Introduction

In the ever-evolving field of dentistry, clinicians are constantly seeking innovative and effective ways to improve patient care through infection reduction and control. Ozone is one such advancement that has gained significant attention over the last 100 years. The use of ozone in dentistry, in the form of ozone gas or ozonated water, is on the rise, especially with biological dentists. Ozonated oil is also available for home use (see DIY uses below).

Indeed, ozone is so versatile that by 2008 research had found it an effective treatment for over 260 different pathologies, killing both gram-positive and gram-negative bacteria, many of which are extremely resistant to antibiotics. Interestingly, it does not harm human body cells if used under closely controlled conditions by trained clinicians.

Some dental researchers advise appropriate caution regarding the use of ozone, while also providing positive feedback on its use alongside more time-tested dental treatment modalities…in addition to the common – and prudent – caution that calls for increased higher-level testing of ozone in the form of randomized, controlled clinical trials.[1][2]

Ozone is valued for its ability to kill bacteria, viruses and fungi, making it the ideal, non-chemical, antimicrobial agent. Because ozone therapy is most often used as a gas, it is able to penetrate well into tissues and spaces that are not easily accessible by other means, resulting in a long-lasting bactericidal effect. [3]

Used appropriately, ozone is safe, free from side effects, stimulates blood circulation, and enhances the immune response. That said, ozone is also highly reactive and, to be safe, must be used in a controlled application, by clinicians experienced in its use, following appropriate procedures.

In 2003 it was discovered that the human body has the ability to generate its own ozone in activated neutrophils (a specific type of white blood cell), making it a powerful oxidant to kill invading microorganisms. [4]

The History of Ozone

The history of ozone dates back to 1785, when Dutch scientist Martinus van Marum first observed the distinctive smell associated with electrical discharges such as lightning, which we now know to be ozone. However, it wasn’t until 1840 that Christian Friedrich Schönbein (considered the father of ozone therapy), a German chemist, discovered and named this gas “ozone” (from the Greek word “ozein,” meaning “to smell”). In 1881 it was used as a disinfectant in the treatment of diphtheria. In 1896 an ozone-generating system was patented by Nikola Tesla. [5]

Ozone was subsequently recognized for its remarkable disinfectant properties.[6]

The concept of ozone therapy gained traction in the early 20th century, particularly in Europe, as a treatment for various medical conditions. Dentistry, with its focus on oral health and infection control, was quick to adopt ozone therapy as a promising adjunct to traditional dental treatments, pioneered by Swiss dentist E. A. Fisch.

Fisch gained notoriety in 1932 when he successfully treated an advanced dental infection in the mouth of Dr. Erwin Payr, an Austrian-German surgeon. Payr immediately embraced the value of using ozone in a variety of surgical applications. He published an extensive paper on the topic and presented it at a major German surgical conference in 1935, spurring an increase in ozone’s use in medical applications in Europe. Unfortunately, ozone’s popularity in Europe did not translate to American medical circles.

These links offer sources of additional background on medical/dental ozone therapy [7,8,9]:

More recent uses of ozone

More recently, ozone was used experimentally to treat liver disease, cancer, pain and HIV; to enhance wound healing, and much more, with varying results, as published in multiple medical journals. It should be noted that ozone, although proven effective for many specific conditions, is not a “miracle cure”.

As of 2012, the Netherlands (part of the EU) had more than 3,000 ozone water treatment plants and in Germany there were more than 11,000 health care professionals using ozone in their daily work.

Despite the robust presence of multiple international ozone therapy organizations, individual countries and medical groups with varying standards have made wide, international acceptance difficult.

Currently, in the USA medical ozone therapy is not FDA approved. That said, it is completely legal for dentists to use ozone. It is only prohibited in medical applications in the US.

This is FDA’s statement about ozone therapy: “… no known useful medical application in specific, adjunctive, or preventive therapy”.

