West Palm Beach Dentist

Ozone TherapyWest Palm Beach, FL

Like oxygen and or hydrogen, ozone is a gas that is naturally found in the air all around us. It is the high-altitude presence of thick ozone that provides a protective barrier between earth and the sun. It may seem odd to hear that this gas is regularly used in the medical and dental fields, but its benefits cannot be understated. In our field, medical grade oxygen is activated using specialized tools to create ozone, which is completely safe, natural and very effective in a number of treatments.

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    The most notable benefit of medical ozone is the gas’s ability to kill bacteria, viruses, fungi, even parasites, within just a few seconds of application. This gas, is known to elicit a number of actions in the human body, including detoxification, antimicrobial, analgesic, and immunostimulating. Including this modality in many of our treatments, we believe we present the patient with the greatest degree of advantage in facilitating oral health. Some of those advantages we use her at Pure Dental Care include:

    • The prevention of dental caries through prophylactic treatment.
    • Treatment of periodontal disease and maintenance of healthy gums, reduction in the number of harmful bacteria that attack teeth and gums, especially in periodontal treatment. Irrigation with ozonated water Ozonated water can be used to irrigate the affected area during and after scaling, root surface planning, and non-surgical pocket curettage.
    • Enhancing the remineralization of tooth structure.
    • Creating a clean tooth surface prior to placing the filling
    • irrigation of surgical site after tooth has been extracted

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    Ozone therapy is a painless treatment to receive, ozone is the ideal first-line treatment to early signs of infection. We incorporate ozone in instances where the area of decay resides in the deeper layers of enamel. In such instances, Dr. Keith removes the decayed tooth structure, cleans the area with ozone gas or ozonated water, and restores the area with biologically sound materials. Ozone therapy has been proven safe and effective, which is why we use it in a vast majority of our procedures. To experience better oral health, contact Pure Dental Care for your holistic dentistry consultation.

    Ozone in gaseous form

    A customized suck down thermoformed hard or medium-soft dental appliance should extend 2-3 mm beyond the affected gingival area, leaving a free space for gas circulation. 2 ports are attached for the gas inlet and outlet respectively at the distal and mesial of the treatment area. The edges of the appliance are lined with light or medium body silicone. The ports to the generator and the suction pump is attached. This procedure will treat both hard and soft tissues of the affected area.

    Irrigation with ozonated water

    Ozonated water can be used to irrigate the affected area during and after scaling, root surface planning, and non-surgical pocket curettage.

    In-office and home use of ozonized olive oil

    After in-office treatment with ozone gas or ozonated water, pockets are filled with ozonized olive oil using an appropriate tip. Patient can be given some of the oils for home use. In-office ozonized oil application can be repeated once a week.

    Biological Actions

    Antimicrobial effect

    Ozone works destructively against bacteria, fungi and viruses. The antimicrobial effect of ozone is a result of its action on cells by damaging its cytoplasmic membrane due to ozonolysis of dual bonds and also ozone-induced modification of intracellular contents because of secondary oxidant effects. This action is selective to microbial cells but does not damage healthy human body cells because of their major antioxidative ability.

    Immunostimulant effect

    One of the most complex and perplexing problems in dentistry today is infection control. The oral cavity is a sea of microorganisms normally living in balance with the entire human body. Under certain conditions pathogenic or "disease causing" microorganisms can become the dominant life forms, thus creating what we call infection. These pathogenic microorganisms live together in what is called a biofilm. This biofilm supports a mixed type of infection made up of bacteria, viruses, fungi and even parasites. The difficulty is that each of these disease-causing types need a different drug to eliminate its dominance. What if we had an agent that could treat and eliminate the infection and in addition support the surrounding healthy tissue without toxic side effects? We do now with oxygen/ozone therapy for dentistry.

    Biosynthetic effect

    It activates mechanisms of protein synthesis increases number of ribosomes and mitochondria in the cells. These changes on the cellular level explain elevation of functional activity and regeneration potential of tissues and organs. Ozone improves the metabolism of inflamed tissues by increasing their oxygenation and reducing total inflammatory processes.


