Comments on how Ozone affects caries by Julian Holmes

How ozone is the missing link in caries control and reversal

Subject: How ozone is the missing link in caries control and reversal

I have been asked by several members of the group to explain exactly how the application of ozone leads to caries reversal and remineralisation. For those of you who have your units, please accept this as revision, and if you want to comment, mail me! I am away from the end of this week until Wednesday next week; Prof Lynch and I are lecturing in Hong Kong from where I hope to send you an update on this symposium. Caries reversal using ozone.

Caries is a multi-factorial disease process. Fermentable carbohydrates alone do not cause caries. Other ingredients are required, like bacteria, surfaces for attachment, proteins, and a supply of substrate that the bugs can use to live. Far from being simple, bugs are very complex, which of course would explain why they have existed for many millions of years almost unchanged, compared to humans who have occupied a very small time-scale period of the world's history. We know from some of the work carried out at Porton Down Government Labs, that bugs talk to each other with chemical messages. For example, when a collection of bugs find a niche to exploit, they send out messages to attract more bugs into the area. And if the host tries to change the environment to make it less favourable for them, chemical messages are sent out that attract different bug species that attempt to change the environment back to the status quo. Clever bugs eh! Up to the last few years, as I am sure you are aware, there has been a large volume of research looking for the `perfect' treatment regime to halt and reverse decay. But if you read this research, there is no simple system, and even where it could be shown that caries reversal could be achieved, it was unpredictable, and often could not be taken from one study area to another and made to work in the new location. The early research looking at chlorhexidine, fluoride, oral hygiene, triclosan and so on all showed the same results; ie unpredictable, and for the main, no positive results! But it was shown that carious lesion could re-mineralise given the right conditions. The concept of a balance between mineral loss and gain as the oral environment changed from basic to acidic to basic was well researched and established, and the concept that saliva contains all the minerals a tooth surface needs to re-mineralise was accepted by the profession. But lets face it, for the vast majority of patients, the regime required was time consuming and required a huge amount of time investment on the part of the dental profession and the patient. Sadly, in the UK and other countries, patients just are not prepared to make this investment, despite the clear benefits. Then came along a whole series of studies that showed the dental profession that we were not actually measuring the disease process correctly, so there were a number of studies that laid down clinical criteria for diagnosis and classification of carious lesions. Then in the late 90's came the first results of studies looking at the effect of ozone on microorganisms. 20 seconds, for example gave a log reduction from 7 to 0.4, or in plain English, 7,000,000 colony- forming units, to 0.4 CFU. In other words, as you cannot have less than one bug, this must be background contamination. Then the ground breaking PhD by A Baysan and Primary Root Carious Lesions (PRCL's) in 2001, and since then a growing number of papers and abstracts from research areas showing the effects not just on bugs, but the bio-molecules (their waste products) they produce to form the acid niche environment ANE. The key to understanding how ozone has revolutionised dental caries management is from the H NMR studies. In these studies, small samples of caries are exposed to high magnetic fields. Samples before ozone treatment show high spikes of pyruvic acids for example, one of the most important acids that is involved it the establishment of the ANE. Samples after ozone treatment show acetates and carbon dioxide, known break down products of these bio-molecules.

So what is happing at the caries site?

Ozone is delivered at a concentration of 2,100(+/- 10%) ppm. At this concentration, it first de-natures the protein coat, the pellicle. Studies have shown that this `protects' the ANE and does not allow pharmaceutical products to penetrate it to knock out the bugs. Once denatured, ozone then oxidises the micro-flora. Then as there is a continual feed of ozone into the cup area, the ozone begins to penetrate the carious lesion, oxidising the bio-molecules, so neutralising the ANE to its entire depth. Of course in deep lesions, more time is required to allow full depth penetration, so for those of you in the early days who did not get a good result with large lesions at 10 and 20 seconds, this is why; the ENE was left intact in the deeper lesions, and the carious lesion re- established within the 14 weeks in preference to remineralisation. Also, as the ANE still existed at the base of the lesion, it could be postulated that this prevented mineral penetration into this base area. So the idea of 40 or more seconds for the large lesions, and continual treatment for the 99+ lesions seems to have sorted the poor results some of the early users were having with large lesions. Many people at both the courses and lectures Prof Lynch and I have been at, have asked what is the point of sterilising the tooth surface and lesion, if when the patient licks the tooth, it will be re-infected. Of course this will happen. But having eliminated the ANE, and restored the balance of oral flora of the lesion to a balance between good / bad bugs, reinforced oral health, prescribed remineralising washes and pastes, the lesion has little alternative than to go through the process of mineral gain, ie remineralisation and caries reversal. The whole balance has been shifted from that of mineral loss, to that of mineral gain. By slightly modifying the way the HealOzone Patient kit is used, it can be made to be even more effective. These products have a large concentration of bio-available minerals. If the paste is smeared over the treated lesions, and the pump spray used 3-4 times each day (just two puffs at each application) the bio available mineral concentration in the saliva is so huge that remineralisation has to occur in preference to mineral loss and re-establishment of the ANE, leading to active caries. My study just sent for publication shows 100% reversal of PRCL's in the treated group. Compare this to those lesions not ozone treated. They are in the same mouth, are exposed to the same oral hygiene care, mineral washes, etc, etc, but only 1% reversed, 59% stayed the same, and 40% got worse. Hence a recent comment that `the elimination of the biofilm is just a small part of treatment' is essentially correct, but misses the whole point of the system that the key to successful caries reversal is elimination of the ANE. The references for those who want to do a little more reading around this posting are below. This does concentrate on PRCL's but will give you a firm basis on which to understand the concepts and issues that I have discussed above.

Regards, Julian

References:

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