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Asiatic - European Association of Ozone Therapists - 2007

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Asiatic - European Association of Ozone Therapists - 2007

O3 Ozone Therapy in Cosmetology

Posted by: Lubov Pavlova in Articles

I. Goltseva

salon “Something different”, Nizhny Novgorod

The progress of today medical science is oriented to development of new technologies allowing not only highly effective treating diseases, but also preventing them, increasing the vital potential of the organism. One of such progressive approaches is ozone therapy. It has a wide range of action in surgery, dermatology, urology, internal medicine.

It would be strange if ozone would not be put into use in cosmetology - one of the most progressive fields of its application. In methods of treatment with ozone a particular attention is paid to improvement of microcirculation, oxygenation, energy supply of cells, proper trophism and protection of skin.

Many cosmetic problems - acne, teleangiectatic rosacea, outflowing of the hair, wrinkles, allergy, cellulites, fatness - are reflecting the internal state of the organism, therefore they should be treated not only from the outside, but also inside. And this task can be successfully done by ozone producing a detoxication, antimicrobial, antiviral effect and increasing the organism’s immunity.

Ozone is a unique agent preserving and restoring the natural beauty and health of skin. Ozone therapy does not mask defects of skin, but normalizes its natural functions and stimulates its own work.

The mechanism of action of ozone can be demonstrated on the example of its use within a complex program for skin rejuvenescence.  

Aging at the level of epidermis is induced by inhibition of proliferous cell division, exhaustion of epidermis, increase in keratin layer, decrease in elasticity and increase in residual epidermis deformation (”crow’s-foot”), formation of deeper wrinkles. 

Skin functions properly and looks young only in case of proper trophism and division of epidermis cells. The natural mechanism of cell trophism is realized by means of tissue liquid, lymph and blood plasma.

The functional efficiency of this network and quality of epidermis trophism are considerably decreased under the influence of negative factors of environment. Aging at the level of dermis is induced by changes in the structure of collagenous and elastic fibers. On exposure of collagen to free radicals it comes to “together-sewing” of collagen, therefore collagenase enzyme responsible for collagen degradation in normal conditions is not able to realize its function.

It comes to accumulation of pathologically modified collagenous fibers, a decrease in their water-retaining ability and in the total level of water in dermis. It comes to a functional disturbance of hyaluronidase, the specific enzyme producing an effect on hyaluronic acid and defining skin penetrance. 

Owing to aging it comes to a decrease in the activity of some key enzymes of respiratory chain and intensity of cytochromoxidase synthesis that leads to energy deficiency in cells. It comes to inhibition of epidermis cell regeneration, exhaustion and fragmentation of elastin fibers, and a result of all these pathological processes is formation of wrinkles.

Skin aging can be inhibited, and skin structure can be restored through neutralization of the above-mentioned pathological processes thereby eliminating the reason, but not only the consequence - formation of wrinkles. Exactly this is the target of ozone therapy.

Ozone is a substance created by the nature, produces a complex, integral effect on the human body. For treatment of “problem” skin and wrinkles it is recommended to use the methods of local and systemic ozone therapy: by local route - subcutaneous ozone injections and ozonized olive oil in the form of face packs and for massage; by systemic route - intravenous drop-by-drop infusions (drips) of ozonated solutions, major and minor autohaemotherapy with ozone, rectal ozone insufflations. The approach to treatment and choice of methods are strictly individual for each patient.

Ozone introduced subcutaneously activates metabolic processes in macroergic cells, normalizes active membrane transport (K-Na pump), penetrance, deformability, viscosity and electric properties of membranes. At the same time, it comes to an increase in the intensity of energy processes: on the one hand, through the increased utilization of oxygen by cells owing to activation of aerobic glycolysis, Krebs’ cycle, b-oxidation of fatty acids, and on the other hand - through optimization of the oxygen-transport function of blood (at presence of ozone the erythrocytes are able to bond and transfer 10 times more oxygen and more easier release it to tissues).

Besides, it comes to stopping of “oxidative stress”, activation of the antioxidant defense system and neutralization of the destroying effect of free radicals. It comes to stimulation of protein synthesis including its own collagen and elastin, an increase in the regenerative potential of proliferative skin layer. It comes to an increase in tissue liquid volume in deep layers and restoration of the natural skin ability to retain water, and as a result, it comes to ironing and disappearance of “crow’s-foot”, deeper wrinkles, and the rejuvenescence effect is well manifested. 

The essential difference of ozone therapy from other cosmetic remedies and procedures is its dual action from the outside and inside of the organism that leads to normalization of trophism, oxygenation, moistening, protection and exchange restoration of skin. It helps to achieve general cleaning, sanation and tonization, but not only a temporary cosmetic effect.

Thus, ozone therapy is a revolutionary remedy for rejuvenescence allowing to restore the barrier, immune, water-retaining, reparative and separative functions of skin as well as to improve its structure.

