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Effect of ozone on dental caries and on cariogenic microorganisms
Umeå universitet, Medicinska fakulteten, Institutionen för odontologi.
2012 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

There are a number of unanswered questions regarding new caries preventive methods such as ozone treatment as well as novel caries detection methods that monitor and evaluate these preventive methods. This thesis seeks answers to some of these questions.

Aims: Paper I investigates the in vitro sealing capacity of a novel ozone delivery system and its re-suction capacity. Paper II studies the in vitro antibacterial effect of ozone on cariogenic bacterial species with and without the presence of saliva and its possible effect on the saliva proteins. Paper III assesses the in vitro validity of laser-induced fluorescence (LF) measurements, visual inspection (colour), and tactile examination (surface texture) on root caries lesions and correlates these with histopathological measurements of lesion depths.  In addition, Paper III investigates how inter-device, inter-examiner, and intra-examiner levels influence LF reading agreements and whether lesion colour and surface texture influences LF readings. Paper IV evaluates the in vivo effect of ozone and fluoride varnish treatments on occlusal caries in primary molars.

Material and methods: Paper I: Full ozone application cycles, including the re-suction period, and interrupted cycles with displacement of the cup during the delivery cycle were studied using an ozone air analyser. Paper II: Ozone gas was exposed to the bacteria in the solution’s buffer and saliva via a tube connected to the ozone generator for 10, 30, and 60 seconds. Paper III: Calibrated examiners assessed lesion colour and surface texture and performed measurements with two LF devices for three separate one-week intervals.  Sections (300µm thick) of 64 out of 93 teeth were obtained and examined under a microscope. Lesion depth was assessed with two references: from the delineated borderline of the original exposed root surface (ref I) or, if loss of surface continuity, the absolute lesion depth (ref II). Paper IV: The split mouth study was conducted in two parts. The participants in part A were children (mean age 4.8 years) with medium-high caries risk. Inclusion criteria were bilateral matched pairs of cavitated or non-cavitated occlusal lesions in primary molars (Ekstrand index score ≤ 3). Children in part B (mean age 4.5 years) with low-medium caries risk had pairs of non-cavitated lesions only (Ekstrand index score ≤ 2a). The assessments and treatments with ozone and fluoride varnish were performed at baseline and at three, six, and nine months. At the 12-month follow-up, only assessments were performed.

Results: Paper I: Ozone leakage levels varied between 5.2 and 9.8 µg/m3. Paper II: In the salt buffer, 92%, 73%, and 64% of the initial numbers of A. naeslundii, S. mutans, and L. casei, respectively, were killed after 10 s ozone exposure and approximately 99.9% of the bacteria were dead after a 60 s exposure. After 10 and 30 s but not after 60 s exposure to ozone, S. mutans and L. casei were less efficiently killed in saliva compared to in the salt buffer. Various saliva proteins were degraded by ozone after the 60 s exposure. Paper III: The correlation between LF readings and histological depth was low with values ranging from 0.22 (p ˃ 0.05) to 0.31 (p < 0.05). The LF devices were significantly correlated with discolouration and with a surface texture denoted as hard. A significant correlation was found between colour and histological depth. No significant correlation was found between surface texture and histological depth. The reliability, evaluated as intra-class correlation coefficient, was 0.99 for intra-examiner, 0.97 for inter-examiner, and 0.98 inter-device level. Large differences were found between two consecutive measurements and high measurement errors indicated considerable deviation of individual measurements.Paper IV: In the first 15 pairs of part A, eight lesions treated with ozone and nine treated with fluoride, including all cavitated lesions, progressed to failure, i.e., required operative treatment during the study time. Due to non-acceptable results, the sample collection was discontinued because of ethical reasons. In part B, of 35 pairs, one of the ozone treated lesions failed at 12 months. A small shift towards increased VI scores was recorded for both ozone and fluoride lesions in this second part.

Conclusions:

- The ozone delivery system can be considered a safe system with low leakage levels in air, also with accidental displacements.

