|Year : 2020 | Volume
| Issue : 2 | Page : 63-69
Effect of subgingival application of ozone oil versus olive oil as an adjunct to scaling and root planing in chronic periodontitis: A clinical and microbiological study
Shruti Shankarrao Lendhey, Triveni Kale, Tejashvi Seth, Govind Bhartiya, Anuja Hudwekar
Department of Periodontology and Implantology, M.G.V's K.B.H. Dental College and Hospital, Nashik, Maharashtra, India
|Date of Submission||22-Jun-2019|
|Date of Acceptance||10-Oct-2019|
|Date of Web Publication||22-Jul-2020|
Shruti Shankarrao Lendhey
Department of Periodontology and Implantology, M.G.V's K.B.H. Dental College and Hospital, Panchavati, Nashik, Maharashtra
Source of Support: None, Conflict of Interest: None
The ozone oil is an oxidizing agent with a high antimicrobial power against oral pathogens, and olive oil is a powerful antioxidant and anti-inflammatory agent. Thus, the efficacy of ozone oil and olive oil was assessed in chronic periodontitis patients.
Aim: The aim of this study was to evaluate the clinical and microbiological effect of the subgingival application of ozone oil and olive oil as an adjunct to scaling and root planing (SRP) in chronic periodontitis.
Materials and Methods: A total of 20 patients with chronic periodontitis (≥5 mm) were randomly divided into two groups: Group I received SRP and olive oil and Group II received SRP and ozone oil. Subgingival application of both the oils was performed following initial SRP and at 7, 14, and 21 days. Clinical parameters including probing pocket depth (PPD), plaque index (PI), and gingival index (GI) were measured. Plaque samples from periodontal pockets were obtained with sterile paper points at baseline and 1 month for anaerobic culture.
Results: The baseline measurements of PI score, GI scores, and PPD show no significant differences among the two treatment groups for up to 1 month. The anaerobic cultures from Group II showed a low colony-forming unit (CFU) on blood agar as compared to Group I at 1 month. There was a significant difference between Groups II and Group I at 1 month in terms of CFU.
Conclusion: Subgingival application of ozone oil is a beneficial adjunct treatment modality to enhance periodontal health with a significant role in periodontal therapy. It serves as a promising antimicrobial agent to treat periodontal disease.
Keywords: Chronic periodontitis, olive oil, ozone oil, subgingival application
|How to cite this article:|
Lendhey SS, Kale T, Seth T, Bhartiya G, Hudwekar A. Effect of subgingival application of ozone oil versus olive oil as an adjunct to scaling and root planing in chronic periodontitis: A clinical and microbiological study. J Oral Res Rev 2020;12:63-9
|How to cite this URL:|
Lendhey SS, Kale T, Seth T, Bhartiya G, Hudwekar A. Effect of subgingival application of ozone oil versus olive oil as an adjunct to scaling and root planing in chronic periodontitis: A clinical and microbiological study. J Oral Res Rev [serial online] 2020 [cited 2020 Oct 24];12:63-9. Available from: https://www.jorr.org/text.asp?2020/12/2/63/290503
| Introduction|| |
Periodontitis is defined as an inflammatory disease of supporting tissues of teeth caused by specific microorganisms or groups of specific microorganisms, resulting in progressive destruction of the periodontal ligament and alveolar bone with periodontal pocket formation, gingival recession, or both. Periodontitis is thought to be associated with anaerobic micro-organisms such as black-pigmented Porphyromonas species and Actinobacillus Actinomycetemcomitans (AA), in the subgingival plaque. Thus, supragingival and subgingival plaque removals form an important part of controlling and treating periodontitis. Mechanical debridement of inaccesible area like deep pockets, furcation area is often incomplete which need the adjunctive use of antimicrobial agents. Thus, the subgingival application of an antimicrobial agent gained favor. The rationale for adding a subgingival application with an antimicrobial agent at chairside after scaling and root planing (SRP) is based on the assumption that bacteria left behind during mechanical debridement could be eradicated by an antimicrobial solution applied into the pocket. Further, it was believed that if additional bacteria could be eliminated, a better outcome could be achieved.
The established oral antiseptics for caries prevention, endodontic irrigation, or adjunctive periodontal treatment include chlorhexidine digluconate (CHX) (0.2%–2%), sodium hypochlorite (NaOCl) (2.25%–5.25%), and hydrogen peroxide (H2O2) (3%) which have some side effects which make a way for alternative approach.
