorial Institute of Dental Sciences, Mangalore, Karnataka, India. 2. Reader, Department of Periodontics, AB Shetty Memorial Institute of Dental Sciences, Mangalore, Karnataka, India.

Correspondence Address :
Surabhi Durgapal,
Postgraduate Student, Department of Periodontics, AB Shetty Memorial Institute of Dental Sciences, Mangalore, Karnataka, India.
E-mail: drsurabhidurgapal@gmail.com

Abstract

Oral disease represents a major concern among all populations. Despite great efforts that have been made in the past few decades to overcome these diseases; a large part of the world population still suffers from oral diseases which are considered a major reason for the loss of a tooth. Different bacterial species colonises the oral cavity, some of the bacteria are found to be associated with the cause of one of the most common disease called periodontitis. The infectious nature of periodontopathogens has been studied extensively. Currently, treatment of various oral diseases includes supragingival as well as subgingival debridement, root canal treatment and in severe cases, extraction along with antibiotic therapy to help achieve a pathogen-free environment. Continued research and development in the field of dentistry have brought new approaches in treatment modalities. The use of ozone is one of the latest therapies that has gained the interest of researchers in the past few decades. Ozone is a pale blue colour gas and is the natural constituent of the atmospheric layer of Earth. It is a modern pharmacological approach that is biocompatible and has shown its effectiveness against bacteria (gram-positive and gram-negative bacteria), viruses, and fungi. The beneficial biological effect of ozone has made its usage at all stages of disease propitious. The explication of the mechanism of ozone at the molecular level has proved to be beneficial in different medical and dental treatments. The use of ozone in clinical practice can be advantageous to the patient in terms of pain relief and treatment time. Therefore, the present article briefly reviews the chemical nature of ozone, its therapeutic uses, and the benefits it can provide in the treatment of various oral diseases.

Keywords

Chlorhexidine, Immune-stimulating, Ozonator, Periodontopathogens

Ozone is an allotrope of oxygen that exists naturally in the atmosphere of the Earth. It is a triatomic molecule consisting of three oxygen atoms. It is considered a healthy component of the environment present in the stratosphere and protects the Earth from harmful ultraviolet rays emerging from the sun. Ozone is primarily accompanied by electrical storms (1).

Periodontitis is a common multifactorial inflammatory disease triggered by bacterial microorganisms and antigens that induce a local inflammatory response and trigger innate immune system activation (2). Dental plaque harbours several bacterial species of which some putative pathogens that were closely associated with the periodontitis are Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis (3),(4). Even though dentistry is constantly improving, the success of treatment depends upon the elimination and reduction of periodontal pathogens (4). However, in interproximal areas, root concavities, deep gingival pockets, complete removal of periodontopathic bacteria can be difficult. To overcome this, adjunctive treatment methods like administration of antiseptics, local and systemic antibiotics were introduced which have been found to be effective (4). However, due to the prevalence of complex periodontal pathogens that require the use of antimicrobial drugs,the development of bacterial resistance to antibiotics has been observed (5). In the era of antibiotic resistance, the use of ozone therapy as an adjunct treatment modality presents an alternative approach to the management of various oral diseases (6). The present review article focuses on the properties of ozone and its advancement with time in various dental treatments and also supports its use following non surgical periodontal therapy.

HISTORY

In 1828, ozone was first identified as the chemical compound by a German Chemist who is also called the father of ozone therapy, Christian Friedrich Schönbein (7). An electric current was passed through water, and a peculiar smell was created, which he referred to as ozone, derived from the Greek word “Ozein,” meaning “odour”. He pointed out that, ozone formation is the reaction of white phosphorous with the moist air and is to be called phosphorised oxygen and so the name ozone prevailed (7). Ozone has a long history of clinical applications and research.

In 1857, a German physicist and physician, Joachim Hansler together with Hans Wolff, who was also a German physicist, created the first ozone generator for the purpose of medical use (7),(8). In 1950, Edward Fisch became the first dentist to make use of ozone (8).