Especially noticeable and fast results through ozone therapy are observed in patients with diagnosis “skin stress”.

The most frequent method of administration of ozone for rejuvenescence is by intravenous drop-by-drop route and in the form of ozone bath “torso”. This is convenient as during the ozonization the cosmetologist can perform other procedures on face, neck, decollete that saves the patient’s time. 

For the organism’s cleaning, elimination of roughages and toxins including stress toxins producing a negative effect on skin the complex treatment of skin fading contains global intestinal cleaning. On completing this procedure it is recommended to perform rectal ozone insufflation thereby creating beneficial conditions for regeneration of “healthy” intestinal flora and producing a beneficial effect on the whole organism.

For correction of available signs of skin fading after 35 years of great benefit can be the rejuvenescence courses of ozone therapy in the form of subcutaneous injections at the places of wrinkle localization and other places with manifested skin fading (chin, cheeks, neck).

After the procedure it is recommended to perform manual massage - plastithermic or cosmetic for equal distribution of ozone-oxygen gas mixture.

The well-manifested effect is observed already after 3-4 procedures: ironing of fine wrinkles, an increase in skin turgor, a decrease in face pastosity, improvement of face color, appearance of glow. The patients report about a decrease in skin dryness, disappearance of skin constriction sensation even after washing. Both the patients and doctors notice a lifting effect in submaxillary and cheen-chin areas. And what is very important is improvement of general feeling.
Acne disease.

Ozone therapy is used in the form of local ozone injections onto inflammatory areas (infiltrates, pustular elements). In some cases it is recommended to perform primary focal sanation by method of electrocoagulation, opening and elimination of purulent content, and then ozone therapy. The depth and number of injections under one focus depends on the size of inflammatory element. Up to 5 ml of ozone-oxygen gas mixture is injected into each point.

On average one treatment course consists of 5-6 procedures at an interval of 5 days.

All patients show clinical improvement already after one procedure. This manifests in infiltrate softening, a decrease in swelling, exudation, hyperemia, painfulness. Treatment time is reduced by 2-3 times as compared with traditional methods.

Any complications and side-effects are not observed. In case of torpid course of acne disease, diffused process the most effective method is autohaemotherapy with ozone considerably increasing the immunity and producing an antibacterial effect.

Ozone is also an integral part of postoperative rehabilitation for prevention of complications. Ozone helps to intensify lymphodrainage, restore microcirculation, improve tissue trophism, stimulate metabolic processes.

The effect is noticeable already after one-two procedures: a decrease in edema, tissue thickening and painfulness. After 4-5 procedures it comes to restoration of skin sensitivity, a decrease in hyperemia and disappearance of constriction sensation in the area of postoperative sutures. More comfortable sensations of the patient have a positive influence on his evaluation of results of the performed operation. 

After the wide practical introduction of such methods as middle and deep chemical peelings, laser and mechanical skin grinding, injection contour plasty we are facing a serious problem - hypertrophic scars. Ozone gas injections around the scar induce disappearance of skin constriction sensation, paling and softening of scars and their further resorption. As a result, it comes to significant ironing of scar surface, restoration of tissue elasticity.

Obviously, ozone therapy in the form of injections allows solving many serious problems arising in the practice of dermatocosmetologist. Of great importance is the fact that the result of similar procedures is not only solution of esthetic problems being a reason for a visit to doctor, but also improvement in general feeling of patients through the many-sided non-specific effect of ozone on tissues and the organism as a whole. 

OZONE THERAPY WITHIN A COMPLEX TREATMENT OF CELLULITES AND FIGURE MODELING 

Edematous-fibrosclerotic panniculopathy or cellulites is an exclusively female problem and represents a pathological state of fat cells (adipocytes). Among the reasons and risk factors inducing a change of fatty tissue are numbered genetic, family, national features, pubescence period, pregnancy and delivery, hormonal disturbances and intake of contraceptive preparations, age and life way.

According to various sources, 80% to 95% of women are suffering from cellulites. The affected areas are thighs and buttocks, more rarely - back and arms.

The initial stage of cellulites is characterized by microcirculatory disorder, swelling, stagnation of liquid in subcutaneous tissue. So, it comes to edematous form of cellulites that in case of further progression is transformed to fibrosclerotic form.

Fatty tissue fulfills a function of energy depot in the organism. Each fat cell is closely surrounded by capillary network, therefore it is in continuous and close contact with blood. 

In healthy fatty tissues the adipocytes receive a sufficient quantity of oxygen and nutritious substances, and products of cell activity are removed via cell membrane and taken away by blood flow.

A disturbance of this mechanism leads to development of local hypoxia, toxicosis and acidosis and in further to cellulites.

In conditions of oxygen deficit in acidic environment it comes to active growth of connective tissue that surrounds fat cells by membrane and forms cellulites small knots (micronodules). Fat cells degenerate, make groups and form in connective tissue thick conglomerates (macronodules) that block circulation and lymphatic flow, it comes to calcination of fat cells.

