For a few months, Christy Kramer had watched as a baby tooth that had hung on for 50 years near the front of her mouth had gradually darkened and turned brown. When she smiled, her daughter noticed it.
Her dentist told her that it needed to be extracted. No one relishes pain in the dentist's chair, but Kramer was not thrilled about spending $6,000 on a dental implant that wasn't going to last, either. When she had her daughter in to see a holistic dentist in Sunnyvale, California, it was suggested she might try treating the tooth with ozone gas, one of the fastest growing tools in the integrative, holistic medical and dental fields.
Figuring she had nothing to lose, Kramer decided to give it a go. After the first painless session having the oxygen/ozone gas flow over her rotting tooth, Kramer was astonished to see it lightened noticeably, and after just four sessions the tooth had changed from dark brown back to its natural color. The large cavity still had to be filled, but the tooth was spared, and there would be no dentist's drill or dental implant.
"I'm still shocked," Kramer told her dentist, Sook Hong, after the treatment. "It's really unbelievable how it can reverse a cavity. It's amazing. It's kind of like a magic wand. Most people haven't heard of this."
Even most dentists, let alone their patients, haven't heard about dental ozone. Only a small cadre at the cutting edge of integrative and 'biologic' dentistry use it in their practice. But their work is based on a growing body of research that has emerged in the past decade or so showing that ozone gas has the potential to wipe out mouth infections.
These infections are the underlying cause of dental decay, mouth ulcers and gum disease—which has been linked to other systemic disorders in the body including killer cardiovascular disease. Ozone has the added benefit of promoting the reversal and healing of these diseases in the mouth, and can also help to address other chronic pain issues in the head and neck.
"Ozone is one of the most exciting, versatile tools in the dental toolbox," says dental hygienist Carol Vander Stoep in her book, Mouth Matters (Ianua Publishing, 2013). Its use in medicine is not new, however.
Ozone's potent antimicrobial effects have been known for more than 130 years, and it continues to be used worldwide as an effective water sanitizer. It's been estimated that one molecule of ozone kills bacteria as effectively as 3,000-10,000 molecules of chlorine, and it does so 3,500 times faster than chlorine, without the toxic effects.1
In World War I, German soldiers used ozone to treat gangrene wounds, and it is currently used in medicine to treat more than 260 conditions. There are more than 3,000 published, peer-reviewed studies of its effectiveness and benefits for problems ranging from back pain and osteoarthritis to age-related macular degeneration in the eye, skin diseases and diabetic ulcers.2 There are also studies showing clinical benefits in inflammatory diseases, neurological disorders and, in a small pilot study, even cancer.3
Ozone is a highly reactive molecule with powerful anti-inflammatory effects. It encourages "friendly" bug ecology, boosts oxygen metabolism, increases circulation and modulates the immune system.
Given the extensive published medical literature on ozone, the attitude of the US Food and Drug Administration, which still posts a 1975 statement on its website calling ozone a "toxic gas with no known useful medical application," is striking. Practitioners say this is the main reason why patients in Britain, the United States and Canada haven't heard about ozone.
"Everyone is afraid of the regulators attacking you for doing something that is not quite mainstream," says Craig Young, a dentist who uses ozone frequently in his private practice, Orijin Integrated Dentistry, in Calgary, Alberta. "Most of us that use ozone seem to be somewhat under the radar."
He estimates that he is one of only 10 dentists among the city's 700 or so practitioners who use it, but he does so because his results are "fantastic."
Ozone vs. cavities
Dealing with tooth decay is a mainstay of dentistry in a culture that consumes highly refined, processed foods, which can lead to nutritional deficiencies as well as promoting the growth of harmful bacteria.
One-quarter of British children have tooth decay before they start school, each with an average of three or four cavitated teeth, and more than 63,000 children and adolescents under 19 years old were admitted to a hospital for tooth extractions in England from 2014 to 2015.4
Despite the old notion of bad British teeth, American teeth fare no better, and possibly slightly worse in the long term. According to the US National Institutes of Health, over 20 percent of American children have at least one cavity by the age of five, along with nearly all—92 percent—of American adults.4 And one study directly comparing the oral health of adults living in the US and England found that Americans have more missing teeth, on average, than the English.5
Notwithstanding the widespread notion that these tooth cavities are irreversible, teeth are not inert rocks in the mouth—they can regenerate and remineralize given the right conditions.