CHEMISTRY

Ozone is a chemical compound that consists of three atoms of oxygen. The formation of ozone takes place when an electrical discharge breaks a molecule of oxygen into two individual atoms of oxygen. One molecule of oxygen then combines with one individual atom of oxygen and results in Ozone (O3) also called as triatomic oxygen (Table/Fig 1) (7). Ozone used in medical field is a combination of 95%-99.5% pure O3 and 0.05%-5% pure O3 (9),(10). The molecular weight of ozone is 41.98 g/mol. Ozone has a high oxidation potential with a half-life of 40 minutes at 20°C (11). Thermodynamically, being a highly unstable compound that depends upon temperature and pressure. Due to this property, ozone is prepared immediately prior to use as it canrapidly decompose to pure oxygen.

OZONE GENERATION

Generation of ozone takes place by the reaction caused when oxygen flows across an electric arc with a potential difference of 10,000 volts (12). Lightning is then used to induce the reaction giving air its typical smell just like the one experienced after the storm. For medical and dental applications variety of ozone concentrations is required (0.5-80 μg/mL). Transformers are used to vary potential and modify the flow of oxygen across the arc. Ozone being the strongest oxidising agent is capable of oxidising most of the plastic materials except polyethylene, silicone, polypropylene, and teflon and most ferrous material except stainless steel 316 and titanium, therefore all ozone generator modules must withstand oxidation (12). This medical ozonator was then used to convert 5% of pure oxygen into ozone, generating an oxygen mixture of 95:5. In medical use, the gas produced by medical grade oxygen is administered in precise therapeutic doses, has excellent health benefits in dental caries, significantly reduces blood cholesterol, and is used in the therapeutic option of the hypoxic and ischaemic syndrome (13).The concentration of ozone generated can be done by the use of a photometer in the ozone generator (14). Some of the systems available for the generation of ozone developed in the past few decades are:

1. Ultraviolet system: This system produces ozone in low concentrations and is typically utilised for esthetics, saunas, and air purification (15).
2. Cold plasma system: This system is majorly used for the purification of air and water (15).
3. Corona discharge system: This generates high ozone levels. In the medical and dental fields, this system is most widely used, due to its controlled production rate of ozone and easy handling ability (15).

APPLIANCES PRODUCING OZONE GAS

In dentistry, ozone application has been advocated as a support for many conventional treatments. For this purpose, various appliances have been introduced for use in dentistry.

1. Heal ozone: Designed by Cur Ozone USA Inc., is now distributed in Germany by Kavo Dental, Biberch. It is an air-based system with a closed circuit. The application of gas takes place within this closed circuit. The concentration of ozone provided to the tissue is about 2100 ppm (11). Perfect airtightness is required for the application of ozone ensuring no gaseous escape. It can only be used in areas where air tightness can be achieved.

2. Ozony tron: This device uses high frequency and voltage concentration and can adjust current intensity at five levels. It consists of a glass probeformed by a double glass camera and a mix of noble gases emitting electromagnetic energy. Probe tip when comes in contact with the body surface, start emission of energy all around the operation field. Ozone generated in the area of operation is 10 to 100 μg/mL (11). It is not a closed circuit therefore can be used in areas that are challenging to reach like the gingival pockets.

3. Prozone: It consists of plastic attachments (Perio tips and Endo tips) that can be exchanged during different dental procedures, thereby providing a hygienic environment (11),(16).

4. Ozotop: This ozone delivery system is compact and convenient to use. It utilises a corona discharge system for the generation of ozone and can easily penetrate the periodontal pocket (11),(16).

5. Customised thermo formed dental appliance: Hard, medium, or soft thermoformed dental appliances can be manufactured that can reach 2-3 mm into the gingival pocket (16).

MECHANISM OF ACTION

Mechanism of action of ozone are supported by many studies. Some of the studies (17),(18) quotes evidence of O3 interacting with fungal cell walls like bacteria. O3 has shown the oxidation of phospholipids and lipoproteins present within the bacterial cell envelope. this results in disruption of bacterial cell envelop. Some of the evidence also demonstrates the ability of O3 to interact with the fungal cell wall. By undermining the integrity of the cytosolic membrane, it can infiltrate the microorganism and cause the oxidation of glycoprotein and block enzymatic function (19). Ozone oxidises the lipoprotein layer of bacterial cell and disrupts the integrity of the cytosolic membrane. The microorganisms when infiltrated results in oxidisation of glycoproteins, glycolipids, and block enzymatic function (20). This wide range of microbiologic properties makes it a useful disinfectant.