Edematous-fibrosclerotic panniculopathy is characterized by development of microangiopathies and disturbances of lymphatic structure manifested as lymphangiectasia and lymph edema. On the initial stage of cellulites a cosmetic effect in skin is manifested in the form of insignificant hilliness, the so-called “orange peel” that in case of further progression is transformed to “grape bunches”.

Thus, the main mechanism of cellulites development is microcirculatory disorder that leads to edema, which in turn aggravates hemodynamics closing circulus vitiosus.

Cellulites treatment should be focused:

? � Firstly, on removal of disease reason; 

? � Secondly, on correction of pathogenetic mechanisms of disease development; ?�

? � Thirdly, on liquidation of its appearances and consequences. 

All these tasks can be successfully fulfilled by ozone.

It is mostly rational to start cellulites treatment on early stages when it only represents an esthetic problem. In this case ozone can be used as a monotherapy, and it takes a few procedures in the form of subcutaneous ozone injections to achieve a good cosmetic effect.

The program of cellulites therapy combines local ozone therapy (subcutaneous ozone injections, massage and wrapping on ozonized olive oil) and systemic ozone therapy (intravenous infusion of ozonated solutions, patent ’s autoblood) that provides a more noticeable and stable result.

The parenteral methods restore hormonal background, protein, fat and carbohydrate metabolism, quickly remove consequences of stress and chronic tiredness, balance the processes of excitation and inhibition of nervous system, increase oxygen supply of the whole organism. 

Treatment variants should be determined individually depending on the stage and form of cellulites, volume of affected surface, age, associated pathology, individual features of the organism (pain sensitivity etc.). The usual course of therapy includes a certain number of sessions (from 10 to 20) with frequency 1-3 times a week. Gas is introduced subcutaneously by means of special microneedles with length of 4 or 13 mm.

Positive results of treatment are observed already after 3-5 sessions and well manifested, the patients start to notice lightness in the lower limbs and a decrease in pastosity and edema. On the next stage it comes to reduction or complete disappearance of “orange peel”, a decrease in volumes of subcutaneous tissue.

Through ozone therapy it comes to a fast-progressive decrease in fat layers, fatty tissue becomes more thick and compact. Good results can be also achieved in the formation of body contours (nonsurgical modeling of figure - nonsurgical liposuction): correction of double chin, face oval, forms of breast, thighs and buttocks. 

Ozone facilitates fast elimination of fat from stomach, particularly from its lower part that undergoes a little change through traditional methods of correction and practically no change through diet therapy and general slimming.

The essential difference of ozone therapy from other forms of lipolysis (mechanical, electric, ultrasound, chemical) is that ozonolipolysis or ozonolysis (destruction of fatty tissue by ozone) combines both a local and systemic detoxication effect, intensifies fat splitting and utilization. It comes to stimulation of cellular processes, an increase in the oxygen-transport function of blood and accordingly the oxidoreduction potential of the organism.

Ozone introduced by parenteral route does not only activate lipid exchange, but also initiates the mechanism of natural processing of the organism’s own energy resources i.e. fat. Ozone stimulates b-oxidation of fatty acids, energy production and activity of the hepatocytes focused on processing of lipid fractions; on this way liver is not affected.

Under the action of ozone in the hepatocytes it comes to activation of structural-functional mechanisms of transformation of fat energy substrates to carbohydrate ones. Ozonization induces production of catalase and peroxides involved in the catabolism of fatty acids and synthesis of glycogen and glucose from products of this catabolism i.e. ozone performs the antioxidant and detoxication functions. 

The anticellulites effect and slimming are realized on a background of tonus restoration, strengthening and tonization of all tissues exposed to ozone therapy. Skin is not hanging like after usual slimming and other methods of cellulites treatment, on the contrary - it becomes more elastic, its appearance improves. It comes to normalization of connective tissue structure as ozone has a fibrinolytic effect, a decrease in the level of hypertrophic adipocytes and metabolism restoration in subcutaneous tissue. 

As a rule, cellulites is not an independent pathology, but manifests on a background of the main disease owing to the organism’s intoxication. Therefore, without removing a reason it is impossible to cure a consequence. Ozone producing a complex effect on the organism acts on the molecular, cellular, systemic levels and treats both actual diseases and their consequence i.e. cellulites.

Ozone therapy provides remission for half to one year, but not only 1-2 months like traditional treatment. So, ozone is used to treat cellulites, but not only to achieve a temporary cosmetic effect. 

Based on the results of numerous clinical investigations it can be claimed that for today ozone therapy is one of the most effective methods for prevention and treatment of cellulites.

The gathered experience allows making a conclusion that ozone therapy is characterized by simplicity of application, good tolerance by patients, practically complete absence of side-effects, high efficiency and reasonable prices for appropriate equipment. This is a very profitable method of treatment. 

