The Synergistic Effect of Ozonated Oil and Desensitising Toothpaste on Dentinal Tubule Occlusion: An In Vitro Study

Introduction Dentin hypersensitivity (DH) is the most common problem encountered by clinicians. It can be managed either by blocking neural activities or by occluding tubules. Ozonated oil facilitates the simple passage of desensitizing agents into dentinal tubules. Aim This study aimed to evaluate the effect of ozonated oil on dentinal tubule occlusion before and after the application of desensitizing toothpaste. Materials and methods The study was carried out in Kalinga Institute of Dental Sciences, KIIT (Deemed to be University), Bhubaneswar, India. The sample size of the study was 80. The first group contained specimens for control. The second group comprised specimens treated with ozonated oil. The third group comprised specimens being treated with a desensitizing agent. The fourth group contained specimens treated with both the desensitizing agent and ozonated oil. The specimens then received an acid challenge. The specimens were observed under a scanning electron microscope (SEM) before any therapy, after the application of the therapeutic agents and after the 37.5% ortho-phosphoric acid challenge. Results Inferential statistics to compare between the groups was calculated using one-way analysis of variance (ANOVA) statistics. Post-hoc Tukey's honestly significant difference (HSD) was performed to compare the groups. The mean scores of the partial tubular occlusion of Group 1, Group 2, Group 3 and Group 4 before the acid challenge were 0.035, 0.691, 0.564 and 0.368, respectively. The maximum score was obtained in the case of Group 2, which was statistically significant. The mean scores for partial tubule occlusion after the acid challenge for Group 1, Group 2, Group 3 and Group 4 were 0.055, 0.531, 0.733 and 0.142, respectively. There was evidence of maximum partial tubule occlusion after the acid treatment in the case of Group 3. The mean scores of Group 1, Group 2, Group 3 and Group 4 before the acid challenge were 0.019, 0.309, 0.442 and 0.609, respectively. The maximum score was obtained in the case of Group 4, implying a greater number of total tubular occlusions before the acid challenge. The mean scores of the total tubular occlusions after the acid challenge for Group 1, Group 2, Group 3 and Group 4 were 0.047, 0.465, 0.272 and 0.890, respectively. There was evidence of maximum tubule occlusion in the case of Group 4, which was statistically significant. Conclusion Overall, the application of a desensitizing toothpaste with ozonated oil holds promise as a potentially more effective treatment approach for DH. Further research and clinical studies may be needed to fully validate its efficacy and safety in dental practice.

Polymeric Nanocapsules Containing Ozonated Oil and Terbinafine Hydrochloride as a Potential Treatment Against Dermatophytes

Terbinafine hydrochloride is a synthetic allylamine whose mechanism of action consists of inhibiting the enzyme squalene epoxidase that participates in the first stage of ergosterol synthesis, interfering with fungal membrane function. Ozonated oils are used for topical application of ozone, producing reactive oxygen species that cause cellular damage in microorganisms, therefore being an alternative treatment for acute and chronic skin infections. This study aimed to develop and characterize Eudragit® RS100 nanocapsules, obtained by interfacial deposition of preformed polymer method, containing 0.5% terbinafine hydrochloride and 5% ozonated sunflower seed oil as a potential treatment against dermatophytes. The polymeric nanocapsules were characterized regarding particle size, zeta potential, pH, drug content, encapsulation efficiency, and stability. The in vitro drug release, in vitro skin permeation, and in vitro antifungal activity were also evaluated. The particle size was around 150 nm with a narrow size distribution, the zeta potential was around + 6 mV, and the pH was 2.2. The drug content was close to 95% with an encapsulation efficiency of 53%. The nanocapsules were capable to control the drug release and the skin permeation. The in vitro susceptibility test showed greater antifungal activity for the developed nanocapsules, against all dermatophyte strains tested, compared to the drug solution. Therefore, the polymeric nanocapsules suspension containing terbinafine hydrochloride and ozonated oil can be considered a potential high-efficacy candidate for the treatment of dermatophytosis, with a possible reduction in the drug dose and frequency of applications. Studies to evaluate safety and efficacy in vivo still need to be performed.