    Oxygen/ozone, when introduced into the living system, creates what is called a "transient oxidative burst". The infective microorganisms have no natural defense against this reaction, and, as a result are overstressed and die. Thus, oxygen/ozone disinfects the area treated, both safely and effectively. This oxidative burst also induces a multitude of natural biochemical and physiological reactions. These reaction include better blood flow, enhanced immune response, and a more rapid healing response.


    Staying within the accepted standard of care, with proper application, oxygen/ozone can enhance the outcome in all aspects of dentistry. For example , periodontal disease is a chronic gum and bone infection . By utilizing the different application forms of oxygen/ozone such as ozonated water, ozonated oils, and placing oxygen/ozone directly into the infected gum pockets, periodontal disease can be arrested without the use of pharmaceutical drugs and associated side effects.

    Another area of concern is infected root canals. Oxygen/ozone therapy sterilizes all aspects of the tooth, even into the smallest canals and tubules. This allows for a truly biological root canal and thus preservation of your natural teeth.

    Tooth decay or caries, which is really a 'tooth infection," can be arrested almost immediately upon proper exposure to oxygen/ozone therapy. This procedure is especially useful when treating children, as minimal to no drilling of the tooth is necessary.


    The scientific literature is vast in support of the effectiveness and safety of oxygen/ozone therapy. Historically, it was a Swiss dentist, E.A. Fisch in the early 1900's who introduced the concept of oxygen/ozone in dentistry, followed by Dr. E. Payyr who introduced this treatment into the medical community. Scientifically we now understand how and why oxygen/ozone therapies work so well. This has led to many treatment advances in the last number of years, especially in dentistry. Recently, the International Academy of Oral Medicine and Toxicology reviewed and accepted Oxygen/Ozone in Dentistry as scientifically valid.


    No, it is impossible to be allergic to oxygen/ozone. Ozone is just energized form of oxygen. Ozone is naturally formed by the sun and lightning in the storms. Without the ozone layer high in the atmosphere, life could not exist on our planet. Ozone actually filters out the sun's harmful ultraviolet rays and, in addition, makes for that beautiful color in the sky.


    You don’t have to look far! Dr.Elizabeth Keith is trained in the use of Ozone therapy in dentistry.

    To find a dentist who is trained in oxygen/ozone therapy, contact the INTERNATIONAL ACADEMY of ORAL MEDICINE and TOXICOLOGY (IAOMT), or the international training center for ozygen/ozone therapy in dentistry at the AMERICAN COLLEGE of INTEGRATIVE MEDICINE and DENTISTRY.

    Evidenced Based Research into Ozone Treatment in Dentistry – An Overview

    Introduction - Dental Disease in Present Day

    The beginning of the 21st Century has seen a quiet revolution in the technology available to detect and arrest dental caries. Research from early 2000 – 2001 started to look at the chemistry of a gas that had been used in medicine for the previous 150 years. Microbiological studies confirmed that this gas could eliminate entire tooth micro-organism ecological systems in seconds, leaving a virtually sterile surface and dentine structure that would predictably remineralize. At last, it seemed that the dental profession has discovered the magic bullet that it had sought for many years that could arrest and reverse the carious process. It would go without saying that the patient and the dentist would undoubtedly prefer this option. There would be no fear, injections, drilling, filling, failed restorations or entry into the cyclic pathway of ever destructive and increasingly costly restorative dental care. The technology that has made this possible uses the well-documented properties of ozone gas. There are a number of portable ozone generators designed especially for dental use and the treatment of intra-oral lesions of the hard and soft tissues. Ozone has been in use in dental hospitals and general dental practice for several years now.

    Conventional Treatment

    The generally perceived wisdom has always been that dental caries is an infective process and the only real ‘treatment’ option was the cutting away, or ‘amputation’ of all diseased tissue and its replacement with some form of restorative material. This is the teaching that most dental students still receive at dental schools around the world today and is practiced by the majority of dentists world-wide. Once the tooth is drilled because of dental decay or trauma to the tooth, the tooth is condemned to a cycle of restorative care that becomes more expensive and complex as it fails and has to be replaced. Some individuals may attain a state of oral health that sees them achieve stability for many years, but the vast majority will continue within this cycle of restorative destruction and replacement.

