Ozone Oil Pulling

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1. Ozone oil pulling refers to the practice of swishing diluted ozone oils around the mouth for oral hygiene and to treat some dental issues.
2. Ozone oils may have ozonides and peroxides that can kill microbes, stimulate local immune functions, and activate healing in the mouth. 
3. Ozone oil pulling can help deliver several of ozone therapy’s benefits at home without the need to handle ozone gas.
4. Ozone oils are not only antimicrobial but also reparative and anti-aging. Conventional dental care does not provide this.
5. Ozone oil pulling may help with bad breath, tooth decay, gum health, teeth sensitivity, plaque formation, and any infectious or inflammatory conditions in the mouth. 

What is Ozone Oil Pulling?

Oil pulling vs ozone oil pulling

Oil pulling originated in Ayurvedic text. They believed that swishing culinary oils, sometimes with herbal extracts, in the mouth could treat various diseases. 

On the other hand, ozone oil pulling uses ozonated culinary oils. Ozone is a form of oxygen (O3) with three oxygen atoms. This highly reactive form of oxygen has powerful oxidizing properties, making it effective as an antimicrobial. 

To make ozonated oil or ozone oil, a mixture of ozone and oxygen gas is bubbled through the oil for up to 10 days in a temperature-controlled reactor. The oil will change color and odor, and may smell like rancid oils. However, these oils are not rancid; they are only oxidized. Ozonated oils create ozonides, which are ozones embedded in double bonds of unsaturated fatty acids. Ozonides can also break down into peroxides, organic acids, aldehydes, and more. These highly reactive molecules can interact with fats in cell membranes and other double bonds in cellular components. 

Ozonides act similarly to ozone gas in several ways as they are like ozone molecules embedded in the double bonds of a fat. The ozonation process also produces many oxidizing molecules. Therefore, ozonated oils deliver many of the benefits of ozone therapy without the risk of ozone inhalation or the need to handle ozone gas. 

During ozone oil pulling, ozonides and peroxides interact with your tissues and the oral microbes. When done right, ozone oil pulling can have antimicrobial effects along with other healing effects.

How to do Ozone Oil Pulling

Simply put, ozone oil pulling involves placing a spoon of ozone oil pulling solution into the mouth and swishing it for 20 minutes. People with oral issues typically do this up to twice daily until the problem is remediated. For general wellness and preventive oral care, two to three times per week is usually sufficient.

The most popular ozone oil is olive oil. However, ozonated oils on the market could be one or a mix of:

• Olive oil
• Sesame oil
• Grapeseed oil
• Coconut oil
• Sunflower oil

These oils vary in fatty acid constituents, phytochemicals, vitamins, along with flavors. Some fatty acids such as lauric acid have antimicrobial properties, which may synergize with ozonides in ozonated oils. 

Most phytochemicals and vitamins get destroyed during ozonation. However, when stable ozone oils are mixed or diluted with non-ozonated culinary oils, you can still get some benefits of the polyphenols and vitamins in the non-ozonated oils.

A proper ozone oil pulling protocol typically involves the following steps:

• Measure about 1 teaspoon (5 mL) of ozone oil pulling solution.
• Swish the oil gently in the mouth for 10-20 minutes, ensuring it moves around all parts of the oral cavity.
• Spit the oil into a trash can (to avoid sink clogs) after pulling.
• Rinse the mouth thoroughly with warm water.
• Follow with regular brushing.

It's important to use ozone oils designed for dental use. They should be produced with pharmacologically standardized methods and tested for harmful impurities. It’s also a good idea to consult with a healthcare professional before starting, especially for individuals with specific health conditions or concerns.

How does ozone oil pulling assist oral health?

When you oil pull with ozonated oils, the ozonides and peroxides in the oil come in contact with your tissue and the microbes in your mouth, resulting in the following effects:

• Reducing microbes in the mouth
• Breaking and removing biofilms, including dental plaques
• Speeding up healing and regeneration process of wounds, lesions, and cavities
• Stimulating anti-aging pathways in the mouth
• Balancing excess inflammation, while jumpstarting stagnant immune responses

Antimicrobial against problematic oral microbes

Ozone oil possesses potent, broad-spectrum antimicrobial properties due to the reactive nature of ozonides and peroxides. 

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Ozonides and peroxidases can disrupt the cell walls of bacteria, membranes of fungi, and capsids (shells) of viruses. This can cause their cells to leak and burst [1].

In the oral cavity, ozone oil targets and reduces the populations of harmful bacteria, including those responsible for:

• Dental caries
• Periodontal diseases
• Halitosis (bad breath)
• Gingivitis (gum inflammation)

Ozone oil pulling also reduces the overall number of bacteria in the saliva [2].  

Some oral health-relevant microbes that could be targeted with ozonated oils include the bacteria [3]:

• Streptococcus mutans, known for causing dental caries
• Porphyromonas gingivalis, associated with periodontal disease and its presence in the mouth may promote cardiovascular disease [4]
• Anaerobic bacteria that tend to cause bad breath [5]

Ozone oil therapy also has activity against:

• Herpes Simplex Virus-1 (HSV-1), responsible for oral herpes infections and cold sores
• Candida albicans, responsible for oral candidiasis (thrush), common in immunocompromised people

Perspective: Much of dentistry and daily oral care focus on antimicrobial treatments. These include chemical antimicrobials in oral care products or mechanically removing plaques or food debris. 

Research is only starting to understand how oral health and flora connect to overall health. An interesting connection is that long-term mouthwash use is associated with higher blood pressure and increased risk of prediabetes and diabetes. This may be because the mouthwash kills off nitric oxide-promoting bacteria in the oral flora [6].

