Efficacy of ozonated water mouthwash on early plaque formation and gingival inflammation: a randomized controlled crossover clinical trial

Efficacy of ozone therapy in dentistry with approach of healing, pain management, and therapeutic outcomes: a systematic review of clinical trials

Ozone therapy has emerged as a promising treatment modality in dentistry due to its antimicrobial and healing properties. This systematic review aimed to evaluate the recent clinical trials on ozone therapy in dentistry and its impact on therapeutic outcomes. A comprehensive literature search was conducted across multiple databases, including Web of Science, PubMed, and Scopus from January 2018 to December 2024, identifying studies that investigated the use of ozone in dental applications. The findings demonstrated that ozone therapy is effective in improving periodontal health, healing soft tissue after dental implant surgery, and reducing postoperative discomfort. The combination of scaling and root planing with gaseous ozone therapy showed superior periodontal response rates. The use of ozone during endodontics procedures resulted in reduced post-treatment pain, while ozonated materials showed promise in the management of dentinal hypersensitivity. However, it is not recommended in restorative dentistry due to potential adverse effects on dentinal bond strength. The findings of this systematic review supported the integration of ozone therapy into dentistry as an adjunctive therapy. More research is needed to elucidate its mechanisms, optimize application techniques, and evaluate long-term outcomes for patient safety and treatment effectiveness.

Ozone Therapy in Medicine and Dentistry: A Review of the Literature

Ozone has been successfully used in medicine for over 100 years due to its microbiological qualities. Its powerful oxidation impact, which results in the production of free radicals, and its ability to cause the direct death of nearly all microorganisms is the basis for its bactericide, virucide, and fungicide properties. Ozone also has a medicinal impact that speeds up blood flow and aids wound healing. Ozone may be applied as a gas or dissolved in water for medical purposes. Despite the benefits of using ozone therapeutically, concerns about its use in dentistry still exist. We aimed to provide a summary of the current uses of ozone in medicine and dentistry. An electronic search was performed for all English scientific papers published between 2012 and 2023 using PubMed, Cochrane, and Google Scholar search engines. Ozone, clinical applications, medicine, and dentistry were the search terms used. Seventy full-text articles describing the use of ozone therapy in medicine and dentistry were included in the present review. Ozone has shown several beneficial effects in the medical field. However, despite the encouraging in vitro evidence, the clinical use of ozone in dentistry has not yet been demonstrated as highly effective.

Reduce the risk of ventilator-associated pneumonia in ICU patients by Ozonated water mouthwash: A double-blind randomized clinical trial

BACKGROUND

The aim of this study was to compare the 2 mouthwash solutions, including chlorhexidine (CHG) and ozonated water (OZW) to reduce the risk of ventilator-associated pneumonia (VAP) in patients on mechanical ventilation in intensive care unit (ICU).

METHODS

This randomized double-blind clinical trial was performed in ICU units of hospitals. Patients (n=73) were selected and divided into 2 groups of CHG (n=37) and OZW mouthwash (n=36). Mouthwash was performed by trained nurses. Chi-square test, independent t-test, paired t-test, Mann-Whitney U-test, and Repeated Measure ANOVA was used to evaluate the effect of CHG and OZW mouthwash on the risk of VAP occurrence by Clinical Pulmonary Infection Score (CPIS) checklists and swab culture.

RESULTS

Both CHG and OZW mouthwash reduced the risk of VAP differ at different time points (the first, the third and the fifth days). There was also difference in the incidence of VAP in terms of culture of pulmonary secretions in the 2 groups. Incidence of VAP in the CHG mouthwash group was 45.9%, and also 25% in the OZW mouthwash group. Most pathogens, that found in the culture of pulmonary secretions in the CHG mouthwash was Acinetobacter baumannii; also, in the OZW mouthwash, A baumannii and Pseudomonas aeruginosa were the most frequent ones.

CONCLUSIONS

OZW mouthwash was more effective than CHG mouthwash to reduce the risk of VAP.

Is Ozone a Valid Adjuvant Therapy for Periodontitis and Peri-Implantitis? A Systematic Review

INTRODUCTION

Ozone is a naturally occurring unstable compound with three oxygen atoms that generally transforms into an oxygen molecule, releasing one oxygen atom. This feature has been exploited in dentistry for numerous applications, including for periodontal diseases and peri-implantitis.