Ozonated triglyceride protects against septic lethality via preventing the activation of NLRP3 inflammasome

OBJECTIVES

Sepsis is a critical dysregulated host response with high mortality and current treatment is difficult to achieve optimal efficacy. Ozone therapy has been revealed to protect infection and inflammation-related diseases due to its role in antibiotic and immunoregulatory effect. Ozonated triglyceride is a key component of ozonated oil that is one of ozone therapy dosage form. However, the potential role of ozonated triglyceride in sepsis remains unclear. This study aims to explore the effect of ozonated triglyceride on septic mouse model and the molecular mechanism.

METHODS

Intraperitoneal injection of lipopolysaccharide (LPS), cecal ligation and puncture (CLP) were applied to construct septic mouse model. The mouse serum was obtained for detection of cytokines, and lung tissues were collected for hematoxylin and eosin (HE) staining to evaluate the extent of lung injury in septic mouse with ozonated triglyceride treatment at different time and doses. The survival of septic mice was observed for 96 h and Kaplan-Meier analysis was used to analyze the survival rates. In addition, primary peritoneal macrophages and human acute monocytic-leukemia cell line (THP-1) were treated with inflammasome activators with or without ozonated triglyceride. The level of cytokines was detected by enzyme-linked immunosorbent assay (ELISA). The cleavage of caspase-1 and gasdermin-D (GSDMD) was detected by Western blotting.

RESULTS

Ozonated triglyceride at different time and doses reduced the release of inflammasome-related cytokines [interleukin (IL)-1β and IL-18] (all P<0.05) but not pro-inflammatory cytokines such as IL-6 and tumor necrosis factor-α (TNF-α) in septic mice (all P>0.05). Ozonated triglyceride significantly improved the survival rate of septic mice and reduced sepsis-induced lung injury (all P<0.05). Ozonated triglyceride significantly suppressed the canonical and non-canonical activation of NOD-like receptor family pyrin domain containing 3 (NLRP3) inflammasome (all P<0.05) but not affected absent in melanoma 2 (AIM2) and NLR family CARD domain-containing protein 4 (NLRC4) inflammasomes in vitro (all P>0.05). Ozonated triglyceride reduced the cleavage of caspase-1 and the downstream GSDMD.

CONCLUSIONS

Ozonated triglyceride presents a protect effect on sepsis lethality via reducing cytokines release and sepsis-related organ injury. The mechanism is that ozonated triglyceride specifically suppresses the activation of NLRP3 inflammasome. Ozonated triglyceride is a promising candidate for sepsis treatment.

Ozonated oil alleviates dinitrochlorobenzene-induced allergic contact dermatitis via inhibiting the FcεRI/Syk signaling pathway

OBJECTIVES

Ozone is widely applied to treat allergic skin diseases such as eczema, atopic dermatitis, and contact dermatitis. However, the specific mechanism remains unclear. This study aims to investigate the effects of ozonated oil on treating 2,4-dinitrochlorobenzene (DNCB)-induced allergic contact dermatitis (ACD) and the underling mechanisms.

METHODS

Besides the blank control (Ctrl) group, all other mice were treated with DNCB to establish an ACD-like mouse model and were randomized into following groups: a model group, a basal oil group, an ozonated oil group, a FcεRI-overexpressed plasmid (FcεRI-OE) group, and a FcεRI empty plasmid (FcεRI-NC) group. The basal oil group and the ozonated oil group were treated with basal oil and ozonated oil, respectively. The FcεRI-OE group and the FcεRI-NC group were intradermally injected 25 µg FcεRI overexpression plasmid and 25 µg FcεRI empty plasmid when treating with ozonated oil, respectively. We recorded skin lesions daily and used reflectance confocal microscope (RCM) to evaluate thickness and inflammatory changes of skin lesions. Hematoxylin-eosin (HE) staining, real-time PCR, RNA-sequencing (RNA-seq), and immunohistochemistry were performed to detct and analyze the skin lesions.