- The cariogenic species S. mutans, L. casei, and A. naeslundii were sensitive to ozone gas treatment. The presence of saliva hampered the antibacterial effect of ozone.

A low correlation between the LF readings and the histopathological depth of root caries lesions was shown. The LF device was found not to be appropriate for application to root caries diagnosis.

- Neither ozone nor fluoride varnish treatments arrested the progression of cavitated occlusal caries lesions. In low and medium caries risk children non-cavitated occlusal lesions remained mainly unchanged during the study period.  No difference in the effect of ozone and fluoride varnish treatments on occlusal caries in primary molars was seen.

Ort, förlag, år, upplaga, sidor
Umeå: Umeå universitet , 2012. , s. 45
Serie
Umeå University odontological dissertations, ISSN 0345-7532 ; 123
Nyckelord [en]
Dental caries, Ozone, Cariogenic microorganisms
Nationell ämneskategori
Odontologi
Forskningsämne
odontologi
Identifikatorer
URN: urn:nbn:se:umu:diva-59066ISBN: 978-91-7459-454-6 (tryckt)OAI: oai:DiVA.org:umu-59066DiVA, id: diva2:551881
Disputation
2013-11-27, Sal B, By 1D, Norrlands universitetssjukhus, Umeå, 09:00 (Svenska)
Opponent
Handledare
Tillgänglig från: 2012-09-21 Skapad: 2012-09-07 Senast uppdaterad: 2018-06-08Bibliografiskt granskad
Delarbeten
1. Ozone air levels adjacent to a dental ozone gas delivery system
Öppna denna publikation i ny flik eller fönster >>Ozone air levels adjacent to a dental ozone gas delivery system
2007 (Engelska)Ingår i: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 65, nr 6, s. 324-330Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Objective. Ozone (O(3)) has been suggested as an anti-microbial treatment in dentistry, with an ozone gas delivery system introduced for the treatment of fissure and root caries. The aim of this study was to investigate the sealing capacity of the novel delivery system and its re-suction capacity during accidental displacement of the cup at different stages of ozone delivery. Material and methods. Ozone leakage was studied in vitro after application on a flat metal surface and on buccal and occlusal tooth surfaces. An ozone analyzer was used to measure ozone gas concentrations adjacent to the delivering cups when adapted to the target surfaces during and after 10-20 s application cycles. The measured levels were compared with the background concentrations in the room. Measurements were performed 1) after complete ozone application cycles, 2) within the cycle before the start of the suction period, and 3) after displacements of the cup during the cycles. Results. Ozone air values varied between 8 and 166 microg.m(-3) for the flat metal surface and between 0 and 108 microg.m(-3) for the tooth surfaces. Ozone leakage levels were 7.6 microg.m(-3) for the flat and 7.4 microg.m(-3) and 5.6 microg.m(-3) for the buccal and occlusal surfaces, respectively, and 5.2 microg.m(-3) and 9.8 microg.m(-3) for the premolar and molar surfaces, respectively. Cycles with displacement showed significantly higher leakage levels than continuous complete cycles (p=0.03). Conclusions. Ozone application cycles with displacements showed significantly higher leakage levels than continuous complete cycles. The largest ozone delivery cups showed the highest leakage values. A change in background levels was seen with similar change in adjacent ozone levels. The overall measured ozone leakage values were low after normally functioning delivery cycles and after repeated displacements. The delivery system can be considered safe.

Nyckelord
Odontologi
Identifikatorer
urn:nbn:se:umu:diva-16976 (URN)10.1080/00016350701687247 (DOI)17934889 (PubMedID)2-s2.0-37049035926 (Scopus ID)
Tillgänglig från: 2007-11-06 Skapad: 2007-11-06 Senast uppdaterad: 2023-03-24Bibliografiskt granskad
2. Antibacterial effect of ozone on cariogenic bacterial species.
Öppna denna publikation i ny flik eller fönster >>Antibacterial effect of ozone on cariogenic bacterial species.
2009 (Engelska)Ingår i: Journal of Dentistry, ISSN 0300-5712, E-ISSN 1879-176X, Vol. 37, nr 6, s. 449-453Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Objective: The aim was to evaluate the antibacterial effect of ozone on cariogenic bacterial species with and without the presence of saliva and a possible effect on the salivary proteins.