Standard dentistry's use of chlorhexidine and fluoridated toothpaste is just not very good at creating these conditions. Teeth lose minerals in an acid environment created by consumption of refined sugar and wheat, for example, and they gain them from saliva that is high in minerals and should be alkaline.
Professor of dentistry Edward Lynch of the University of Warwick in the UK is part of the vanguard of researchers investigating the powerful effects of ozone as a painless treatment for tooth decay. Exposing a decaying tooth lesion to ozone gas for 10-20 seconds creates what he called a "sort of ozone 'hurricane' based on a low ozone concentration" that kills all microbes.
Within an hour, he and his colleagues discovered, the area of the tooth exposed to ozone could be remineralized—hardened—by the calcium phosphate in saliva, which makes it resistant to bacteria in the future.7
In one study, 89 people who each had decay in two teeth received ozone treatment in one tooth, while the other tooth served as the 'control.' With ozone treatment, 98 percent of tooth decay lesions hardened at 12 months, compared with 1 percent in the control teeth (which received regular air treatment plus a remineralizing toothpaste). After 21 months, 100 percent of lesions became hard with ozone treatment, compared to 8 percent of lesions becoming hard, 80 percent remaining leathery, and 12 percent becoming soft and decaying further in the control group.8
Another ozone pioneer, South African dentist Julian Holmes, showed that ozone gas application reversed 69 percent of cavities at three months and, with repeated applications, 100 percent at 18 months.9
A 2017 study by researchers at Moscow State Medical University and the Russian Ministry of Health found that treating 'white spot'-type early tooth decay, which contained up to 16 kinds of microorganisms, in 86 patients with professional oral hygiene treatment including ozonated gas was significantly more effective at halting microbe growth than the standard treatment of hydrogen peroxide and chlorhexidine alone. The researchers concluded that "it is strongly advisable to include ozone in protocols of noninvasive treatment of initial dental caries."10
"Ozone gas can penetrate 3-5 mm into a tooth, killing all the pathogens that have migrated into it and neutralizing their erosive waste products," writes hygienist Vander Stoep. It "shifts the tooth's internal environment towards a neutral pH," she adds. "The tooth lesion can then remineralize or petrify using minerals primarily from pulp fluids, but also from saliva. Because ozone annihilates both the bugs and their environmental bughouse, it is the only predictable way to reverse a decaying lesion."
As well as annihilating bugs like Streptococcus mutans, ozone tackles Candida yeast overgrowth in the mouth that traditional dental mouthwashes like chlorhexidine cannot fight, says Calgary dentist Craig Young. "Sixty-four percent of cavities in between teeth contain Candida albinos as part of their biofilm," he says, as do 100 percent of cavities on roots, and ozone is "very effective" in destroying it to take apart the biofilm matrix that is resistant to other treatments.
Young says he prefers to use ozonated gas and water, which must be professionally delivered, especially in the cases of children's decay, because ozonated oil interferes with the bonding material on fillings and can taste rancid.
As well as having surprising effects at healing advanced decay like in Christy Kramer's case, ozone is about 85 percent effective at halting cavity formation, or cavitation, early in the process—with areas of early decay that appear as gray shadows on X-rays no longer visible after treatment, according to a 2014 review paper by dentist William Domb.11 "I see that every day in practice," says Young.
Battling the silent epidemic
The US Centers for Disease Control and Prevention reports that almost half (47 percent) of all American adults over age 30—that's 64.7 million people—and 70 percent over age 65, have mild to severe gum disease, beyond the initial stages of gingivitis.12 The incidence is about the same in the UK and other developed countries.13
Gum disease is caused by bacteria in the mouth building up in a sticky plaque in the crevices between the teeth and around the gums. These bacteria thrive in the moist, low-oxygen conditions of the mouth, and they clump together to form impenetrable, tough biofilms of tartar. They also produce toxic waste that can spread to other parts of the body, wreaking havoc on the immune system and triggering inflammation at distant sites including the heart and brain.
The American Academy of Periodontology calls rampant gum disease a "significant public health problem" because of a landslide of new studies finding correlations between gum infections and heart disease, stroke, cancer, diabetes, rheumatoid arthritis, lung disease, impotence in men, and prematurity and low birth weight in infants born to women with periodontitis.