Thus, ozone therapy in conditions of cosmetic salon allows:

?� To widen the spectrum of medical services;

?� To increase the salon image; 

?� To attract new patients, increase their flow; 

?� To reduce treatment time; ?� To improve efficiency of cosmetic procedures; 

?� To achieve a stable positive result; 

To increase the salon income

Application Forms for O3 Ozone/Oxygen Mixtures in Viral Diseases Such as Hepatitis and Herpes

Posted by: Lubov Pavlova in Articles

Hartmut Oorstewitz

HD

ABSTRACT

One of the most important indications in treatment with ozone /oxygen mixtures is that involving forms of viral hepatitis (A, B, nonA and nonB in their acute and chronic progression forms respectively) and herpes diseases.

In view of the fact that no safe and effective antiviral treatment is known up till now, ozone and its peroxides here acquire a special importance as they are highly atoxic in effect and completely free of undesirable side-effects.

Due to an inactivation process, they take an active part in the viral infection cycle and increase phagocytosis; in addition to this, a protective effect on healthy cells and an increased elimination of virally damaged cells is observed.

Major autohemotherapy with ozone and rectal ozone/oxygen gas administration are its two most important application ‘forms:

1. In major autohemotherapy, 50 to 100 ml venous blood are extracted, enriched with ozone extracorporeally (at a dose of 1,000  ?�?? per up to max. 10,000 g treatment session), and reintroduced via drip infusion.

The concentration and application frequency depend on the  viral infection involved and the course of its development.

2. Here, rectal insufflation has proved itself to be particularly effective; this method consists of applying 50 to 300 ml of an ozone/oxygen gas mixture at a concentration of 10 to 60 g/ml through a catheter.

The most recent results of animal studies show that, in this application form, an oxygen effect is also produced in addition to the ozone component. The advantage of this application technique is its extreme manual simplicity, making it an economic form of treatment in addition to its absolute safety, this also applying for infants and children.

Further application forms are also found in minor autohemotherapy and local ozone/oxygen gas baths, for example in their application as additional therapy forms for herpes diseases; generally, combinations of the various therapy forms given are both expedient and successful.

INTRODUCTION MAJOR AUTOHEMOTHERAPY

Due to the fact that no safe virucidal and virostatic substances are available up to the present time, the treatment of viral diseases presents a special problem. Nevertheless, previous observations argue in favor of the fact that we now possess a highly effective and, in addition, practically atoxic, risk-free and economic method of treatment where ozone/oxygen therapy is involved.

Thus, in vitro tests applying 1.5 mg ozone per ml oxygenKave shown that it is possible to eliminate polio viruses at a rate of more than 99.9 ?� within a matter of seconds.

Following the ozonization of approx. 12000 stored blood units by WOLFF and WEHRLI, it was found that no single case of (virally transmitted) hepatitis was contracted as a result.

The effects of ozone/oxygen mixtures in systemic viral infections are nowadays considered to be found in 4 partially synergiatic reaction processes:

1. The virus-inactivating property of ozone and its peroxidic products,

2. The activation of phygocytosis,

3. The cellular projective effect of healthy organ cells, and

4. Their cytotoxic effect on virally damaged cells bhus ensuring their rapid elimination.
For this total effect to act as thoroughly as possible, the ozone must be applied under predetermined conditions which may, thanks to the equipment and application forms available at the present time, be taken as a matter of course.

In the strict sense of the word, this is not a direct form of ozone therapy, as the ozone is merely added to extracorporal blood taken from the patient’s own body. In an instantly occurring biochemical reaction on the phoepholipid chains of the erythrocyte membranes (so-called erythrocytic mechanism ace. to ROKITANSKY), ozone-induced peroxides inherent to the membrane are formed which, in a way very similar to that of ozone itself, behave aa powerful oxidants, even if their actual effect is somewhat dampened due to the energy loss involved.

It is assumed that peroxides, via an oxidative intervention on the cell receptors, exert an change on the virus so that it is inhibited, i.e. prevented from attaching itself to the membrane receptors of the host cell. The virus is thus inactivated and the infection cycle interrupted. In addition to this, the peroxides in the phagocytes activate endogenous cellular metabolism.

Consequently, the cell’s own hydrogen peroxide, H202, is formed, a substance1 which plays a major part in the destruction of foreign microorganisms such as viruses.

The intracellular peroxide concentration increases due to the ‘ presence of the additional, ozone-induced peroxides, which results in a considerable improvement of the cell’s phagocytic performance on account of this synergistic effect.

The cell-protecting effect of ozone and its peroxides is apparently also based on processes involving an activation of cellular metabolic activities, such as ROKITANSKY has very accurately described in the case of the erythrocytes.

Furthermore, due to a possible damage of their membranes, virus-infected cells are less ozone-resistant than healthy ones; this could explain, for example, the frequently observed initial increase in liver enzymes.