In lipid enveloped viruses, O3 plays a role in the oxidation of lipoproteins, glycoproteins and result in interference with the reproductive cycles of the virus (20). Due to multiple causative factors like microorganisms, diet, host response, etc., complete elimination of dental infection has not been very successful. Adaptation of acute infection for longer period coverts to chronic infection. Pathogenic organisms being opportunistic causes damage to the tissues. All pathogenic organisms have weak antioxidant or enzyme systems present in the cell membrane. When ozone is used to treat the infection, it destroys the cell membrane and causes the death of an organism. The pathogenic contents are then exposed to the internal environment, allowing the immunologic system to initiate its physiologic property (20). Treatment of oral infection involves oral prophylaxis, therapeutic mouth rinses, antibiotics, and sometimes surgical procedure. The use of ozone to treat the dental infection can reduce the use of antibiotics and sometimes the need for surgery (21).

APPLICATION MODALITIES

Aqueous Ozone

Ozone can also be administered in the form of water. It is not only a natural disinfectant but also is biocompatible with oral tissues. Therefore, it is not toxic for use and no negative gastrointestinal effects have been found from ingestion. It is also effective against a number of pathogenic bacteria and helps in reducing inflammation. Apart from bacteria, ozonated water is very effective against various, fungi and viruses (11). Some system that provides a solution up to 4.0 ppm, can be sustained for 30 minutes due to their unstable nature. Even then high levels of aqueous ozone should not be used for long-term repeated use without specific indication. It can be used in the form of nano bubble water that can be retained for six months as aqueous form of ozone (16). Takahashi M et al., indicated the potential functionality of microbubbles in the form of aqueous application (22). One of the newly introduced devices called Purecare oral irrigator from Purecare Dental manufacturer has been recently introduced into the market which consists of a patented capsule through which regular water passes and produce ozonated water (23).

Gaseous Ozone

Ozone used in the form of gas is carried by a device corona discharge ozone generator, which transmits ozone by a suction device that deploys oxygen only when there is negative pressure. If the suction is compromised, ozone deployment is immediately stopped causing a negative secondary effect on respiratory tracts. To avoid this, devices that localise gaseous ozone administration at the target area are used to protect adjacent tissues to the respiratory tract (24).

Ozonised Oil

Apart from gaseous or the aqueous form, it is possible to administer ozone in the form of oil, commercially available as ozonised olive oil (oleozon) or ozonised sunflower oil (Neozone 4000). Some studies performed using ozonised sunflower oil as an adjunctive treatment have found it to be very effective against microorganisms like Streptococci, Escherichia coli, Pseudomonas, and Staphylococci (25),(26),(27).

THERAPEUTIC ACTION

Ozone in dentistry has a physiochemical property. There are several known actions of ozone. Some of the most important biological action of some known actions of ozone are listed below.

Antimicrobial Effect

Ozone acts by disrupting the cytoplasmic cell membrane due to dual bond ozonolysis. Due to its substantial antioxidant ability, it does not cause any harm to human body cells. The research application of ozone for few seconds to the bacteria with no immunity can damage the cytoplasmic membrane of the cell and also stops all vital functions of bacteria (26). Gram-positive bacteria have been found to be more susceptible to ozone exposure than gram-negative bacteria (26).

Immune-Stimulating Effect

Ozone affects both cellular as well as the humoral immune system. It induces immunocompetent cell proliferation and helps in the synthesis of immunoglobulin. It also enhances the function of macrophages and leads to the production of cytokines. Ozone has also been found to synthesise biologically active substances such as prostaglandins or interleukins that play a significant role in inflammation reduction and facilitate wound healing (26),(27).

Antihypoxic Effect

Ozone by increasing the partial pressure of oxygen in the tissues, promotes the transportation of oxygen in the blood, resulting in alterations in cell metabolism. Ozone changes the configuration of erythrocytes by raising the 2-3 diphosphoglycerate (2,3-DPG) concentration, and allow the return of oxygen to the inflamed tissues (28).

Biosynthetic Effect

Ozone causes increases in the number of mitochondria and ribosomes and causes activation of protein synthesis in cells and contributes to up-regulation of function and the capacity of tissues for regeneration (29). It also could attack many biomolecules like cysteine, histidine, methionine, and residue of proteins. Ozone being highly oxidative has a disruptive effect on cariogenic bacteria.