Besides being associated with these health dangers, periodontitis progresses stealthily, out of sight under the gums, frequently without symptoms, causing gums to pull away from the teeth and destroying the bone that supports the teeth. Gum disease is the leading cause of tooth loss in adults, but people often don't know they have gum disease until their teeth become loose or abscessed.
When people hear of infected gums, they may think of bad breath or bleeding gums, but it is far more insidious—and larger than they think. "Upon adding up all the pustulent, raw tissue, it can quickly sum up to the surface area of the palm of the hand or even the entire forearm," dentist Domb explains.11
"The only saving grace is the lesion is generally hidden. If a patient walked into your office with a lesion over half the face, it would probably demand immediate attention. But with periodontal attack, there's rarely pain until the very end stages, so it's frequently out-of-sight, out-of-mind."
A coalition of professional periodontology associations issued a "global call for action" on gum disease in 2015, calling it a "silent epidemic" and "responsible for 3.5 million years lived with disability, $54 billion USD/year in lost productivity and a major portion of the $442 billion USD/year cost for oral diseases."14
'They were blown away'
Mainstream, the dental profession tackles this epidemic of gum disease with public health campaigns to encourage teeth brushing and largely unheeded messages to floss daily.
Once diagnosed, however, patients get prescription antimicrobial mouthwashes and are treated with dental scaling and root planing procedures to scrape crusty biofilms from teeth below the gums. Sometimes it requires anesthetic.
If scaling and planing don't work, periodontal specialists may lift the gums to scrape the infected bone, and in advanced cases of decay they may graft tissue from other areas like the palate onto infected areas or graft natural or synthetic bone onto decayed jaw.
These methods sound painfully invasive and crude, but there is a professional reluctance to try ozone, which, being able to penetrate deep into tooth tubules and crevices, seems an obvious weapon of choice.
Young describes how he was contacted by a maxillofacial surgeon and periodontist from Calgary's Foothills Hospital about a year ago who referred him a patient: a 43-year-old woman whom they had been treating for advanced infection in her jaw bone. For the previous eight to nine months, her doctors had been using their full artillery, including IV antibiotics, to fight the entrenched infection without making progress, and they reached out to him after reading about ozone.
Young used a battery of ozone injections, ozonated water and oils along with implementing nutritional changes, and the woman's infection began to heal dramatically in just a week. Her original doctors "were just blown away," he says.
At least 700 oral bacterial species and as many as 19,000 different phenotypes have been suspected as causative agents in periodontal attack, according to Domb. "Ozone gas, ozonated oils and water can be applied into the sulci, directly into abscesses or even directly into areas of chronic infection to curb and eliminate the bacterial populations."
Young says ozonated oils, infused with the gas, are ideal to use for periodontitis because patients are generally older and can tolerate the taste, and the ozone lingers for hours. Patients should look for pure ozonated oils (olive rather than coconut oil, which is highly saturated and carries less ozone) to apply to hard-to-reach areas on a daily basis.
Ozone can also promote healing when root canals are necessary or when dentists have to extract infected teeth. Extraction carries the risk of creating a "dry socket," a painful condition that occurs if the blood clot that normally fills the tooth socket is lost, leaving raw nerves exposed. Since he began applying ozonted oil to extraction sites, Young says he has not had a single dry socket.
Treating mouth sores
A number of studies have found that ozone is useful for treating mouth ulcers, cold sores and painful conditions like oral lichens planus, a chronic inflammatory condition that creates painful, burning sores in the mouth.
A 2015 study of 120 patients with oral lichen planus tested three different treatments—corticosteroids, ozone and laser therapy—and found that ozone was similarly effective to the steroid treatment and significantly more effective than the lasers.1
A 2016 study by researchers in Jordan, the UK and Saudi Arabia compared 69 patients with recurrent mouth ulcers (also called canker sores) treated with just a 60-second blast of ozone gas mixture against a control group that received a blast of normal air instead, and found that those treated with the ozone healed faster and with less pain than the controls.2
Another 2018 study split 150 patients with denture-related ulcers into two groups receiving either ozone gas treatment or a sham air treatment. It concluded that those given the ozone experienced less pain and faster shrinking and healing of ulcers.3
Furthermore, ozone can substantially decrease pain in people suffering from herpes ulcers on the mouth and speed up their recovery. "Thirty seconds to one minute of applying ozone gas instantly makes the sore much more comfortable, and it regresses rapidly," says Domb. Additionally, in his experience, in about 25 percent of these cases, the treated ulcer does not recur.