THE TECHNIQUE OF OZONE PREPARATION

From a steel cylinder containing medical oxygen, a continuous  flow of gas is conducted through a high-voltage generator which converts an accurately dosed amount into ozone; in this way, an ozone/oxygen mixture at the selected concentration is obtained from the pick-up nozzle for medical application.

APPLICATION FORMS

The following application forms in the treatment of viral  diseases:

1. Ozone/oxygen autohemoth.erapy vie infusion, called major autohemotherapy (MajAHT)

2. So-called minor autohemotherapy (MinAHT)

3. Rectal ozone/oxygen gas insufflation

4. Gas application under plastic bag (PB) or suction cup (SC).

MAJOR AUTOHEMOTHERAPY: APPLICATION TECHNIQUE

A quantity of 50 - 100 ml venous blood is first transferred via a transfusion device to a plasma bottle, an anticoagulant  then added to it (e.g.. sodium citrate or heparin), following which 3000 - 9000 |ig ozone/oxygen gas mixture are carefully added; finally, the. blood is reinfused without pressure via continuous drip.

50 ml venous blood are sufficient for a concentration of up to 4000 |ig. Approximately 100 ml aare necessary for higher concentrations.

We recommend the following procedure in acute viral forms of hepatitis of the ??, ?� and NANB types:

1st week, 1st day: ,”tolerance sample” of 1000 ug, which is increased from 3000 to 9000 \ig from the second day on. Treatment every 2nd day from the 2nd week on.

Regular clinical and laboratory (chemical) monitoring checks are absolutely indispensible. The total quantity applied is to be reduced from 9000 ?�?? to between 4000 and 6000 ?�?? as soon as the patient’s clinical condition and the laboratory values improve. 30 to 40 treatment individual sessions may be necessary; these can be carried out in a number of series.

Treatment is naturally to be discontinued when laboratory chemical and clinical findings become critically aggravated.In the case of infections of the Hepatitis ?� and NANB type with a chronic progression, we apply treatment in the acute aggravation phase in the same way as the acute infection itself.In the intervals between acute aggravation phases, we apply 3000 to 6000 ?�?? ozone in 2 - 3 treatments per week.

According to the patient’s response, series of 10 - 15 sessions are then conducted 2 - 3 times per year. In agreement with to the present state of the art, the addition of a small quantity of ozone/oxygen mixture to blood stored for transfusions is able to prevent the transmission of hepatitis and especially HIV viruses.

This method is a safe and extremely simple, economic and elegant way of preparing blood for transfusions.In acute cases of herpes zoster, we carry out treatment in the same way as with acute hepatitis.In this, case, 5 - 8 treatment sessions are sufficient as a rule.

With very elderly (aged over 70) and/or debilitated patients, we generally apply lower concentrations (up to max. 6000 ?�??). Neuralgia following herpes zoster is no indication for ozone /oxygen treatment.

However, the treatment of recurrent, herpes simplex infections  is very successful. In most cases, acute phases can be caused to subside rapidly, and relapses prevented to a large extent or even completely. In cases of severe or aggravated conditions, major autohemotherapy is indicated at doses between 4000 and 9000 ?�?? ozone.

As a preventive measure, we recommend a series of 8 - 10 treatments of 2 - 3 sessions per week. Where the. condition shows a mild development, minor autohemotherapy is ideal as an alternative.

MAJOR INDICATIONS

These are: Recurrent herpes simplex Mild herpes zoster  Acute viral influenza Susceptibility to infections Interval therapy in chronic hepatitis.RECTAL INSUFFLATION (RI) According to recent studies by KNOCH, the rectal insufflation of’ozone/oxygen mixtures acquires a special importance in the treatment of various forms of hepatitis.

This author demonstrated that the partial oxygen pressure in the portal vein consequently increases within a very short period. This form of application can by all means be carried out as an alternative to major autohemotherapy. It is specially suitable in those cases where MajAHT cannot be used, thus for example, in children.

As a rule, we apply RI every day if possible, first over a period of 2 weeks, and then as indicated and with intervals of one or several days.

The concentrations are within a range of 30 -60 ?�?? ozone per ml ozone, the quantities being being 20 - 50 ml for neonates and infants, 50 - 100 ml for larger children and 100 - 300 ml total quantity for adults. la persistent cases, combinations of RI with MajAHT are admirably suitable, either during the same treatment session or at MajAHT/RI treatment ratios of 1:1, 1:2 or 1:3.

As it would be going beyond the scope of this paper to discuss the applications of ozone/oxygen gas under plastic bag (PB) or suction cup (SC) (listed above under No. 4), these forms will be described separately. As regards viral infections,’they are only applied far example as an adjuvant therapy for herpes simplex or h. zoster, insofar as the skin areas under consideration are accessible.