RESULTS

Ozonated oil significantly alleviated DNCB-induced ACD-like dermatitis and reduced the expressions of IFN-γ, IL-17A, IL-1β, TNF-α, and other related inflammatory factors (all P<0.05). RNA-seq analysis revealed that ozonated oil significantly inhibited the activation of the DNCB-induced FcεRI/Syk signaling pathway, confirmed by real-time PCR and immunohistochemistry (all P<0.05). Compared with the ozonated oil group and the FcεRI-NC group, the mRNA expression levels of IFN-γ, IL-17A, IL-1β, IL-6, TNF-α, and other inflammatory genes in the FcεRI-OE group were significantly increased (all P<0.05), and the mRNA and protein expression levels of FcεRI and Syk were significantly elevated in the FcεRI-OE group as well (all P<0.05).

CONCLUSIONS

Ozonated oil significantly improves ACD-like dermatitis and alleviated DNCB-induced ACD-like dermatitis via inhibiting the FcεRI/Syk signaling pathway.

In vitro antimicrobial activity of ozonated oil in liposome eyedrop against multidrug-resistant bacteria

Bacteria are the most common causative agents of ocular infections. Treatment with topical broad-spectrum antibiotics is recommended in severe cases. However, antibiotic resistance has become a major concern in recent years, although antibiotics are generally effective in treating ocular infections. Antibacterial compound screening is performed to identify alternative therapeutic options to antibiotics. The aim of this study was to assess the in vitro antimicrobial activity of an ophthalmic solution containing ozonated oil. Strains of bacterial species with a multidrug resistance profile, which are responsible for a large proportion of ocular infections, were isolated and selected from different biological samples. The bacterial isolates were cultured, and ozonated oil was used to evaluate the inhibition zones at different time points. The treatment exhibited antibacterial activity against all the tested species. The effect was lower against the strains of Pseudomonas aeruginosa and more evident against Staphylococcus and Streptococcus spp. Our results suggest that the administration of ozonated oil may be a candidate agent to treat some infections of the ocular surface with a potential role in antimicrobial prophylaxis.

Ozonated oil in wound healing: what has already been proven?

Acute or chronic inflammatory reactions aim to control lesions, resist to pathogens attack and repair damaged tissue. The therapeutic administration of ozone known as ozone therapy appears as a possible treatment for tissue repair, as it promotes the healing of wounds. It has bactericidal, antiviral and antifungal properties and has been used as a therapeutic resource to treat inflammation. The objective was to carry out an integrative review regarding the use of ozonated oil in acute and chronic inflammations. The keywords “ozone therapy,” “inflammation” and “ozone” were used in the Portuguese, Spanish and English languages. The paper selection was based on inclusion and exclusion criteria. In total, 28 articles were selected. It has been seen that ozonated oil is effective in healing cutaneous wounds. The beneficial effects are due to the healing of wounds, due to the reduction of microbial infection, debridement effect, modulation of the inflammatory phase, stimulation to angiogenesis as well as biological and enzymatic reactions that favor the oxygen metabolism, improving the wound cicatrization. In addition to promoting healing, ozonated oil reduces symptoms related to skin burns, prevents post-lesion hyperpigmentation, and reduces the pain of aphthous ulcers. Therefore, ozonated oil represents an effective and inexpensive therapeutic alternative that must be implanted in the public health system.

Topical Liposomal Ozonated Oil in Complicated Corneal Disease: A Report on Three Clinical Cases

Infectious and traumatic corneal diseases require adequate therapy against infection and promote re-epithelialization. The appearance of multidrug-resistant bacterial strains, induced by excessive use of antibiotics in the treatment of infectious diseases, has urged researchers to study new antimicrobial formulations. Ozonated oils have demonstrated antiseptic (antibacterial, antifungal and antiviral) and reparative properties and can be proposed for the prevention and treatment of acute and chronic local infections, as an alternative to conventional topical antimicrobials. In ocular treatment, ozonated oil can exert tissue repair and anti-inflammatory and bactericidal activity. Moreover, its specific formulation makes it well tolerated and biocompatible with the ocular surface. Herein, we report on three cases of corneal inflammation (dendritic epithelial keratitis, corneal injuries caused by olive leaves, and neurotrophic corneal ulcer), treated with liposomal ozonated oil (Ozodrop^®, FB VISION S.p.a. San Benedetto del Tronto, Italy), successfully resolved using topical liposomal ozonated oil.