Nevertheless, ozone is approved for both medical and dental use by: Germany, Brazil, Italy, Russia, Portugal, Spain, Turkey, Oman, UAE, Greece, Egypt, China, Cuba, Mexico, Venezuela, Honduras and several Eastern European countries. [10]

The following links offer more helpful background and established guidelines for the medical and dental uses of ozone: [11, 12]

Ozone in Dentistry

Where to find a dentist who uses ozone

Many dentists in the following countries use ozone in their practices: UK, Canada, Australia, India, Pakistan, New Zealand, Philippines, Thailand, Morocco, Iran, Kenya and South Africa, among others.

Ozone for dentistry is not prohibited in these countries.

Ozone therapy in dentistry is a versatile approach with a wide range of applications, offering clinicians innovative and effective tools to improve patient care.

Though I need to add a word of caution here. You probably already know if your own dentist is on board with ozone use, and you may need to change dentists – or at least work with an additional dentist – if you want ozone therapy.

That said, dentists who offer ozone in their practices are not easy to find. They typically, but not always, advertise as ‘biologic’ dental practices. The failure of dental insurance to cover ozone treatments may be a factor in why so few dentists offer it. You will likely need to do some research and make some phone calls.

Dental Associations

You can also check to see if the dentist is a member of IABDM or IAOMT. Both organizations have member listings, however there are dental practices offering ozone who may not be a member of either of these, so it pays to do your own research if you aren’t sure.

Both these organizations offer a more in-depth explanation of ozone in dentistry and member directories.

IABDM – International Academy of Biological Dentistry and Medicine [13]
IAOMT – International Academy of Oral Medicine and Toxicology [14]

Here are two more recent reviews offering additional background on ozone’s uses in dentistry: [15,16]

Ozone Use in Dental Practice

1. Ozone Generator Systems:

Ozone generators are used to produce medical-grade ozone gas in the dental office. These systems are equipped with safety features to ensure the controlled and precise delivery of ozone to the targeted area. Ozone gas is often applied in a gaseous form using a dental handpiece or a specially designed delivery system. Some ozone generators incorporate the ability to create ozonated water as well.

Ozonated water is produced by an ozone water generator. As water goes through it, ozone gas is added that immediately begins oxidizing and removing any contaminants such as: bacteria, viruses, fungi, parasites, and more that may be present, leaving only super clean water with no chemicals.

2. Pre-treatment:

Before the patient begins any treatment, if they rinse with ozone water it helps not only reduce bacteria, viruses and yeast in the patient’s mouth, but also improves the safety of the dental team and overall air quality. All this with none of the potential side effects of chemical mouth rinses or damage or dehydration to oral tissues.

3. Dental Caries Management:

Ozone treatment for dental caries (cavities) involves applying ozone gas to the affected tooth surface once the decay is removed, thereby killing any remaining bacteria that might otherwise be trapped under the new filling, ultimately resulting in failure of that filling. The ozone gas kills cariogenic bacteria and encourages enamel remineralization. This minimally invasive approach can be particularly beneficial for pediatric patients. [17]

4. Periodontal Therapy:

In the treatment of periodontal (gum) disease, ozone gas can be directed into periodontal pockets to disinfect and eliminate harmful bacteria. The application is often used in conjunction with scaling and root planing for comprehensive periodontal care.

5. Endodontic Use (root canal):

Ozone therapy can be incorporated into endodontic (root canal) treatment to deeply disinfect and clean the dentinal tubules and accessory canals within the tooth. The ozone gas can penetrate into the smallest areas, to eliminate bacteria that can’t be reached in any other way. By eliminating the bacteria and preventing them from becoming trapped under the material used to fill the tooth root canals, the chance of infection can be minimized and the tooth is far less likely to have problems after the treatment.

6. Reducing Tooth Sensitivity:

Ozone treatment for tooth sensitivity involves exposing the sensitive tooth structure (often exposed dentin and exposed dentinal tubules) to ozone gas, which can seal dentinal tubules and reduce sensitivity. This method offers a non-invasive solution for patients with dentin hypersensitivity. The effects can last a few days or as is often the case, indefinitely.

7. Post-Oral Surgery Care – Extractions:

When a tooth is extracted, ozone gas can be directed into the space left by the removal of the tooth and root. This will kill any remaining bacteria that might later cause infection as well as cleaning the diseased bone (which is porous) by getting into microscopic areas, as well as cleaning away any unhealthy tissue, thereby allowing the bone around the extraction socket to heal naturally, without the use of antibiotics.