MINOR AUTOHEMOTHERAPY: APPLICATION TECHNIQUE

10 ml ozone/oxygen gas at a concentration of 300 - 600  ?�?? is introduced into a 20 ml rejectable plastic syringe, following which a vein is punctured and a small quantity of approx. 1 - 5 ml blood removed. By gentle shaking the blood is immediately ozonized and oxygenized and immediately reintroduced via intramuscular injection.  

Treatment is carried out 1 - 2 times per week with 5-10 sessions.
F i g . 6

DIE INTRJLARTICULARE OZON-THERAPIE

kleine Gelenke nittelgroQe Gelenke

Osonaeqge

20-40 Gamna (Fingergelenke, Zehengelenke)
80 -  ?�00 Gamma (Handgelenke, Ellbogengelenke, Bprunggelenke, Schultergelenke)

Infection Control by O3 Ozonizing Aspects of Medical Hygiene

C. Beck, A. Filippi and F. Tilkes.

Institute of Hygiene, University of Giessen (Justus-liebig-Universltet), FR Germany

ABSTRACT

General and particular aspects of infection control are presented and discussed.
Water hygiene in the form of disinfecting drinking mater - whirlpools - and water for swimming pools and the practice of ozonization, in dental treatment units are all well-known aspects of ozonization.

In water-based systems, ozone has proved its very high level of efficacy against bacteria and in the inactivation of viruses, especially in the elimination and rapid destruction  of legionella, pseudomonas, hepatitis A + ?�viruses and HIV viruses.

In particular, our results show promising possibilities for the use of ozone in dental treatment units.

INTRODUCTION

Studies on the antibacterial effect of ozone were described for the first time by OHLMUUER in 1893. In the same year, ozone was applied technically for cleansing  Rhine water in the Dutch community of Oudshoon.

Here, its importance is not only to be seen in disinfection, but also in its further effects such as the precipitation of iron and mangasnese, the destruction of sulfites and substances active on-the surface, the elimination of turbidity, the oxidation of aromatics, odoriferous substances and flavorings as well as other organic compounds (e.g. 3,4-benzpyrene).

Ozone, which is considered to be the strongest oxidant applicable in practice, is not only used in the disinfection of drinking and swimming pool water (hot whirlpool), but also in the pharamaceutical field for the purpose of protecting water VE preparation units, particularly their critical sections (such as ion exchangers, reversible osmosis units and sterilization filters etc.), from microorganism deposits. For example, VE*)- ozonized water can be used in autoclavlng.

In an aqueous envi- *VE: aqua demineralisata ; ronment, ozone breaks down very rapidly into oxygen and water, so that no toxic decomposition products whatever are formed. When using ozone for water cleansing, care must be taken that compatible, i.e. acceptable, materials are used.

Glass, ceramics, stainless/high-quality steel and Teflon are resistant to direct ozone exposure. On the other hand, rubber sealing parts and rubber tubing is extremely susceptible to corrosion from ozone.

Ozone has a wide range of action; the concentrations needed to destroy vegetative bacteria and spores are within a range of 1 - 5 mg/Liter. Approximately within the same magnitude limits, but only at a low concentration range. (0.025 mg/Liter), we find that a concentration 3 times higher is necessary to obtain a sporicidal effect. Fungi are also included in this range, in the same way as viruses (BOTZENHART and HERBOLD, 1988).

The following factors influence the microbicide action of ozone: Concentration; The time needed for the destruction of microorganisms decreases considerably as the ozone concentration is increased. Most of the microorganisms are already killed off after less than 1 minute at a concentration of 5 ug ozone per ml.

In spite of this, its concentration in water is subject to a number of different influences: - Ozone consumption: a large number of organic and inorganic compounds react with the oxidant ozone, resulting in a decrease of the “freely available” ozone. In this aspect, ozone behaves in a way similar to chlorine or iodine.

- Light effect: ozone decomposes at a considerably more rapid rate in light than in darkness.
- Life: the life of ozone in water depends to a great extent on the composition of the water (aqueous medium) and the above factors. After a standing period of JO hours and at an -ozone concentration of 4.5 ug per ml in VE*-water, only approx. 0.3  ?�g ozone/ml can still be found.
Temperature: The action and effect of ozone are better at 0 ? �C (32 ?�F) than at 20 0C (68 ?�F) INGRAM H. and HAINES R.B. (1949).

Humidity; In water, considerably lower concentrationa are necessary to destroy microorganisms than in a dry atmosphere. pH value; its antimicrobial effect is optimal in an acid pH range (pH 2) but decreases rapidly as the pH value increases, so that only 1 5 of this value is present at pH 7.8 by comparison, and its presence may be practically neglected at a pH value of 11. This drop in activity follows the pH-dependent ozone *) aqua dbermeiankedroawlni.sata

After ozone action over an extended period of time, pyrogens contained in water are inactivated, a fact which has been demonstrated by the addition of 40 ml Pyrifer strength VIII to 100 Liter bidistilled water, corresponding to 2 units/ml in the presence of 4 - 5 ppm ozone. The tests by WALLHSUSER (1988) here cited show that approx. 9 hrs are necessary for such an inactivation.