METHODS

This review was performed in relation to the PRISMA flow chart and was annotated in the PROSPERO register. PICO questions were used as research questions. The risk of bias in the non-randomized clinical trials was appraised using the ROBINS-I tool.

RESULTS

An electronic search found a total of 1073 records, in particular, 842 from MEDLINE/PubMed, 13 from Bio Med Central, 160 from Scopus, 1 from the Cochrane library databases, and 57 from the PROSPERO register. A total of 17 studies were included in the present systematic review. Information regarding the characteristics of the periodontal clinical and radiographic parameters for gaseous ozone, ozonate water, ozonate oil, and ozone gel, including clinical attachment loss (CAL) probing depth (PPD), bleeding on probing (BoP), plaque index (PI), gingival index (GI), and marginal bone levels (MBL), were obtained.

CONCLUSIONS

The studies included in this systematic review show different results regarding the ozone in periodontal treatment in association with or without SRP.

The Current Antimicrobial and Antibiofilm Activities of Synthetic/Herbal/Biomaterials in Dental Application

Herbal and chemical products are used for oral care and biofilm treatment and also have been reported to be controversial in the massive trials conducted in this regard. The present review is aimed at evaluating the potential of relevant herbal and chemical products and comparing their outcomes to conventional oral care products and summarizing the current state of evidence of the antibiofilm properties of different products by evaluating studies from the past eleven years. Chlorhexidine gluconate (CHX), essential oils (EOs), and acetylpyridinium chloride were, respectively, the most commonly studied agents in the included studies. As confirmed by all systematic reviews, CHX and EO significantly control the plaque formation and gingival indices. Fluoride is another interesting reagent in oral care products that has shown promising results of oral health improvement, but the evidence quality needs to be refined. The synergy between natural plants and chemical products should be targeted in the future to accede to the formation of new, efficient, and healthy anticaries strategies. Moreover, to discover their biofilm-interfering or biofilm-inhibiting activities, effective clinical trials are needed. In this review article, therapeutic applications of herbal/chemical materials in oral biofilm infections are discussed in recent years (2010-2022).

New tendencies in non-surgical periodontal therapy

The aim of this review was to update the evidence of new approaches to non-surgical therapy (NSPT) in the treatment of periodontitis. Preclinical and clinical studies addressing the benefits of adjunctive antimicrobial photodynamic therapy, probiotics, prebiotics/synbiotics, statins, pro-resolving mediators, omega-6 and -3, ozone, and epigenetic therapy were scrutinized and discussed. Currently, the outcomes of these nine new approaches, when compared with subgingival debridement alone, did not demonstrate a significant added clinical benefit. However, some of these new alternative interventions may have the potential to improve the outcomes of NSPT alone. Future evidence based on randomized controlled clinical trials would help clinicians and patients in the selection of different adjunctive therapies.

Evaluation of Salivary Matrix Metalloproteinase (MMP-8) in Periodontal Patients Undergoing Non-Surgical Periodontal Therapy and Mouthwash Based on Ozonated Olive Oil: A Randomized Clinical Trial

Background: Extracellular matrix metalloproteinases (MMPs) play a pivotal role in the damage to the periodontal tissue in patients with periodontitis. Scaling and root planning (SRP) attempt to control the plaque amount and consequentially reduce the bacterial load. Non-surgical periodontal treatment could be integrated with drug therapy and physiotherapy procedures such as ozone therapy. The aim of this study was to evaluate in a cohort of patients with a diagnosis of periodontitis: (1) the efficacy of non-surgical periodontal therapy assisted by the use of ozonated olive oil-based mouthwash on salivary metalloproteinase (MMP-8) and (2) the reduction of periodontal indices. Methods: Ninety-six subjects with a diagnosis of periodontitis were enrolled in this study and randomly assigned to the study group (SRP + mouthwash) or control group (SRP). The study duration was 3 months. Data on MMP-8, plaque index (PI), bleeding on probing (BoP) and probing pocket depth (PPD) were recorded at T0, T1 (14 days), T2 (1 month) and T3 (6 months). Group differences were assessed using Student's t-test for independent samples. Results: A significant improvement in PI, BoP, PPD and salivary MMP-8 levels was observed in both groups. An analysis of differences in relative changes of indices revealed the efficacy of ozonated olive oil in decreasing MMP-8 level. Simultaneously, it slowed the decrease of BoP index. Conclusions: Scaling and root plaining with the aid of ozonated olive oil mouthwash were found to be more effective on salivary MMP-8 reduction than scaling and root plaining alone.