Methods: Suspensions of Actinomyces naeslundii (ACTCC 12104T), Lactobacilli casei (N CTC 151) and Streptococcus mutans (NCTC 10449), in salt buffer or in saliva, were exposed to ozone gas delivered by the ozone generator Healozone™ 2130C. Aliquots of the suspensions were taken after 10, 30 and 60s ozone exposures and cultivated on agar plates. Initial number of bacteria per ml was 8.0×107 (SD 2.2×107) (A. naeslundii), 1.0×108 (SD 3.1×106) (L. casei) and 1.0×108 (SD 7.0×105) (S. mutans), respectively. The proteins were separated by SDS electrophoresis and visualized by silver staining.

Results: In salt buffer 92%, 73% and 64% of the initial numbers of A. naeslundiiS. mutans and L. casei, respectively, were killed already after 10s ozone exposure, while approximately 99.9% of the bacteria were dead after a 60s exposure. After 10 and 30s, but not after 60s exposure to ozone, S. mutans and L. casei were less efficiently killed in saliva compared to the salt buffer. Various saliva proteins were degraded by ozone after a 60s exposure.

Conclusions:The cariogenic species S. mutansL. casei and A. naeslundii were almost eliminated following 60s of ozone treatment. This killing was reduced in the presence of saliva although increasing the ozone application time to 60s overcame these reductants in saliva. Detection of altered salivary proteins indicates that saliva components constitute additional targets for ozone.

Ort, förlag, år, upplaga, sidor
Bristol: J. Wright & Sons, 2009
Nyckelord
Ozone, Streptococcus mutans, Lactobacillus casei, Actinomyces naeslundii, Saliva, Saliva proteins
Identifikatorer
urn:nbn:se:umu:diva-31885 (URN)10.1016/j.jdent.2009.02.004 (DOI)19342147 (PubMedID)2-s2.0-64549117752 (Scopus ID)
Tillgänglig från: 2010-02-21 Skapad: 2010-02-21 Senast uppdaterad: 2023-03-23Bibliografiskt granskad
3. Validity and reliability of laser-induced fluorescence measurements on carious root surfaces in vitro.
Öppna denna publikation i ny flik eller fönster >>Validity and reliability of laser-induced fluorescence measurements on carious root surfaces in vitro.
2009 (Engelska)Ingår i: Caries Research, ISSN 0008-6568, E-ISSN 1421-976X, Vol. 43, nr 5, s. 397-404Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

The aim was to assess the validity of laser fluorescence (LF), visual inspection and surface texture on root caries lesions in vitro, related to histological lesion depths. Agreement on interdevice, interexaminer and intra-examiner levels as well as the influence of discolouration and surface texture on LF readings were investigated. Calibrated examiners assessed lesion colour and surface texture and performed measurements with 2 LF devices in 3 separate series at intervals of 1 week. Sections (300 mum thick) of 64 out of 93 teeth were obtained and examined under the microscope. Lesion depth was assessed with 2 references: from the delineated borderline of the original exposed root surface (ref. I), or if loss of surface continuity, the absolute lesion depth (ref. II). The correlation (Spearman rho) between LF readings and histological depth was low with values ranging from 0.22 (p > 0.05) to 0.31 (p < 0.05). LF 1 and LF 2 were significantly correlated with discolouration (rho = 0.52 and 0.46, respectively) and with surface texture denoted as hard (rho = 0.34 and 0.33, respectively). A significant correlation between colour and histological depth ref. I (rho = 0.51) and ref. II (rho = 0.56) was found. No significant correlation between surface texture and histological depth was found. The reliability, evaluated as intraclass correlation coefficient was for intra-examiner 0.99, interexaminer 0.97 and interdevice level 0.98. Large differences were found between 2 consecutive measurements, and high measurement errors indicated considerable deviation of individual measurements. Based on these findings, the LF device is not suitable as a diagnostic tool for root caries.

