Periodontal application of ozone therapy

INTRODUCTION

Periodontal disease is a chronic inflammatory response of the periodontium surrounding teeth, leading to irreversible damage to the periodontal ligament with progressive destruction of alveolar bone in advanced stages. Periodontal-related diseases are the most common oral condition in the human population. The prevalence of periodontal diseases affects about 20–50% of the population globally.^[1] This condition is considered one of the two core threats to the oral cavity, leading to tooth loss.^[2] The percentage of affected adolescents in developing countries ranges from 35% to 70%, whereas in developed nations the affected ranges from 4% to 34%. The percentage of the affected adult population in developing countries ranges from 36 to 63%, with 14–47% of the affected adult population in developed countries. These diseases have shown an increased predilection for geriatric patients, with periodontal pockets of 6 mm or above in both developed and developing countries.^[3] Due to the chronic nature of the disease, it becomes imperative to restrict its severity and prevalence through a comprehensive treatment planning and an effective prophylactic approach of the same. One such recent discovery involves, ozone therapy administered in either aqueous or gaseous form. Being a potent oxidizing agent with high biocompatibility, this non-invasive treatment modality is been widely used in various fields of interest, including medicine, dentistry, and veterinary medicine.^[4] The studies discussed below in this literature review will focus on the biological efficiency of ozone with inferences from various studies confirming the same, particularly in surgical and non-surgical procedures concerning the field of periodontology when used as a supplement.

HISTORY

The word “OZONE” took its origin from the Greek word ozein meaning “to smell.” Ozone was originally discovered by a Dutch chemist, Martinus van Marum, in 1785 while conducting electric sparking over water, when he noted a distinct smell, only to acknowledge later the smell being of ozone. A half-century later, it was Christian Friedrich Schobein, who theorized the presence of ozone.^[5]

Ozone was first implicated in the medicinal field by Landler in 1870. However, it was in 1936 that it was taken under serious consideration by a Swiss dentist, Dr. E. A. Fisher,^[6] where it was studied in the form of ozonated water and put into use during his daily practice. It was when one of his patients, Dr. E. Payr was getting treated for a gangrenous pulpite that and developed a great sense of interest in the local action of ozone during his treatment of the disease and later extended its application.

In 1957, Joachim Hänsler and Hans Wolff, German physicists, developed the first ozone generator for medical usage, which now continues to be a basis for modern medical-grade ozone generators.^[7]

BIOLOGICAL ACTION UNDERTAKEN BY THE OZONE ADMINISTRATION

This non-invasive treatment modality is now used as an adjunctive or preventive treatment, resulting in successful prognoses in the field of medicine, which is now gaining popularity. Ozone therapy is well known for its antibacterial activity along with its anti-hypoxic effect and has proven its efficacy in immune stimulatory activity as well. The following are the biological actions undertaken by the ozone administration:

GENERATION OF OZONE

Medical grade ozone is used in the ratio of 0.05–5% of O3 and 95–99.95% of O₂. Due to the unstable nature of ozone, it is to be manufactured freshly before the treatment. The three systems used for the generation are as follows: ^[10]

MANUFACTURE OF OZONE IN DENTISTRY

The table 1 mentioned below has stated the various manufacturing industries responsible for medical grade ozone producing devices, with a holistic overview of the same.

SAFETY PRECAUTIONS AND GUIDELINES FOR HANDLING

Ozone, when administered in its gaseous form, without any proper administration specification, can source ozone toxicity via inhalation. Has been known to show the following side effects mentioned below:^[10]

1. Epiphora

2. Upper respiratory tract irritation

3. Rhinitis

4. Cough

5. Headache

6. Occasional nausea.

Adversities caused either by leakage or unmoderated gaseous doses can potentially result in ozone intoxication. The following must be performed, immediately:^[10]

1. The patient must be placed in a supine position

2. Inhalation of humid oxygen

3. Administration of ascorbic acid, Vitamin E, and N-acetylcysteine [Figure 1].

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Figure 1:

Ozone therapy in periodontology.

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EVIDENCE OF OZONE APPLICATION IN PERIODONTOLOGY

The table 2 mentioned below is an assemblage of various studies conducted regarding the application of ozone therapy and its results in applied periodontolgy with Inferences of the same.

CONTRAINDICATIONS OF OZONE THERAPY IN PERIODONTOLOGY

The following mentioned below are some of the contraindications, during the administration of ozone therapy:^[10]

• Pregnancy, particularly the early phase, excludes any mutagenic risk, although it is unlikely^[23]

• Glucose-6-phosphate-dehydrogenase deficiency (G-6-PD) (favism): The enzyme G-6-PD is crucial for eliminating equivalents able to abolish excessive oxidation and intensive hemolysis. Deficiency of the same, results in hemolytic disease known as favism. On exposure to ozone, it is associated with the precipitation of acute hemolysis in such cases^[24]

• Hyperthyroidism: The sensitivity of the lung to damage due to ozone therapy may be highly dependent on an individual’s thyroid hormone status. The chances of aggravation of the lung toxicity in patients with a hyperthyroid state are more likely^[25]

• Severe anemia

• Severe myasthenia gravis

• Active hemorrhage

• Acute alcohol intoxication

• Recent myocardial infarction.

CONCLUSION

Ozone has wide application in both medical and dental fields due to its various benefactors aiding in faster healing processes and disinfection has proven to be an efficient adjunct to conventional surgical procedures. Due to its simplicity of usage, it has no side effects and has been shown to have good tolerance among patients and economic efficiency thus becoming a popular modality. In periodontology, this modality is used effectively in the treatment of peri-implantitis, disinfection of periodontal pockets, regeneration of bone, and speeding the process of wound healing post surgeries.