Beyond the mouth
The growing body of evidence that the condition of the mouth is closely linked to the condition of the entire body and vice versa suggests that effectively treating mouth conditions with ozone may have far-reaching effects on general health. A recent case study published in the journal Autoimmunity Highlights illustrates the point.
California physician and ozone specialist Robert Rowen reported the case, in which extracting infected teeth and providing intravenous ozone therapy reversed a serious autoimmune condition called dermatomyositis.
Dermatomyositis is a rare inflammatory disease marked by a distinctive purplish rash, chronic progressive muscle weakness and fatigue, and it's been shown to substantially shorten life expectancy compared to the general population.1
Rowen's patient was a 48-year-old husband and father who had been diagnosed with dermatomyositis in 2012 after several misdiagnoses of "sun rash" and eczema. He was taking multiple drugs to combat the inflammation but was in extreme pain and deteriorating.
Rowen began blood ozone treatment and suspected an underlying dental problem based on the patient's history. He referred him to a dentist for the treatment of failed root canals and another tooth infection.
The man eventually underwent multiple tooth extractions in 2013, and with ongoing ozone injections, his extreme condition went into full remission. In 2017, his symptoms flared briefly, and he revisited his dentist, who discovered three more infected teeth. After they were extracted, he again recovered fully.
Notably in this case, the patient's teeth were not specifically treated with ozone, as the dentist was not involved in this aspect of the therapy, and as Dr Rowen writes, "neither ozone therapy nor any drug therapy would be expected to singularly remedy closed foci of infection, such as in this case, essentially abscesses."
Nonetheless, he claims, "the strength of this case is that it showed high value in addressing a medically unsuspected cause of systemic disease (occult dental infection) and in tailoring a specific treatment plan to the individual patient and not the disease model."2
The end of root canals?
Despite being performed more than 15 million times a year in the US alone, root canals, which involve scraping infected dental pulp out of a tooth and replacing it with inert material, don't work in 15 to 32 percent of cases.1
Mostly that's because clearing an infection from the interior of a tooth that contains miles of microscopic tubules—30,000 microscopic tubule networks in the typical adult molar—is an enormous challenge.
It's particularly difficult when bacteria and yeast build up in complex layers of mutually protective species called biofilms, which are tough to eradicate. In these cases, one root canal can lead to another, or to the tooth "dying" and needing to be extracted.
Tim Rainey, who has been practicing what he calls "minimally invasive preventative dentistry" in Refugio, Texas, for 47 years, says many root canals are done needlessly, however, and the infection can be prevented and/or reversed using ozone. "Cleaning and disinfecting the canals improperly is why root canals have such a dismal failure rate," he says, "and my suspicion is that most of those that remain asymptomatic are root canals done unnecessarily on vital teeth."
Most often, deep decay or cavities are what lead to root canals, as the infection spreads from the tooth surface to tissue inside the tooth. This can be halted using ozone in water or ozone gas, which has the ability to penetrate into tubules and other microstructures.
This was shown more than a decade ago in a study that compared decayed teeth roots treated with ozone to those treated with just air—98 percent of the ozone-treated lesions hardened after 12 months compared to just one in the control group. The others had remained "leathery" or progressed with even more softening.2
Test-tube studies have confirmed that high-concentration ozone is as effective as standard disinfecting agents at killing the bacteria that form biofilms,3 and more recently, this observation was extended to actual patients undergoing root canals, in whom the addition of ozone to the standard antimicrobial irrigation procedure killed significantly more microbes.4
Another integrative dentist, Carey O'Rielly of La Costa, CA, boasted on his blog this spring about how ozone has transformed his treatment of root caries:
• It eliminates bacteria leaking into the pulp in the first place, preventing infection.
• Ozonated cavities don't need to be so deeply excavated, so ozone eliminates the risk of exposing a root nerve.
• Ozone reduces trauma in treatment.
• It supports healing by reducing inflammation and increasing blood flow.
Says O'Rielly: "I can't tell you how many root canals I have avoided by using ozone in my practice on teeth with cavities and deep decay."