    Minimal Invasive Dentistry

    There has been a movement towards cutting smaller preparations, towards an approach of minimally invasive dentistry, with the associated benefits to both the dentist and the patient. Many techniques, however, still involve the physical removal of tissue before the final restoration is placed. The ideal treatment solution is the simple removal of the disease process with no associated loss of sound tissue and no associated physical discomfort for the patient. This is now available with recent advances in the field of ozone treatment. For the first time, the dentist can break the ongoing circle of restorative dentistry. It would appear that this cycle is no longer necessary in order to place an initial restoration, which will require eventual replacement and subsequent re-treatment.

    The first record of ozone use in dental care was by a Swiss dentist, E.A. Fisch, who used ozone in dentistry before 1932 and introduced it to the German surgeon Erwin Payr who used it from that time. However, ozone seems to have disappeared from usage in dental care until 2001 when the first scientific studies were published examining the bacterial species found in dental caries, before and after treatment with ozone. These studies showed that acids produced by bacteria were oxidized to less acidic products. These oxidative by-products adjusted the lesion pH to being more alkaline, allowing a net gain of minerals by the lesion. This remineralization process is the fundamental by-product of ozone treatment that leads to predictable mineral uptake by a treated surface. By eliminating the acid niche environment, the lesion can undergo a natural mineral uptake, in essence, healing itself. Many studies have shown that caries reversal is possible, but it is impossible to predict which lesions will, and which will not reverse.

    Ozone treatment, combined with added oral hygiene products that increase the oral fluid concentration of bio-available minerals, makes this remineralization process predictable.

    Diagnosis of Demineralisation (tooth cavity starting)

    Integration of ozone treatment into the operatory environment totally change the dentist’s approach to the treatment of his or her patients. When looking at dental caries and the potential treatment of the carious lesion. The dental probe is limited in detecting caries in that the cavity has to break the enamel and dentine of the tooth before we can detect the damage. Examination based on the use of a digital intra oral camera combined with digital radiographs (xrays) and the dental probe are all used to detect caries (decay). The holistic dentist looks towards prevention and long lasting restorative treatments. Thus, the detection of demineralization within the enamel layer is of paramount importance, before the carious process has an opportunity to penetrate into the dentine. The studies show that ozone in its oxidative pathways has a profound effect on the remineralization for enamel.

    Patient acceptance of Ozone treatment

    In the past number of years continual advances in both materials science and treatment methods have brought outstanding benefits for our patients in terms of simplicity of treatment. Successful dentine bonding systems have obviated the need for the design of a retentive cavity in most cases and hence dramatically reduced the use of the air turbine handpiece to design what may be termed as classical cavity preparations. These bonding systems have allowed dentists to concentrate almost exclusively on the removal of carious tissue while retaining as much sound hard tissue as is possible. This is a first step towards the minimally invasive approach, now advocated. However, this carious tissue must still be removed whether by use of the handpiece, air abrasion or with hand instruments when used in conjunction with caries removing liquids and gels. Ozone treatment in dental caries remineralization reduces the requirement for physical removal of all diseased tissue (affected dentine) as the dental profession is now promoting remineralization and not the amputation of carious dentine. Ozone is key in promoting this cleansing and sterilization of the tooth surface prior to filling with a biocompatible material which is BPA free.

    The benefits to patients are, therefore, obvious. For most patients, fear and apprehension arise from their perception that the use of the handpiece may be an unpleasant and possibly traumatic experience. This, combined with the requirement for local anesthesia, the fear of which is virtually universal, has led to the widespread view that the visit to the dental office is an unpleasant one. In the employment of ozone treatment, dentists now have the capability to alleviate those concerns and change the public’s perception of dental treatment as a whole. Of course, there are still situations where treatment will follow more classical lines. However, these instances are becoming increasingly rare. Patient acceptance of ozone therapy is therefore, universal. Dentists can offer treatment of a wide variety of carious lesions where there is no need for local anesthesia, no need for drilling, and treat many lesions in a very short space of time, totally painlessly and totally atraumatically. Patients are delighted after this type of treatment and are particularly motivated towards oral hygiene home care and dietary control when they realize that in improving and concentrating on these areas they can effectively avoid the local anesthesia / drill approach.