Ozone can also be used in the postoperative phase of oral surgery, to reduce the risk of infection and accelerate the healing process. Gargling with ozonated water or using ozone gas directly on the surgical site can stimulate the natural immune system and enhance recovery. Home use of ozonated oils can also help heal an extraction site and help with pain control. This can be particularly helpful for the extraction of third molars (wisdom teeth).

8. Soft Tissue Applications:

Ozone therapy is used for soft tissue applications in dentistry, including the management of oral ulcers, cold sores, herpes virus lesions and other conditions of the tissue inside the mouth. Its antimicrobial and anti-inflammatory properties can aid in the healing process.

Benefits of Ozone Therapy in Dentistry

1. Non-Invasive Approach:

Ozone therapy offers a non-invasive alternative to traditional dental treatments. It can often eliminate the need for drilling in the case of early-stage caries (cavities) and is well-tolerated by patients. This is especially important for children needing dental work.

2. Antimicrobial Properties:

Ozone’s powerful antimicrobial properties make it an effective tool for eliminating bacteria, viruses, and fungi in the oral cavity. This can be particularly valuable in managing dental infections, rather than relying only on antibiotics.

3. Minimized Chemical Exposure:

Ozone therapy reduces the need for chemical agents such as disinfectants (to which patients or the dental team may be sensitive) and which may have side effects or pose risks of resistance development.

4. Accelerated Healing:

Ozone promotes gum-tissue healing, bone regeneration and can accelerate the recovery process following oral surgery or other dental procedures.

5. A cleaner dental office environment:

Ozonated water can be used for disinfecting the water lines used by the dental hygienist, reducing contamination by microorganisms that may be in the lines and reducing the chance for biofilm to form. It can quickly be used to disinfect and sterilize a room, whether that is a dental treatment room, a hospital room…or even a hotel room.

Summary

In summary, the integration of ozone therapy into the field of dentistry is an exciting and evolving development. Its historical roots in disinfection and healing, combined with its contemporary clinical applications, make it a valuable tool for dentists seeking innovative and minimally invasive approaches to oral health and patient care.

With continued research and clinical experience, ozone therapy in dentistry holds promise for increased growth as a complementary and effective treatment option. As with any dental therapy, clinicians should be properly trained and stay current with best practices and guidelines to ensure the safe and effective use of ozone in patient care.

Home use ozonated products for DIY

In recent years, there has been a growing interest among patients in harnessing the potential of DIY ozone applications in dentistry. These methods often involve readily available products like ozonated oils, which can be used to support oral health at home. However, understanding the principles and limitations of DIY ozone use is essential for safe and effective application.

1. Ozonated Oils:

Ozonated oils are commercially available and can be a convenient option for at-home ozone therapy. These oils, often infused with ozone gas, are used for various purposes in oral care. Patients should closely follow the product’s instructions to ensure proper use and avoid misuse.

2. Dental Caries Prevention:

Ozonated oils can be used to support dental caries prevention as part of a daily oral hygiene routine. A small amount of ozonated oil applied to the teeth can help inhibit bacterial growth and encourage enamel remineralization. This approach should be used in addition to regular brushing and flossing – not replace it. [18]

3. Gum Health Maintenance:

For patients with a history of gum disease or persistent oral health issues, the use of ozonated oils can be a supplementary measure between dental visits. Gently massaging ozonated oil into the gums may help reduce amounts of harmful bacteria and support gum health. However, professional dental care remains essential. Consultation with the treating dentist is recommended – but again, approach this topic carefully (…or even ‘diplomatically’) when initiating a discussion of ozone therapy with a dentist who may not be on board with its use.

4. Postoperative Care:

After oral surgery, patients can utilize ozonated oils to promote postoperative healing. Applying ozonated oil to the surgical site or using it for oral rinses may assist in reducing the risk of infection and speeding up the recovery process. Observing the above caveat, consultation with the treating dentist is recommended.