Topical Application of Ozonated Oils for the Treatment of MRSA Skin Infection in an Animal Model of Infected Ulcer

Simple Summary

Methicillin-resistant Staphylococcus aureus is often found in skin lesions infected in particular in diabetic foot ulcers, in which the prevalence can reach 40%. Clinical methicillin-resistant Staphylococcus aureus is generally resistant to most classes of antibiotics and therefore it is necessary to develop new antimicrobial agents. Ozone has a recognized bactericidal activity and has been widely used as a clinical therapeutic agent for chronic wounds, such as ulcers and other injuries, due to its ability to heal wounds. This is a preliminary study that reports the effectiveness of ozonated oils on the eradication of skin infection in vivo. The study provides further insights into the antibacterial effect of ozone in infected skin ulcers in diabetic rats and also, the potential wound healing effect of ozonated oils. Furthermore, this is the first study investigating the efficacy of ozone in the eradication of diabetic foot ulcers infected by methicillin-resistant Staphylococcus aureus. Our results indicate that topical application of ozonated oils infected skin in rats have significant antimicrobial activity as well as wound healing capacity. Achieving the healing of infected diabetic foot wounds has become a challenge and ozonated oils may be used to treat these infections.

Abstract

Diabetic foot ulcers are a common cause of morbidity in diabetic patients. One of the main pathogens found in these ulcers is methicillin-resistant Staphylococcus aureus (MRSA). MRSA often carries resistance to several classes of antibiotics and their infections are becoming harder to treat. Therefore, new alternatives are urgently needed. Thus, this study aimed to investigate the capacity of topical ozonated oil application on the treatment of early-stage skin infected with MRSA in an animal model. Ozonated oil was prepared from a mixture of oils subjected to a gas stream of O₂/O₃ mixture. Sixteen Wistar rats were inoculated by an intradermic injection of MRSA suspension, producing an abscess lesion. After 3 days, the skin epidermis was removed to open the wound. Group 1 received an application of oil mixture without ozone treatment and Group 2 received an application of ozonated oil. After the treatment period, skin was collected, colony-forming units (CFU) of bacteria were quantified and the histological analysis of the skin was carried out. Skin samples from the control 1 and 2 had a bacterial load was of 1.1 × 10⁵ and 5.7 × 10³ CFU/mL, respectively. Group 2 showed better wound healing from mild to moderate epidermal regeneration. Topical application of ozonated vegetable oil in MRSA-infected skin in rats showed a small reduction of the bacterial load and better wound healing.

Evaluation of Salivary Matrix Metalloproteinase (MMP-8) in Periodontal Patients Undergoing Non-Surgical Periodontal Therapy and Mouthwash Based on Ozonated Olive Oil: A Randomized Clinical Trial

Background: Extracellular matrix metalloproteinases (MMPs) play a pivotal role in the damage to the periodontal tissue in patients with periodontitis. Scaling and root planning (SRP) attempt to control the plaque amount and consequentially reduce the bacterial load. Non-surgical periodontal treatment could be integrated with drug therapy and physiotherapy procedures such as ozone therapy. The aim of this study was to evaluate in a cohort of patients with a diagnosis of periodontitis: (1) the efficacy of non-surgical periodontal therapy assisted by the use of ozonated olive oil-based mouthwash on salivary metalloproteinase (MMP-8) and (2) the reduction of periodontal indices. Methods: Ninety-six subjects with a diagnosis of periodontitis were enrolled in this study and randomly assigned to the study group (SRP + mouthwash) or control group (SRP). The study duration was 3 months. Data on MMP-8, plaque index (PI), bleeding on probing (BoP) and probing pocket depth (PPD) were recorded at T0, T1 (14 days), T2 (1 month) and T3 (6 months). Group differences were assessed using Student’s t-test for independent samples. Results: A significant improvement in PI, BoP, PPD and salivary MMP-8 levels was observed in both groups. An analysis of differences in relative changes of indices revealed the efficacy of ozonated olive oil in decreasing MMP-8 level. Simultaneously, it slowed the decrease of BoP index. Conclusions: Scaling and root plaining with the aid of ozonated olive oil mouthwash were found to be more effective on salivary MMP-8 reduction than scaling and root plaining alone.