    Uses of Ozone in the General Dental Practice

    Ozone and Caries Management

    According to “The Niche Environment Theory”, a “bacterial niche” is established within a carious lesion. Bacteria are far from the ‘simple bugs’ as they are often referred to. They have survived for billions of years. Humans have a minute time frame of existence in comparison. The dental profession should not be surprised to learn that bacteria set up complex interactions with other bugs, ‘talk’ to neighboring colonies when times are good and call for help from others when their host attempts to change their environment. Protein coatings, plaque and debris are known to protect these colonies by reducing the effect of pharmaceutical agents designed to eliminate these bacterial colonies.

    Progression of the carious lesion occurs when conditions are suitable for acidogenic bacteria to release acid as a metabolic by-product. The acid produced may lead to a breakdown of mineralized tooth structure. At times, an equilibrium situation may occur when the rate of re-mineralization equals the rate of de-mineralization. Ozone has the effect, through its powerful oxidizing properties, of not only removing the protein protection and being bactericidal, but also oxidizing the biomolecules that allow the niche to survive and expand.The oxidative process kills the damaging bacteria, fungi and virus and allow healthy cells to grow and promote remineralization of tooth surface. This effect of ozone application has a severe disruptive effect on the bacterial population in the carious lesion and obliterates the cariogenic bacteria and their ecological niche, thereby swinging the equilibrium in favor of re-mineralization. No more acid can be produced within the lesion when the acid-producing bacteria are eliminated. For example, the acid Pyruvate, one of the strongest naturally occurring acids manufactured by bacteria, and implicated in the progression of caries, is oxidated by ozone to acetic acid and carbon dioxide. Acetic acid is less acidic than pyruvate, and this decarboxylation reaction leads to mineral uptake due to the more alkaline conditions in a carious lesion. The lesion will become populated with normal mouth commensals, which do not produce acid, after ozone therapy.

    Treatment of pits and fissure carious lesions

    Ozone is used in conjunction with fissure sealants at the eruption of permanent dentition and as prophylaxis in populations at risk of rampant carious lesions. Current protocols for fissure sealants are the use of a bristle brush and pumice to clean the occlusal surfaces of teeth prior to sealing. However, it is known that food debris and bacteria will remain impacted at the depths of the fissures. Fissures are tear-drop shaped on cross section. Subsequent micro-leakage will allow the acid-niche to resume its activity, so that over a period of time, the surface can collapse into a large carious cavity. However, air abrasion powders will flush out the debris, prepare the fissure for either acid etching or placement of glass ionomers and produce a more reliable sealing along the fissure edges.

    Early diagnosis of primary pit and fissure caries is of great importance in children and adults because it minimizes the extent of damage and thus treatment needed to restore the tooth to health and may even prevent the loss of the tooth. Lesions have a natural history of deepening into dentin, leaving a macroscopically undamaged surface enamel. Minimal mineral loss prevents x-rays showing clear evidence of decay and no macroscopic cavitation shows any probe stickiness. The dental probe was found to be 40% effective in determining whether a cavity was present or not. Systems using indirect light fluorescence have been demonstrated effective in the clinical diagnosis of decay in permanent and in deciduous dentition.

    Published studies using ozone therapy, have shown a reversal rate of from 84% to 99%,. Periodic ozone treatment is combined with oral hygiene instruction, strict usage of remineralization products, where reversal rates of 99% can be achieved. This would point to the development of a treatment protocol that starts with changes in oral hygiene and home care, ozone treatment on a regular basis and the use of remineralizing mouthrinses and pastes. In this way, the treatment outcome becomes much more predictable. Ozone is used in conjunction with fissure sealants at the eruption of permanent dentition to prevent cavities.