Ozone is one such agent which has powerful antimicrobial action against Gram-positive and Gram-negative bacteria, fungi, protozoa, and viruses. Ozone (O3) is naturally produced by the photodissociation of molecular oxygen (O2) into activated oxygen atoms which then react with further oxygen molecules. This transient radical anion rapidly becomes protonated, generating hydrogen trioxide (HO), which, in turn, decomposes to an even more powerful oxidant, the hydroxyl radical (OH). Ozone exerts its antimicrobial action through the synergistic action of damaging the cytoplasmic membrane of cells and of inducing the modification of intracellular contents because of secondary oxidant effects. Ozone can be administered in 3 different forms like gaseous form, oil form, liquid form.
Olive oil possesses antimicrobial activity against a broad spectrum of microorganisms involving Gram-positive and Gram-negative anaerobic microorganisms. Olive oil gum massage reduces Streptococcus mutans count, Lactobacillus count, plaque scores, and gingival scores. It can be used as a valuable preventive agent in maintaining and improving oral health. Different components of olive oil other than fatty acids were responsible for the bactericidal action. There is a lack of literature on the effect of ozone oil versus olive oil on clinical parameter of periodontal inflammation; hence, the aim of the present study was to evaluate the effect of subgingival application of ozone oil and olive oil adjunct to SRP in periodontal pockets on clinical parameters and microbial profile of subgingival plaque in chronic periodontitis. We hypothesize that subgingival application of ozone oil adjunct to SRP is more effective than subgingival application of olive oil adjunct to SRP.
Hence, the objectives of the study were to evaluate and compare the effects of subgingival application with ozone oil and olive oil on clinical parameters such as plaque index (PI), gingival index (GI), and probing pocket depth (PPD). The secondary objective was to evaluate and compare the antimicrobial effect of ozone oil and olive oil on periodontal pocket microbes on the basis of anaerobic microbial analysis (colony-forming unit [CFU] counts).
| Materials and Methods|| |
The participants for this study were selected from the Outpatient Department of Periodontics, M.G.V'S K.B.H. Dental College and Hospital, Nashik, Maharashtra, India. A randomized controlled clinical trial was performed. A total of twenty patients (both the sexes) suffering from generalized chronic periodontitis were selected for the study. Patients within the age limit of 20–50 years having the pocket depth of 4–7 mm not associated with recession were included in the study. Ethical clearance was obtained from the institutional ethical committee MGVM KBH dental college MGV/KBHDC/790/2017-18. Dental College, Nasik, Maharashtra, India. Informed consent was given to all participants.
Pregnant or lactating females, Patients suffering from any known systemic diseases, patients who had received any surgical or nonsurgical therapy 6 months before the start of the study, patients who had received any antibiotic therapy in the past 6 months, patients who had received any chemotherapeutic mouthrinses during the past 6 months and tobacco users in any form, pockets with recession were excluded from the study.
Patients were selected randomly by coin toss method into two study groups (10 in each group)
- Group I – SRP + subgingival application of olive oil
- Group II – SRP + subgingival application of ozone oil (ozonil).
Patients qualified for this study underwent a full-mouth scaling using ultrasonic scalers and hand instrumentation followed by subgingival application of oil in the deepest selected periodontal pocket using a disposable 5-ml plastic syringe with a needle of 24G and of 0.55 diameter bend at the tip. The selected teeth were thoroughly dried and isolated carefully with cotton rolls, and then, oil was applied carefully subgingivally and interproximally until excess oil was observed from the gingival margin. This procedure was repeated for all teeth to be treated [Figure 1] and [Figure 2]. The excess oil was removed with a cotton roll. Any side effects were noted, and supragingival deposits were removed at recall visits. Oil application was performed after initial SRP and at 7, 14, and 21 days. The reinforcement of oral hygiene instructions at each appointment has been done.
After the oil application, patients were instructed not to eat, drink, or rinse for at least 30 min. Patients were also instructed to refrain from chewing hard or sticky foods, brushing near the oil-treated site, or using interdental aids. Instructions with supragingival brushing at the site of application were given. The patients were dispersed and instructed to report on the subsequent 7th day.
The clinical examination was carried out with a manual probe (UNC-15 probe [Hu-Friedy]) from the deepest pocket for each patient. The following clinical measurements were recorded: PI assessed according to Silness and Loe in 1964, GI according to Loe and Silness in 1963, and probing depth according to Ramfjord in 1967. Clinical measurements were taken on day 0 after SRP and 1 month without any additional treatment performed to the patients.