High Efficacy of Ozonated Oils on the Removal of Biofilms Produced by Methicillin-Resistant Staphylococcus aureus (MRSA) from Infected Diabetic Foot Ulcers

Ozone has a high wound healing capacity and antibacterial properties and can be used as a complementary treatment in infections. Methicillin-resistant S. aureus (MRSA) is the most common pathogen found in infected diabetic foot ulcers. Most of MRSA are resistant to several classes of antibiotics and, therefore, there is a need for new, effective, and well-tolerated agents. Thus, we aimed evaluate the antimicrobial and antibiofilm potentials of ozonated vegetable oils against MRSA strains isolated from diabetic foot ulcers. Six ozonated oils were produced with concentrations of ozone ranging from 0.53 to 17 mg of ozone/g of oil. The peroxide values were determined for each oil. Ozonated oils content on fatty acid was determined by gas chromatography equipped with a flame ionization detector. The antimicrobial susceptibility testing was performed by the Kirby–Bauer disk diffusion method and the effect of ozonated oils on biofilm formation ability and on established biofilms was investigated. In general, the content in identified unsaturated fatty acid in oils decreased with the increase of ozonation time and, consequently, the peroxide value increased. Most bacterial strains were inhibited by ozonated oil at a concentration of 4.24 mg/g. Ozonated oils had moderate to high ability to remove adhered cells and showed a high capacity to eradicate 24 h old biofilms. Our results show promising use of ozonated oils on the treatment of infections, in particular those caused by multidrug-resistant MRSA strains.

Antimycotic Activity of Ozonized Oil in Liposome Eye Drops against Candida spp

Purpose

This study aims to investigate the antifungal activity and mechanism of action of ozonized oil eye drops in liposomes (Ozodrop), commercialized as eye lubricant for the treatment of dry eye syndrome and eye inflammation. The activity was tested against four clinical Candida species: C albicans, C glabrata, C krusei, and C orthopsilosis.

Methods

The antifungal activity of the eye drop solution was ascertained by microdilution method in accordance with EUCAST obtaining the minimum inhibitory concentration for Ozodrop. The mechanism of action was further investigated in C albicans by measuring cell vitality, intracellular reactive oxygen species production, levels of cellular and mitochondrial (∆Ψ_m) membrane potential, and the extent of membrane lipid peroxidation.

Results

All Candida isolates were susceptible to Ozodrop with minimum inhibitory concentration values ranging from 0.195% (v/v) for C glabrata to 6.25% (v/v) for C orthopsilosis. After 1 hour of exposure at the minimum inhibitory concentration value about 30% of cells were killed, reaching about 70% at the highest Ozodrop value. After Ozodrop exposure, C albicans showed cell membrane depolarization, increased levels of lipid peroxidation, depolarized ∆Ψ_m, and increased reactive oxygen species generation.

Conclusions

The significant increases in reactive oxygen species production cause the accumulation of reactive oxygen species-associated damages leading to progressive Candida cell dysfunction.

Translational Relevance

The antifungal activity of Ozodrop was demonstrated at concentrations several times lower than the concentration that can be retrieved in ocular surface after its application. The antifungal activity of the eye drops Ozodrop would represent an interesting off-label indication for a product basically conceived as an eye lubricant.

