Abstract
Ozone has been used as an antibacterial agent for various purposes in healthcare. The use of ozone in dental practice is also well-established. Its utilization as a mouth rinse needs to be explored for further application in clinical practice, especially for cases of gingivitis, a common complaint. This systematic review aims to analyze the literature on the effects of ozonated water in managing gingival inflammation and bleeding across diverse populations. A systematic search adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted in PubMed, MEDLINE, Embase, and Cochrane. Studies published between January 2012 and December 2023 employing ozonated water as a treatment for gingivitis or gingival bleeding were included. Five studies met the inclusion criteria, demonstrating the varied efficacy of ozonated water. While some studies showed promising results in reducing bleeding and gingival inflammation, others indicated limitations compared to chlorhexidine. Methodological heterogeneity and lack of standardization were notable. The evidence suggests potential benefits of ozonated water in managing gingival inflammation and bleeding, but methodological variations hinder conclusive findings. Long-term studies with larger sample sizes and standardized protocols are needed to establish the effectiveness of ozonated water as an adjunctive therapy for gingival health.
Introduction & Background
Oral diseases represent a significant global health concern, with a well-established bidirectional relationship between systemic health and oral cavity status . Conditions like diabetes mellitus, cardiovascular diseases, and respiratory disorders can manifest initial symptoms within the oral cavity, highlighting the critical link between oral and overall health. Therefore, maintaining optimal oral health is crucial for preventing and promoting overall well-being . Gingivitis and periodontitis are inflammatory oral diseases triggered by the accumulation of microbial biofilms on tooth surfaces, commonly called dental plaque . Gingivitis signifies the initial inflammatory response of oral tissues to dental plaque, characterized by gingival redness, edema, and bleeding on probing . When left untreated, gingivitis can progress to periodontitis, a more severe condition involving progressive alveolar bone loss and potential tooth loss . Historically, dental interventions focused primarily on invasive treatments rather than preventive measures. However, contemporary approaches emphasize the importance of preventive strategies for optimal oral health . Plaque management, a cornerstone of preventive oral care, relies on mechanical procedures and specific chemical agents.
While tooth brushing is a widely recommended mechanical method, chemical approaches often use anti-plaque agents containing chlorhexidine or alcohol . However, the emergence and increasing prevalence of antimicrobial resistance against these conventional agents necessitate exploring alternative strategies . Ozone, a naturally occurring trioxygen gas known for its protective role against ultraviolet radiation, also possesses noteworthy medicinal properties . Notably, ozone dissolved in water decomposes rapidly into highly reactive hydroxyl radicals with potent oxidizing capabilities . These properties confer ozone with diverse therapeutic effects, including bactericidal, virucidal, fungicidal, immune-modulatory, and anti-inflammatory benefits, making it an attractive option for various dental applications . Gingivitis prevalence increases in individuals with predisposing factors, such as diabetes and smoking . With its broad-spectrum antimicrobial activity and lower toxicity than conventional agents, ozonated water presents a promising alternative for managing gingivitis . This systematic review aims to comprehensively evaluate the existing literature on the efficacy of ozonated water, specifically focusing on its potential to manage gingival inflammation and bleeding in diverse populations.