The supragingival plaque was removed with a sterile curette and cotton gauze. Subsequently, a subgingival plaque sample was obtained using one sterile paper points, inserted into the pocket until resistance was met or the paper points bent. It was kept in place for 10 s and then transferred to 10 ml thioglycolate broth. This test tube was kept in an incubator for 24 h. Blood agar plates were used to conduct the microbial analysis. Blood agar was used because it is a general purpose, nonselective, and enriched medium that promotes the growth of the microorganism. Anaerobic (using) microbial analysis was performed [Figure 3]. Ozone oil used was commercially available at the Bisleri Forum of India [Figure 4].
|Figure 3: Collection of Plaque sample with paper points,Paper points transferred to thioglycolate broth, o.1 ml of thioglycollate broth sample spread on blood agar with help of L shaped spreader, placed in the anaerobic gas jar with anaerobic gas pack, Gas jar incubated in the incubator, colonies observed on the agar plate|
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| Results|| |
Results were expressed as mean ± standard deviation and proportions as percentages. Intragroup comparisons were made by paired t-test and unpaired t-test for intergroup comparisons. For all the tests, P = 0.05 or less was considered for statistical significance GRAPH PAD software Inc.11452 EI Camino Real #215, san digeo 92130, USA.
Both the treatment modalities were well tolerated by the patients without any complications. The baseline measurements of PI score, GI scores, PPD, and clinical attachment level (CAL) show no significant differences among the two treatment groups. [Graph 1] shows the comparison of pre- and postvalues of the PI scores between olive oil (Group I) and ozone oil (Group II). [Graph 2] shows the comparison of pre- and postvalues of the GI scores, between olive oil (Group I) and ozone oil (Group II). There was a statistically significant difference between the pre- and postmean values of PI and GI scores of both the groups. There was no statistically significant difference (P = 0.40) between the post mean values of PI and GI scores of both the groups indicating that they were almost the same. There was a statistically significant difference between intergroup comparison values of probing the pocket depth of both the groups at 1 month (P = 0.026) [Graph 3].
Intergroup comparison showed that there was a statistically significant difference between CFUs of both the groups at 1 month (P = 0.007) [Graph 4]. There was a statistically significant difference between intergroup comparison values of CAL of both the groups at 1 month (P = 0.026) [Graph 5]. The appreciable difference was seen between bacterial colonies observed after anaerobic incubation in the olive oil group and ozone oil group at baseline and 1 month [Figure 5].
|Figure 5: (a) The anaerobic microbial analysis result of olive oil at baseline and (b) at 1 month. (c) The anaerobic microbial analysis result of ozone oil at baseline and (d) at 1 month|
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| Discussion|| |
The initiation and progression of periodontitis are caused by a different bacterial accumulation in subgingival pockets. There is considerable evidence implicating that these bacteria are mainly facultative and obligate anaerobes. The control of the prevalence and severity of periodontal disease implies a managed reduction of those microbes considered to be pathogenic. This is performed routinely by mechanical SRP. A study conducted by Meseli et al. concluded that the sites with PPD =3 mm show attachment loss rather than gain following SRP. As mechanical cleaning alone cannot eliminate all bacteria involved in periodontal disease, adjunctive antimicrobial protocols have been devised and tested. However, the effectiveness of this method is limited by various anatomic factors such as concave tooth surface, margins of restoration, and inaccessibility to the deep and tortuous periodontal pocket. This has led to the adjunctive use of antimicrobial agents.
There are various antimicrobial agents available such as CHX and tetracycline, but there is a certain side effect of this agent. The most common side effect associated with the use of CHX is extrinsic tooth staining. This can be explained in terms of a local precipitation reaction occurring between tooth-bound chlorhexidine and chromogens found within foodstuffs and beverages. Hence, there is an alternative approach to conventional antimicrobial agents is ozone oil, which acts by inhibiting the growth of subgingival bacteria by changing the subgingival environment. Ozone is an unstable gas and it quickly gives up nascent oxygen molecule to form oxygen gas. Due to the property of releasing nascent oxygen, it has been used in human medicine since long back to kill bacteria, fungi, to inactivate viruses, and to control hemorrhages. Another antimicrobial agent is olive oil which has been used medicinally in various times for its health benefits.
The aim of this study was to evaluate the clinical and microbiological effect of the subgingival application of ozone oil versus olive oil as an adjunct to SRP in chronic periodontitis.
In the present study, twenty chronic periodontitis patients were selected having pocket depth ≥5 mm. Subgingival application of oil was done at the baseline, 7th day, 14th day, and 21st day. The ozone oil application is done once per week for 1 month as the application of ozone for more than 1 month resulted in degeneration of the lamina propria. Zaki et al., 2012, found that only normal histopathological samples were obtained when ozone was applied once per week for 1 month or twice per week for 1 month.