OZONE IN DENTISTRY

Effect of Ozone in Endodontics

The success of endodontic treatment depends upon the effectiveness of antimicrobial agents used in treating periapical lesions. A randomised trial done by Kist S et al., in 2017, to assess the efficacy of ozone gas for periapical lesion found to be equally effective as compared to sodium hypochlorite when used as the root canal disinfectant (30). (Table/Fig 2) provides the summary of studies on the effect of ozone against different bacterial strains (31),(32),(33),(34). While some studies have successfully proved the effectiveness of ozone against bacterial strains [31,33], some in-vitro studies stated, otherwise finding the effect of ozone gas inconsistent (32),(34).

Effect of Ozone in Oral Surgery

Dry socket has been one of the displeasing complications that occur after the extraction. Use of ozone therapy by application of ozone in the intra-alveolar region of the affected area for 12 seconds using a plastic attachment with the help of a device called Prozoneby W and H, has been one great success in preventing dry socket after extraction and reducing the incidence by 3.3% along with improved healing after third molar removal (35). Application of ozone in the extraction can accelerate the wound healing process (36).

It has also been used in the treatment of osteonecrosis of the jaw in combination with antibiotic therapy. Where, efficacy of a 15-day course of antibiotics, surgery, and ozone therapy in 12 multiple myeloma patients with osteonecrosis of the jaw was evaluated. Treatment results were effectual with eight out of 12 patients having complete resolution (37).

Effect of Ozone in Prosthodontics

A common problem that is addressed in denture-wearing patient is denture stomatitis. The causative pathogen that results in denture stomatitis is Candida albicans. Immersion of denture in ozonated water was found effective in reducing the number of Candida albicans in denture plates when used in 10 ppm of concentration when exposed for 30-60 minutes (38). A previous study found ozone gas to be more effective against C.albicans than its aqueous form (39).

Ozone in Caries Management

Dental caries is a disease of multifactorial origin. Management of caries ranges from a surgical approach based on “extension for prevention” (Blacks’ philosophy) to the newer concept of minimal intervention. The remineralisation effect of ozone was evaluated by Baysan A and Lynch E in a clinical study with a six month and 12 months follow-up where he exposed root caries with 2100 ppm of gaseous ozone and found ozonated lesion getting rehardened when compared to the control groups (40). Also, a longitudinal study on management of primary root caries using ozone therapy demonstrated its capability to reverse the carious lesion causing remineralisation and also suggested its use against conventional drilling method (41). An in-vitro study by Samuel SR et al., also illustrated the remineralisation effect of ozone on the carious toothwhen teeth specimen were subjected to ozone (ozonated water 0.1 mg/L and 10% nano-hydroxyapatite paste, AclaimTM), without ozone (only 10% nano-hydroxyapatite paste, AclaimTM), and control (subjects’ saliva alone). The laser fluorescence recorded greater depth of remineralisation following application of ozonated water and nano-hydroxyapatite were found compared to those of the without ozone and control groups (42),(43).

Effect of Ozone in Biofilm

Ozone gas or ozonated water wa sfound very effective concerning the removal of bacteria as well as a biofilm. With 60 seconds of exposure to the ozonated water or gaseous ozone, microflora like Lactobacillus casei, Streptococcus mutans, and Actinomyces naeslundii, have been found to be inactivated. For reduction of plaque, 0.1 ppm concentration of ozonated water showed positive results (44),(45). When used in a concentration of 0.5-4 mg/dL it can inhibit both gram +ve and gram -ve bacteria and also Candida albicans which further prevents the formation of plaque (44).

Effect of Ozone in Periodontics

Periodontitis is one of the most common chronic disorders which starts with gingivitis and if not treated during this stage causes destruction of supporting tissues, leading to loss of teeth. The severity of disease and its transition depends upon the host response, presence of pathogens and also genetic variance (46). Principal periodontal pathogens found in the subgingival microbiome are considered an aetiologic factor for periodontal disease. Treatment includes non surgical periodontal therapy (phase I) and in some cases where phase I therapy is found to be ineffective, surgical approach is the treatment of choice. A randomised placebo-controlled clinical trial conducted by Al Habashneh R et al., investigating the effect of scaling and root planning followed by irrigation with ozonated water in 20 lg/mL concentration has expressed significant improvement in terms of plaque index, clinical attachment loss, probing depth, recession (47). The antibacterial effect of aqueous or gaseous form of ozone, when exposed for 1 minute, was addressed to be beneficial against periodontal pathogens like Tannerella forsythia Porphyromonas gingivalis, and Parvimonas micra (47).

