Ozone therapy in the management and prevention of caries

The purpose of this article was to assess the effectiveness of ozone therapy in the management and prevention of caries, reviewing clinical and in vitro studies. Ozone has proven to be effective against gram-negative and gram-positive bacteria, viruses, and fungi. In dentistry, most of the published articles are based on ozone’s antimicrobial effects and the treatment of caries. Most of the clinical studies reported ozone to be a promising alternative to conventional methods for caries management. However, a few studies have shown ozone to be insufficient for preventing caries and reducing microorganisms in open occlusal carious lesions. Ozone might be a useful tool to reduce and control oral infectious microorganisms in dental plaque and dental cavity. However, the results of in vitro studies are controversial; while some researchers reported that ozone therapy had a minimal or no effect on the viability of microorganisms, others suggested ozone to be highly effective in killing both gram-positive and gram-negative oral microorganisms. Therefore, more evidence is required before ozone can be accepted as an alternative to present methods for the management and prevention of caries.

Introduction

Dental caries is a bacterially mediated disease characterized by the demineralization of the tooth surface, which may lead to cavitation, discomfort, pain, and even tooth loss,¹ and it is a major oral health problem that affects 60–90% of schoolchildren and a vast majority of adults.2, 3 Bacteria play a very important role in the initiation and progression of carious lesions.4, 5 Reducing the levels of caries associated bacterial species in dental plaque is one of the preventive strategies to prevent the initiation of caries and to treat the disease.6, 7 Furthermore, to prevent secondary caries that may be related to the presence of residual bacteria under restorations,8, 9 the use of an antibacterial treatment after caries removal seems to be meaningful.⁵ To arrest caries progression, several antibacterial treatments have been proposed in order to mechanically and/or chemically reduce biofilm formation3, 10, 11, 12 and reduce the amount of residual bacteria after caries removal.5, 13, 14, 15 Nowadays, to treat dental caries, pharmaceutical approaches have gained popularity. Such approaches give the opportunity of caries treatment without drilling. A novel concept ozone therapy has been introduced for the treatment of caries,16, 17 disinfection of the cavity,¹⁸ and reduction in the levels of caries-associated microorganisms.19, 20