The water needed for the dental treatment of a patient should have the quality of normal drinking water at. least. Nevertheless, completely germ-free water is much better, as microlesions to the mucous membrane are always possible in practically all forms of dental treatment, so that the possibility of an infection from water and air used as coolants can never be excluded. The following studies were carried out for this reason.

METHODS AND RESULTS

1. The tests were carried out in parallel on two dental units. One was opersted without water disinfection, the other with a continuous addition (by dosage) of hydrogen peroxide and silver ions (as preliminary test).

Five water samples were taken at all removal points of the unit every day, end the number of microorganisms (germ count) per ml recorded in the form of a weekly chart. Subject to circadian deviations, there was a pronounced accumulation of microorganisms at all removal points.

The germ counts recorded were up to 1000 times higher than the limit of 100 cfu*) per ml laid down by the law for drinking water in the Federal Republic of Germany.Differences in reduction of (the number of) microorganisms with or without disinfection as depending on use thus became
clear.

2. Comparison of the disinfectant effect of ozonized water and hydrogen peroxide in vitro at 20 ? �C (68 ?�F) and 37 ?�C ?�F ). Microorganism tested: Pseudomonas aeruginosa Concentration: 3 x 10* colony forming units per ml Procedure: quantitative suspension test, i.e. 100 ml of the disinfectant are incubated with 1 ml suspension of the micro organism) samples are taken immediately, after 1 minute and after 5 minutes and the number of microorganisms still press
In them recorded.

Concentration of disinfectant; Ozonized water: 10 (ig ozone/ml water )
H2 O2 : SO mg H2 O2 /L water ) as in the dental unit In the case of the ozonized water, the disinfectant effect was immediate, compered with which the hydrogen peroxide and the bidistilled water selected as a reference both behaved in the tically no disinfection The hydrogen peroxide showed per definitionem, p r a c - See Fig. 1

INITIAL NO. OF MICROORGANISMS

Ozonized water hydrogen peroxide Bidistilled Water 2*109 units/ml ) 4*107 unite/ml 2*109 units/mi

START OF TEST

Ozonized water hydrogen peroxide Bidistilled Water 0.0 units/ml ) 2*107 units/ml 4*109 units/ml

AFTER ONE MINUTE

Ozonized water hydrogen peroxide Bidistilled Water 0.0 units/ml*) 2*107 unite/ml 2*109 units/ml

AFTER FIVE MINUTES

Ozonized water hydrogen peroxide Bidistilled Water 0.0 units/ml ) 2*107 unite/ml 2*107 unita/ml
* ) colony forming units

3. Comparison of the disinfectant effect of ozonized water and hydrogen peroxide in the dental chair.

A very high degree of microorganism contamination indeed is found on monday mornings in both disinfection systems, which drops after disinfection during the course of the day to 0 cfu } per ml, this being more rapid with ozone than with hydrogen peroxide. The dental unit and/or the water samples taken are free of microorganisms during the remainder of week.

4. Determining the increase in the number of microorganisms over the weekend
Water samples (2 ml) were taken on Friday midday, Saturday morning, Sunday morning and Monday morning from both nozzles, of which one. had been disinfected the previous week with hydrogen peroxide, and. the other with ozonized water.

The major increase in the number of microorganisms occurred between Saturday morning and Sunday morning,- i.e. about 15 - 39 hours after termination of treatment. After this, the number of microorganisms only increased to an unimportant extent. This applied for both disinfection systems.

5. Test to reduce the number of microorganisms by simply removing a specific quantity of water on Monday prior to starting treatment *) colony forming units.

Following each of the three weekends, 170 ml were removed from the nozzle on the dentist’s side in fractions of 10 ml and examined for the number of microorganic colonies. The volume of standing water in the dental chair was 90 ml.

After each of the three weekends, disinfection was carried out by “flushing through” with another disinfectant, once with ozonized water, once with hydrogen peroxide and finally with (sterile) distilled water.

When the chair unit had been flushed clean of the remaining 90 ml and refilled with disinfected water, the number of micro- t organisms in the ozonized water immediately dropped to 0 cfu’s per ml. In the case of the hydrogen peroxide, this lasted for a further 60 ml. With distilled water, the number of microorganisms counted only dropped very slowly and this merely due to the rinsing effect.