In the past few decades, ozone has been gaining the interest of many scientific researchers. Various studies have been carried out to evaluate the effectiveness of ozone when used as an adjunctive treatment modality to a periodontal treatment (Table/Fig 3) (48),(49),(50),(51),(52),(53),(54).

Effect of Ozone in Healing of Wounds

When a wound is subjected to oxygen it can help in accelerating the wound healing. A study undertaken to evaluate the effect of Ozone therapy on cutaneous wound healing in the guinea pig model showed a significantly smaller wound size and residual wound area. It also stated that topically applied ozone can affect the granulation tissue formation of the wound healing during the inflammation phase (55).

A chronic wound can significantly affect the health of an individual. A study done by Fitzpatrick E et al., evaluated the response of skin cells when exposed to ozone. It stated that ozone when administered in a controlled dose can help accelerate the cell cycle and also induce the production of growth factors like nuclear factor kappa B, which is a regulatory factor for inflammatory response and wound healing (56).

The injury to tissue elicits many biological processes which promote wound healing. Failure of the wound to heal can lead to severe complications. The immune response plays a very important role in removing the dead cells and helps in preventing further infection (57). Ozone therapy has proved to be very efficient in the repair of the affected tissue. It can inhibit fungal growth, inactivate bacteria via disrupting their cell envelopes, and can also damage the capsid of the virus. According to a study done by Xiao W et al., on mice, suggested that the treatment of wounds by ozonised oil increases critical genes that increase the production of fibroblast resulting in new tissue formation and wound healing (58).

OZONE TOXICITY

Given the high oxidative strength of ozone, all components in the contact with ozone gas must be impervious to its effect, some of the material that was found to be resistant to ozone are glass, teflon, and silicone. The maximum ozone concentration in the oral cavity is 0.01 ppm. Up to 0.05 ppm of ozone administered for eight hours does not cause toxicity, but can also be fatal when used in a concentration of 0.3 ppm for 15 minutes or 0.06 ppm, eight hours a day for five days (59). Ozone therapy-induced complications are uncommon at 0.0007 ppm per application in any form (12). Some of the reported side effects of ozone over-exposure are: Upper respiratory tract irritation, poor circulation, rhinitis, cough, occasional nausea, vomiting, headache, blood vessel swelling, shortness of breath, heart problems, and epiphora (59),(60).

However, in the case of ozone intoxication, the patient must immediately be placed in the supine position, asked to inhale humid oxygen, and take ascorbic acid, vitamin E, and should be treated with n-acetyl cysteine (12),[61]. Cytotoxicity of ozone water was considered less when compared to its gaseous form and other antimicrobial agents when observed its effect on gingival fibroblast and epithelial cells [62].

Contraindication(S)

Some of the contraindications to be considered before the administration of ozone are Glucose-6-phosphate-dehydrogenase deficiency, severe myasthenia, pregnancy, hyperthyroidism, severe anaemia, recent myocardial infarction, acute alcohol intoxication, haemorrhage was also observed from some organs, allergic to ozone [62].

Conclusion

With the advancement in modern sciences, the face of dentistry has also changed providing a new vision of painless treatment. The present article found ozone therapy to be more advantageous than any other traditional therapeutic modalities. Ozone therapy is a non invasive, conservative, and inexpensive method of treatment that offers a dynamic approach to dental care. Some of the studies have suggested its positive effect in clinical practice. Furthermore, studies are required to prove its effectiveness. Treating patients with ozone therapy has helped minimised recovery time and patient anxiety level with remarkable outcomes following the treatment. Many scientific supports have demonstrated its potential as an adjunct to periodontal therapy. Due to lack of knowledge and evidence use of ozone and its beneficial effect are still not accepted in routine dental practice. However, to allow the use of ozone therapy as a standardised treatment procedure, more clinical research in the dental and medical fields is needed.

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DOI and Others

DOI: 10.7860/JCDR/2022/52741.16150

Date of Submission: Oct 07, 2021
Date of Peer Review: Nov 03, 2021
Date of Acceptance: Jan 20, 2022
Date of Publishing: Apr 01, 2022

AUTHOR DECLARATATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? NA
• Was informed consent obtained from the subjects involved in the study? NA
• For any images presented appropriate consent has been obtained from the subjects. NA

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