Ozonated Oils and Cutaneous Wound Healing

Wound tissue repair is a complex and dynamic process of restoring cellular structures and tissue layers. Improvement in this process is necessary to effectively treat several pathologies characterized by a chronic delayed wound closure, such as in diabetes, and the investigation of new approaches aimed to ameliorate the wound healing process is under continuous evolution. Recently, the usage of vegetable matrices in the form of ozonated oils has been proposed, and several researchers have shown positive effects on wound healing, due to the bactericidal, antiviral, and antifungal properties of these ozonated oils. In the present review, we intend to summarize the actual state of the art of the topical usage of ozonated oil in cutaneous wounds with special emphasis to the importance of the ozonated degree of the oil.

Effect of sesame oil, ozonated sesame oil, and chlorhexidine mouthwash on oral health status of adolescents: A randomized controlled pilot trial

CONTEXT

Oil pulling procedure involves swishing of oil in the mouth for various oral health benefits.

AIM

The aim of the study was to evaluate the effectiveness of sesame oil (SO), ozonated SO (OSO), and chlorhexidine (CHX) mouthwash on the oral health status of adolescents.

STUDY SETTINGS AND DESIGN

Parallel multi-arm double-blinded randomized trial was done in a Government higher secondary school.

MATERIALS AND METHODS

A total of 75 adolescents aged 12-14 years with decay-missing-filled index ≤3 were randomly assigned to three groups (n = 25): Group I (SO), Group II (OSO), and Group III (CHX mouthwash). Baseline (T1) Debris Index (DI-S), Calculus Index (CI-S), Oral Hygiene Index-Simplified (OHI-S), Plaque Index (PI), and salivary Streptococcus mutans count were recorded. All the groups were subjected to intervention with the respective mouth rinses for 15 days. The index scores and the salivary S. mutans count were reassessed after 15 days (T2) and 1 month (T3), and the results were statistically analyzed.

STATISTICAL ANALYSIS

The statistical analysis was done using IBM SPSS Statistics for Windows. The statistical significance was set at P ≤ 0.05. Kolmogorov-Smirnov and Shapiro-Wilk test were used to test the normality of the data. The Friedman test and Wilcoxon-signed rank test were carried out for intragroup comparison. Kruskal-Wallis and Mann-Whitney U-test were employed to analyze inter-group comparison.

RESULTS

All the groups showed statistically significant reduction in DI-S, CI-S, OHI-S, PI, and S. mutans count after 15 days.

CONCLUSION

Oil pulling therapy using SO and OSO showed a significant improvement in oral hygiene.

Effect of ozonated oil and chlorhexidine gel on plaque induced gingivitis: A randomized control clinical trial

BACKGROUND

Several chemotherapeutic agents have been developed to prevent gingivitis and its progression into periodontitis. In this present study, the efficacy of ozonated oil and chlorhexidine gel was assessed and compared on plaque induced gingivitis.

AIM

To evaluate the effect of ozonated oil on plaque induced gingivitis and to compare its efficacy with chlorhexidine gel.

MATERIALS AND METHODS

A total of 20 subjects, aged from 18 to 65 years, with plaque-induced gingivitis were selected from the outpatient Department of Periodontology, Government Dental College and Hospital, Aurangabad, for this study. They were divided randomly into the test or ozonated oil group (Group I) and the control or chlorhexidine gel group (Group II) with 10 subjects in each group. Subjects were randomly assigned to massage their gingiva thrice a day for 3 weeks with ozonated oil (test), and chlorhexidine gel (control). Plaque index and gingival index scores were recorded for the 20 subjects at baseline and after 3 weeks.

RESULTS

Ozonated oil (Group I) and chlorhexidine gel (Group II) groups showed statistically significant differences with respect to plaque index and gingival index, from the baseline to 3 weeks (P < 0.001 in both). But the difference between Group I and Group II, at the end of the study period, was not statistically significant with respect to the plaque index and gingival index.

CONCLUSIONS

The ozonated oil and chlorhexidine gel, both can be used as an effective agent in maintaining and improving gingival health.