6. Determination of the ozone concentration at the water outlet points of a dental treatment unit as depending on external temperature when the instant flow water heater is switched off
Titrimetric method determination according to the KJ Water samples were tested with and without connected dental device Ambient temperature: 15 0 C (59 ?�F)

Samplinq point _without/________ with connected instrument

Cytozon (immediate) 14.16 g/ml
(Dentist’s) nozzle 6.96 g/ml 6.96 g/ml
Turbine 7.68 g/ml 0 g/ml
Micromotor 1 7.20 g/ml 0 g/ml
Micromotor 2 6.96 g/ml 0 g/ml
Ultrasonic unit 8.40 g/ml 0 g/ml
Cytozon (after 60) 14.16 g/ml
Ambient temperature: 20 ?�F (68 )
Sampling point______ without/______ with connected instrument

Cytozon (immedate) 12.96 g/ml
(Dentist’s) nozzle 5.52 g/ml 5.52 g/ml
Turbine 6.72 g/ml 0 g/ml
Micromotor 1 5.52 g/ml 0 g/ml
Micromotor 2 5.28 g/ml 0 g/ml
Ultrasonic unit 6.48 g/ml 0 g/ml
Cytoron (after 60′) 12.72 g/ml
*) colony forming units

Ambient temperaturei 25 ?�C (77 ?�F)
Sampling point ______ without/______ with connected instrument

Cytozon ( immediate ) 11.04 g/ml
(Dentist’s) nozzle 2.88 g/ml 3.12 g/ml
Turbine 5.76 g/ml 0 g/ml
Micromotor 1 2.16 g/ml 0 g/ml
Micromotor 2 2.16 g/ml 0 g/ml
Ultrasonic unit 3.36 g/ml 0 g/ml
Cytozon (after 60′) 10.56

7. The effect of an instant flow mater heater on the invitro ozone concentration Simulation of a heater by using a Siemens cooler and HOG ) determination of the ozone concentration using the KJ method.

In this case, the moat important result obtained was that approx. 40 % of the initial ozone concentration was lost through heating of the water by theinstant flow heater to 37 ?�C (98.6 ?�F). In total, the concentration dropped in a linear slope. *) special cylindrical ozonization container

8. The effect of the heater on the ozone concentration in the dental chair unit The in vitro results mere confirmed.

9. The influence of the heater on the degree of contamination of the water through microorganisms

In spite of the ozone concentrations reduced by the heating effect, no significant differences could be established upon comparison with the weekly charts recorded without the instant flow heater.

10. Determination of the ozone concentration at work site when operating an ozone water disinfection system DrSger tubes were used for ozone detection and recording. No atmospheric ozone at all could be detected at any of the water outlets and in the vicinity of the Cytozon unit, either during operation or during ozonizing.

DISCUSSION

As an infection-controlling agent, ozone has proved itself to be invaluable in preventive medicine and, particularly here, in the case of water hygiene.

Both our own tests as well the studies on the microbiological water quality in dental treatment units described in literature show that, particularly on Monday mornings before starting work, the turbine spray and the water of the mouth rinsing device are contaminated to a very high degree by potentially pathogenic microorganisms.

The reproduction of bacteria in dental treatment units is encouraged by the following criteria:

- The water ia kept in the unit for a long time,

- The water is heated,

- Tubes and other water-conducting unit elements are made of plastic,

- Different passage widths for the water in the units, on account of which water exchange can only take place slowly,

- The presence of hollow spaces in which microorganisms are able to multiply unhindered.

When non-disinfected water is used, the number of colonies counted can rise to 10,000 per ml. This number decreases once more after a treatment period of 1 - 2 hours. Another increase of microorganism contamination takes place during the lunch break. In the.- first place, the source of such a contamination is to be looked for in the water supply of the dental treatment- unit in question.

The not infrequently contaminated water tubes, with which the turbines, angular handpieces, angular motor units and mouth rinsing devices are connected, present a hygiene problem. Microorganisms introduced into the unit via unaterilized water or insterile containers are able to multiply in the water which is kept still for- long periods of time.

They are then also able to form colonies in the turbine. However, microorganisms are also capable of entering the treatment unit due to the properties of back-pressure suction valves, this also being possible from the patients’ “end. In the microbial contamination of water paasages in dental treatment units, we are dealing for the most part with pseudomonaa aeruginosa and pseudomonads of the fluorescent group and legibnella; furthermore, the-presence of alcaligenes faecalis, flavobacteria and escherichia coll has also been demonstrated (BECK and SCHMIDT 1986, J. BORNEFF 1982, M. BORNEFF 1986, PRUCHA and TILKES 1986), The various plastic tubes and connections inside a dental unit are known to favor the growth of paeudomonas aeruginosa, whose pathological effects need not be described here.

A reduction in the number of microorganisms colonizing such a system to values lying within the legally allowed contamination of drinking water (less than 100 colonies per ml) is not only possible through disinfection of the water used in it. Although simply allowing the residual water to flow off prior to dental treatment produces a reduction in microorganisms, the values of the main water supply to the unit are still never reached.

A one-time cleansing of the unit by chemical disinfectants or steam can have no permanent effect, as a continuous supply of new microorganisms comes from the water itself or from the patients.

Therefore-, success can only be expected when the water throughout the entire unit is subjected to a continuous disinfection process. As our tests have shown, a noticable hygienic improvement is, fundamentally, only possible where an ozone-dosing disinfection unit is put into use.

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