Clinical parameters such as PI, GI, and PPD were measured, and microbial analysis was done at baseline and after 1 month. Our study shows a significant reduction in PI and GI in the ozone oil and olive oil groups at a month. This is in agreement with the study done by Ramzy et al. who found a significant reduction in PI scores at the end of their 4-week study. The GI is improved in both the groups with more significance at day 30. This is in agreement with Ramazy et al., and this could be attributed to accelerating healing of oral mucosa associating hemostatic action and bactericidal effect of ozonized water.
There is no significant difference between intergrouP values of plaque and GI at 1 month. The possible mechanism behind this was the viscosity of the oil which probably inhibits bacterial adhesion and plaque coaggregation. Other possible mechanisms might be the saponification or the “soap-making” process that occurs when oils are acted upon by salivary alkalis like bicarbonates, the soap-making process is initiated. Soaps are known to be good cleansing agents because they are effective emulsifiers. Emulsification greatly enhances the surface area of the oil, thereby increasing its cleansing action. Singla et al. conducted a study where chlorhexidine gel, olive oil, sesame oil, and coconut oil were used for gingival massage and concluded that these oils and chlorhexidine gel can be used as valuable preventive agents in maintaining and improving oral health status. AL-Chalabi and Mohamed conducted a study where ozonated oil (OZ) or chlorhexidine gel (CHX) applied on the gingiva of patients affected with plaque-induced gingivitis and found that OZ oil-treated group showed significantly lower gingival crevicular fluid volume and interleukin-1β concentration. This highlighted the evidence in favor of the OZ oil in the treatment of gingivitis.
There was a significant reduction in PPD on 30th day from baseline, and the changes were highly significant from baseline to 30 days in the ozone oil group compared to the olive oil group. These findings are in agreement with the study conducted by Katti and Chava, and this could be explained by the oxidizing mechanisms of ozone which may involve direct reactions of molecular ozone and free radical-mediated destruction. These findings are also in agreement with Ciancio et al. who concluded that irrigation with or without an antimicrobial agent has a beneficial effect on oral health.
In the present study, number of CFUs in the ozone oil-treated group is significantly less than the olive oil-treated group at 1 month. This result is in agreement with the study done by Patel et al. who found that the adjunctive use of ozonated olive oil with SRP resulted in a significant improvement of clinical parameters as well as microbiological parameters over time and in comparison to the control groups. The results agreed with Nagayoshi et al. who found that ozonized water should be useful in reductions of microorganisms in dental plaque which, in turn, reduces the gingival inflammation. Moreover, thein vitro study done by Eick et al. reported that ozone adjunctive application to SRP has a potential effect in periodontitis patients due to its strong antibacterial activity against putative periodontal pathogenic microorganisms. Moreover, Huth et al. found a significant reduction in periodontal pathogens, namely Porphyromonas gingivalis, Parvimonas micra, and Tannerella forsythia on irrigation with gaseous/aqueous ozone as compared to 0.2% CHX. None of the agents could substantially reduce AA count in biofilm cultures. On the contrary, anin vitro study by Müller et al. reported that there is no success in reducing the microbiota on applying ozone. The study, the antimicrobial properties of a new ozonized olive oil (ozone oil) against oral and periodontal pathogens, will be evaluated and compared with that of common CHX-based agents. Pietrocola et al. studied that the antimicrobial properties of a new ozonized olive oil (ozone oil) against oral and periodontal pathogens will be evaluated and compared with that of common CHX-based agents and found that the ozonized olive oil demonstrates a lower antibacterial activity if compared to the CHX-based agents tested. Uraz et al. found that adjunctive ozone therapy did not provide additional benefits to clinical, microbiological, and biochemical parameters over SRP in chronic periodontitis patients.
| Conclusion|| |
Within the limitation of this study in terms of small sample size and short follow-up period, it can be concluded that
- Subgingival application with ozone oil is beneficial adjunct treatment modality to enhance periodontal health and has a significant role in periodontal therapy
- Subgingival application of both these oils is a simple, inexpensive, and noninvasive, home care technique which reduces gingival inflammation
- From the evidence of this study, it can be concluded that ozone oil is more effective as compared to olive in reducing the subgingival microbiota and is an effective antimicrobial agent.
We indebted Dr. Milli Shah and Dr Jignasha captain (Ozone Forum of India) for providing us useful information regarding the ozone oil and Dr. Prutha Rathod, Postgraduate in Department of Oral Medicine and Radiology, M.G.V'S K.B.H. Dental College, Nashik, Maharashtra, India, for helping us during the study.
Financial support and sponsorship
This study was financially supported by the Ozone Forum of India.
Conflicts of interest
There are no conflicts of interest.
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