QuickScan Reviews in Pediatric Dentistry, May 30 2009

Background: We continually look for better ways to slow down or hopefully even arrest the caries process. It is well known that oxygen, particularly in the form of ozone, can be effective in reducing the number of or even killing cariogenic microflora. Recently, a device had been developed to manufacture and deliver ozone in situ, on the tooth, with the intention of killing the caries-causing bugs and thereby halting the progression of demineralization. Objective: To evaluate the HealozoneTM device in terms of its ability to kill a variety of cariogenic organisms based on delivery time of the ozone and whether or not the surface treated was contaminated with saliva. Methods: Caries-causing bacteria of the genera Actinomyces , Lactobacilli , and Streptococcus in either a buffered saline solution or in saliva were treated with 10-, 30or 60-second exposures of ozone and were cultivated on agar plates in vitro. The percentage of bacteria of each of the genera with the various treatment times, and with or without saliva contamination was calculated. Results: After 10 seconds of exposure to ozone, the vast majority of bacteria of each type were killed. After 10 or 30 seconds of exposure, the Lactobacilli and Streptococcus types of bacteria were less efficiently killed when contaminated with saliva, but after 60 seconds, even with saliva contamination, nearly all bacteria were killed. The results of this study are consistent with those of many other in vitro studies and a few clinical studies that have examined the killing effect of the Healozone device on cariogenic bacteria. Other work has also shown that removal of debris and biofilm from the surface has aided not only in kill rates of the microflora, but also in halting progression of existing caries demineralization. Work by Lynch and others has, in several clinical instances, shown that even when leathery-type demineralization was exhibited clinically and was subsequently treated with the Healozone device, progression of lesions can be halted. Some early work has even shown reversal of lesions in the form of increase in dentin microhardness suggesting remineralization. Conclusions/Reviewer's Comments: The present study shows only the core potential of the Healozone device to kill caries-causing bacteria. This work combined with the work of other studies showing the need to debride the surface might yield better clinical findings in a study designed to test the combined effect of some caries-affected tooth structure removal combined with ozone therapy. In considering better ways to treat the earliest manifestations of early childhood caries on the lingual surface of primary incisors, this combined technique might yield benefit.