Nationell ämneskategori
Övrig annan medicin och hälsovetenskap
Identifikatorer
urn:nbn:se:umu:diva-57782 (URN)10.1159/000239754 (DOI)19776571 (PubMedID)2-s2.0-70349264556 (Scopus ID)
Tillgänglig från: 2012-08-15 Skapad: 2012-08-15 Senast uppdaterad: 2023-03-24
4. Treatment effect of ozone and fluoride varnish application on occlusal caries in primary molars: a 12-month study
Öppna denna publikation i ny flik eller fönster >>Treatment effect of ozone and fluoride varnish application on occlusal caries in primary molars: a 12-month study
2014 (Engelska)Ingår i: Clinical Oral Investigations, ISSN 1432-6981, E-ISSN 1436-3771, Vol. 18, nr 7, s. 1835-1843Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

AIM: The aim of this study is to evaluate the effect of ozone and fluoride varnish on occlusal caries in primary molars in a split-mouth study.

MATERIALS AND METHODS: Caries risk was estimated by treating Public Dental Health Service dentists. Children with occlusal caries with Ekstrand index scores ≤3 (VI ≤3) were included. Selection of caries lesions was discontinued for ethical reasons due to non-acceptable clinical results during the follow-up. In the continued evaluation pairs of teeth with non-cavitated caries lesions, Ekstrand score ≤2a (VI ≤2) were selected. Fifty pairs of carious primary molars were included, 18 boys and 15 girls (mean 4.7 years, range 3-8). At baseline, the lesions were assessed by visual inspection (VI) and laser-induced fluorescence (LF), in each pair to treatment with 40 s ozone (HealOzone(TM), 2,100 ppm) or fluoride varnish Duraphat®. The treatments and evaluations were repeated at 3, 6 9 months and evaluations only at 12 months.

RESULTS: Medium-high caries risk was observed in VI ≤3 children and low-medium risk in VI ≤2a children. In the 15 pairs VI ≤3 lesions, 8 treated with ozone and 9 with fluoride progressed to failure. In the 35 pairs VI ≤2a lesions, one lesion failed. Median baseline LF values in the VI ≤3 group were 76 and 69, for ozone and fluoride lesions, respectively, and 21 and 19 in the VI ≤2a group. At 12 months, LF values in the VI ≤2a group were 15 and 18. No improvement or difference in LF values was found over time between the caries lesions treated with ozone or fluoride.

CONCLUSIONS: Neither ozone nor fluoride varnish treatments stopped the progression of caries in cavitated lesions. In low and medium caries risk children, non-cavitated lesions following both treatments showed slight or no progression. The use of ozone or fluoride varnish treatments in this regime as caries preventive method, added to the daily use of fluoridated toothpaste, to arrest caries progression in primary molars must therefore be questioned.

Ort, förlag, år, upplaga, sidor
Springer Berlin/Heidelberg, 2014
Nyckelord
T cells, aggressive periodontitis, Porphyromonas gingivalis, cytokine production
Nationell ämneskategori
Odontologi
Identifikatorer
urn:nbn:se:umu:diva-84709 (URN)10.1007/s00784-013-1160-7 (DOI)000341417400011 ()24327235 (PubMedID)2-s2.0-84947033321 (Scopus ID)
Anmärkning

Originaly published in thesis in manuscript form, by authors: Johansson, E, Karlsson, L and Andersson-Wenckert, I. 

Published online: 11 December 2013

Tillgänglig från: 2014-01-17 Skapad: 2014-01-17 Senast uppdaterad: 2023-03-24Bibliografiskt granskad

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