    Ozone treated non-cavitated pit and fissure caries lesions had no adverse effects when followed for twelve months. Remineralization, in the ozone treated group, had already occurred at the first month recall visit. Fissure sealants applied over ozone treated lesions did not affect short-term or 1 year retention rates. Significantly, more lesions became arrested in the ozone treated teeth and this translated to less dental procedure requirements being required for the affected teeth. Therefore, ozone treatment is a clinically proven alternative treatment for non-cavitated occlusal pit and fissure caries.

    The combination of ozone treatment with fissure sealants, both carried out on the same patient visit, did not reduce sealant retention. A therapeutic approach for initial lesions, to allow more remineralization to occur after the ozone treatment and before the sealant is applied, can be achieved by fissure sealing on a second visit. Other combinations of treatments, along with ozone, can include fluoride applications.( However , fluoride is always a controversial mineral).

    Treatment of deciduous teeth lesions

    Dental treatment of young people can have long lasting effects. If dental care is painful and unpleasant, as these patients grow into adults, they will tend to only attend when if pain. As all dentists know, at this stage, restorative care tends to be more difficult and more extensive. The use of ozone and mineral releasing glass ionomers can play a significant role in the dental management of these patients. As confidence in the treatment by the patient and parents or guardians is gained, so the compliance with important oral hygiene message will be increased.

    Where caries is found, it is simple to treat. The application of, for example, FujiVII (GC Japan) will supply long-term fluoride and mineral release, as well as preventing the ingress of food debris and re-establishment of the acid-niche environment. Treatment is simple and fast (the average ozone time for practitioners using ozone is 30 seconds) and involves little preparatory work. The loose debris is first cleaned away, until a leathery base is reached. This can be done with air abrasion or hand instruments. Ozone is applied. The lesion is wetted with a remineralizing wash and then the glass ionomer can be applied.

    Treatment of the larger carious lesion

    Where caries has penetrated into the deeper dentinal tissue, ozone still has a role to play. In these cases, the loose debris is first removed to the leathery subsurface, ozone is applied, and glass ionomers can be applied followed by the filling or crown or inlay/onlay restorations.

    Root Canal Therapy

    The aim of conventional root canal therapy is to provide a clean, well shaped, root canal that facilitates the placement of root filling systems. As practitioners adopt some of the newer obturation systems, the need for shaping decreases. In the apical area multiple canals linked by a “web” of accessory canals may be found. This is the so-called “apical delta” with the common lateral canals. Until recently, the dental profession relied on irrigants to reach these remote areas to disinfect and dissolve organic debris where it is impossible to instrument mechanically. In cases where previous root canal treatment has failed, bacteria seems particularly prominent and especially difficult to eradicate. Ozone will eliminate this bacterial species. It is also postulated that ozone will penetrate through the apical foramen and enter into the surrounding and supportive bone tissue. The effect of ozone on these tissues will be to encourage healing and regeneration.

    Studies on Ozonated Oils

    Some ozone units for use in a dental setting are manufactured to a design that makes it impossible for free ozone to be released into the oral cavity and into the oro-nasal complex. In the same way that some antibiotics have various delivery systems (for example a liquid, capsule and cream presentation), practice has shown that an alternative delivery system for ozone would be an advantage. Ozonated oils are not new, and have been manufactured for a number of years. Call Pure Dental Care to find out how we use ozonated olive oils to help healthier you!

    In Conclusion

    Ozone therapy provides a treatment modality with considerable benefits for dental patients of all ages. It is applicable to a wide range of conditions of the intra-oral hard and soft tissues. The current published research shows that the prevention and treatment of carious lesions and periodontal disease is effective and is made much more acceptable for the patient. This makes it especially relevant to the younger patient, who may find conventional treatment unacceptable and also for the elderly, who may have medical problems, which may complicate conventional dental treatment. The treatment is simple, completely safe to provide in conjunction with traditional dental treatments. Ozone certainly has a major role to play in a preventative and treatment disease.