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Inconclusive evidence of ozone’s antimicrobial or disinfectant effects on teeth

Judy Fan-Hsu DDS, FAGD .


Systematic Review Conclusion

Clinical studies do not support the application of ozone to arrest dental decay or reverse demineralizations.

Critical Summary Assessment

This review of the best evidence finds lack of reliable evidence to support ozone’s effectiveness in dental use.

Evidence Quality Rating

Limited Evidence

Structured Abstract

Clinical Questions:

Does the clinical application of ozone arrest or remineralize caries lesions? Is ozone useful as a disinfectant or antimicrobial agent?

Review Methods:

The authors conducted a comprehensive search of 3 databases that produced 53 relevant articles. Of those articles, 6 of them described clinical (5 randomized) studies and 16 of them described in vitro studies.

Main Results:

Six clinical studies addressed 3 types of caries lesions (incipient, established and root caries). Each study had different outcome variables, different time intervals and/or different types of caries. One study that examined the effect of ozone on incipient caries showed significant reduction at 3- and 6-month ECM readings. However, this study showed no difference at longer-term assessments, as well as no significant difference at any recall interval for clinical severity or DAIGNOdnet assessments. A second study found no significant differences in DIAGNOdent assessments at a recall of 3 months, while a third study reported significantly more arrested lesions with ozone at recalls of 1, 3 and 6 months. One trial that studied the effect ozone on open caries, found statistical significant improvement in hardness in ozone-treated lesions after recall periods of 4, 6, and 8 months. A study on the effect of ozone on root caries found significant immediate reduction of microorganisms in freshly extracted teeth (p


There is a lack of reliable clinical evidence to support the use of ozone gas to arrest or remineralization of teeth However, some in vitro studies suggest that ozone may be efficacious. Additionally, there is insufficient clinical evidence to conclude that ozone is a useful antimicrobial or disinfectant agent in prosthodontic, endodontics, operative dentistry and oral surgery.

Source of Funding:

None Stated


Importance and Context:

The ease of applying ozone on carious teeth has potential benefits especially for anxious patients. However, the clinical use of ozone remains controversial due to the lack of high quality evidence to support its efficacy.

Strengths and Weaknesses of the Systematic Review:

The systematic review used accepted methods to search the literature. It adds three clinical studies to those reviewed in a prior systematic review of ozone’s effect in 2004. This review made no attempt to quantify the heterogeneity of the results from the clinical studies, nor did it attempt to synthesis results across the studies.

Strengths and Weaknesses of the Evidence:

Six clinical studies were included in the systematic review: 4 randomized clinical trials, 1 nonrandomized clinical trial and 1 randomized pilot study. The studies assessed the effect of ozone on 3 different types of lesions. One of the studies (on root lesions) did not include any assessment of caries. Also, most of the assessments were based on indirect measures of caries, ECM (electric caries meter), and DIAGNOdent. The second part of the review identified 16 in vitro studies: 4 on the bactericidal effect of ozone, 4 on its effectiveness as a denture cleanser, 4 on its antimicrobial effect in endodontics , 3 on its efficacy on restorative dentistry and dental material, and 1 its effect on refractory osteomyelitis. Most of these studies did not use statistical analyses, and many did not report sample sizes.

Implications for Dental Practice:

The clinical evidence is inconclusive for the clinical use of ozone in dentistry. There is still a need for the highest level of evidence, i.e., well-designed, double-blind randomized clinical trials with adequate sample size, limited or no loss to follow up, and carefully standardized methods of measurement and analysis in order to justify the use of ozone as a treatment modality in dentistry.

Critical Summary Publication Date:


These summaries are not intended to, and do not, express, imply, or summarize standards of care, but rather provide a concise reference for dentists to aid in understanding and applying evidence from the referenced systematic review in making clinically sound decisions as guided by their clinical judgment and by patient needs. American Dental Association © 2018