5. Soft Tissue Concerns:

Patients experiencing oral ulcers, cold sores, or other soft tissue issues can explore the use of ozonated oils. These products may help alleviate discomfort and expedite the healing process. They should follow product guidelines and consult with a dental professional if the condition persists.

Important Considerations for DIY Ozone Use:

Safety and Adherence: Patients should prioritize safety by strictly following the instructions provided with ozonated products. Overuse or improper application should be avoided. More is not necessarily better – and could make things worse.

1. Professional Consultation:

Before initiating any DIY ozone therapy, patients should consult their dentist. Dental professionals who are trained in ozone use can offer guidance on how to effectively use ozonated oils in their home oral care routine. As mentioned, this may involve adding an ozone-friendly dentist to your health-care team!

2. Supplement, Don’t Replace:

Ozonated oils should be viewed as a complement to professional dental care, not a substitute. Regular dental check-ups, cleanings, and treatments are essential for maintaining oral health.

3. Monitoring and Feedback:

Keeping the dentist informed about DIY ozone therapy use and any changes in oral health is crucial. Regular dental check-ups help track progress.

4. Legal and Regulatory Awareness:

Patients should proactively research and be aware of legal and regulatory considerations related to ozone therapy in their state or country. Some areas may have restrictions on the sale and use of ozonated products.

Insurance:

And, no, ozone therapy is not covered by medical insurance, as it is not FDA approved for medical use, as noted earlier.

Although Ozone is accepted and allowed for dental use, at this time dental insurance does not cover it – BUT that may change!

Conclusion

DIY ozone use – especially when combined with ozone use in the practice of dentistry – empowers patients to actively participate in – and potentially optimize – their oral health. When used alongside professional dental care – and under the guidance of a dentist trained in the use of ozone – ozonated oils can:

1. Provide additional support for dental caries prevention

2. Provide gum health maintenance

3. Facilitate postoperative care

4. Address soft tissue concerns

Patient safety, professional consultation, and a holistic/biologic approach to oral care are key to the successful integration of DIY ozone therapy.

References:

2 Comments

Healthy Mouth Media on November 2, 2023 at 09:43

Hi Jill,

That is a really great question! Have you asked your dentist? If the practice uses ozonated water, they should have literature on the safety of ozone from the manufacturer of the ozone generator they use in their office. That may cover consuming it, as well as its use for dentistry.

It should be noted that ozone water is highly unstable, and the ozone will break down into its components of water and oxygen in under 30 minutes.

The quick answer to your question is: swallowing smaller amounts is generally considered safe. However, I could find no definitive research on drinking ozonated water and its effect on the gut microbiome. Bear in mind, also, that the human body generates small amounts of ozone naturally, to fight infection.

That said, there is quite a bit of anecdotal (observational, not based specifically on controlled scientific studies) evidence that drinking ozonated water can be beneficial for people known to be suffering from specific gastrointestinal issues because it kills the bad (or excess) bacteria, viruses, yeasts and parasites that may be causing the problem. The ozone will also kill beneficial bacteria, but beneficial bacteria normally regenerate more quickly than bad bacteria, thus giving the gut a chance to equalize and reduce inflammation caused by the previous imbalance.

There is little research specifically on your question and the scientific literature offers very differing opinions. Because the FDA has come out strongly in 2019 against the use of ozone – outside of very controlled circumstances for disinfection – there has been little to no research in the US on medical ozone. However, there is a huge amount of research on ozone use in the dental field, and its excellent disinfection and tissue regenerative properties. All the dental research studies I could find deal ONLY with the use of ozone in the oral cavity.

One last word of caution: do NOT inhale ozone gas, it is toxic and can cause serious lung damage. Using ozonated water has been shown in some studies to make asthma worse.

A long answer to what, I’m sure, seemed a simple question.

Thanks for asking!

Dr. Scott Saunders
Jill on November 1, 2023 at 14:08

Hi Dr. Saunders,

My dentist has patients swish ozonated water in our mouths and then swallow it prior to starting a dental cleaning. I am fine with swishing it in my mouth but am wondering your thoughts on if it is safe or wise to swallow the ozonated water or if swallowing it will kill good microbes in my digestive tract.

Thanks,

Jill

The Many Uses of Ozone in Dentistry