There was a time when medicine believed antibiotics were completely harmless, but now they have discovered numerous problems with antibiotics. Killing the entire gut flora makes you more susceptible to opportunistic infections like Clostridium difficile, which can be deadly. Analogously, killing all your oral flora with mouthwash might save your teeth and freshen your breath in the short term but have grave long-term health consequences. Also, research is still uncovering how dental care or oral care routines affect your health. 

Possibly, the future of antimicrobial therapy and oral care would be to preserve a healthy flora while specifically killing the harmful microbes.

At therapeutic concentrations, ozone is a different kind of antimicrobial in that it both works with your immune system and attacks the microbes simultaneously. We still don’t fully understand how but the following ozone clinical trials suggest that ozone oil pulling likely preserves a healthy oral flora rather than killing everything:

• Ozone rectal insufflation in IBS patients significantly improved their gut flora [7]
• Ozonated water treatment could treat vaginitis but protected friendly bacteria like Lactobacilli in the vaginal flora of healthy women [8]

Breaks and removes biofilms in the mouth

Biofilms are communities of various microbes that camp out on a moist surface in your body. They may cover themselves with polysaccharides or sticky substances that protect them from your saliva, medications, toothpastes, and anything else meant to eliminate them. Any attempt to kill these microbes can fail because they can’t penetrate or break biofilms [9].

Dental plaques are a type of biofilms on your teeth that can contribute to gum diseases and dental caries (damaged areas in teeth due to cavities resulting in a hole). Also, there are several other types of problematic oral biofilms, especially in periodontal diseases and oral infections.  

Ozonated oils and water can break biofilms and destroy microbial substances they tend to release [10]. This is one of the reasons ozonated oils can reduce dental plaque and caries [11].

Speeds up wound healing and tissue regeneration in the mouth

Ozone oil pulling speeds up wound healing, especially when it has become chronic or slow healing due to chronic inflammation, poor circulation, or excess oxidative stress. 

Ozone oil pulling delivers these benefits by [12]:

• Enhancing oxygen utilization, which may stimulate mitochondrial function and metabolism in the mouth tissues. This means more energy for healing and repairing.
• Improving local blood circulation, which improve nutrient delivery and waste removal
• Activating the body's antioxidant defense systems. This can result in a net reduction in oxidative stress within tissues
• Increasing growth factors that stimulate tissue growth, collagen production, and blood vessel regeneration [12]
• Normalizing local inflammation, which may allow healing processes to be more efficient
• Stimulating some aspects of the stagnant immune function
• Reducing local microbial loads, allowing the immune system to focus on repairing the tissues

Issues that ozone oil pulling can help include:

• Oral lesions (prosthetic stomatitis)
• Gingival grafts  
• Gingivitis  

In a clinical trial involving 200 patients who received dental extraction, the ozone therapy group applied ozone oil to their extraction socket. The control group received painkillers and antibiotics, which are standard post-extraction procedures. While both groups experienced the same amount of discomfort, the ozone group had significantly better wound healing [13]. 

Activates anti-aging and regenerative pathways in oral tissues and gums

The cells that line the mouth and gum constantly renew themselves, and this renewal slows down with age. 

As your cells age, your mouth tissues become less able to self-repair or defend themselves from the elements like food, oxidative stress, and pathogens. Ozone oil pulling activates anti-aging pathways that enhance antioxidant defense mechanisms within the body [14]. 

Ozone's interaction with lipids and fluids in the oral cavity produces lipid oxidation products and reactive oxygen species (ROS). These can stimulate the body's own antioxidant systems, such as the enzymes superoxide dismutase (SOD) and glutathione peroxidase (GPx).

Any kind of inflammation in the mouth, such as gingivitis and periodontitis, can increase oxidative stress [15]. Excess oxidative stress tends to inhibit the healing process and may perpetuate the damages. 

SOD and GPx neutralize ROS, reducing oxidative stress and providing the following protective effects.

• Preventing DNA damage
• Maintaining telomere length
• Promoting cellular repair mechanisms

Therefore, activating the anti-aging pathways preserves tissue health and allows the cells to continue to grow and replenish for longer. 

Stimulates local immune responses

Some of your immune cells use peroxides and lipid peroxides to communicate with each other and as weapons to attack microbes. Also, debris of peroxide-attacked microbe stimulate the immune system. Therefore, the peroxides from ozone oil pulling can temporarily stimulate these immune functions [16]:

• The release of signals and growth factors from local immune cells
• Immune surveillance and defense mechanisms against pathogens [12, 17].
• Coordinating some immune response genes and pathways, such as NF-κB
• Expanding the numbers of immunocompetent (ready) cells and antibodies
• Activating macrophages

With ozone oil pulling, these effects are more localized to tissues in your mouth, such as the cell lining, tongue, and gums. Therefore, ozone oil pulling is beneficial in fighting infections and wound healing for these tissues.

What is ozone oil pulling used for?

Ozone oil pulling can help with a full range of oral health issues, from bad breath and gingivitis to more complex dental conditions such as periodontitis, root canals, and other oral surgeries.

Can ozone oil pulling deliver full-body benefits? Currently, no published study exists to show that oil pulling has systemic effects. However, we do understand that oral infections can have ripple effects throughout the body, such as increasing inflammation and circulating microbial toxins. This can increase the risk of cardiovascular diseases and obesity [18, 19].  As such, ozone oil pulling is well positioned to have positively impact the whole body by addressing underlying mechanisms of disease states stemming from the mouth. It helps put the body into a more homeostatic condition, allowing the body to heal. 

In addition, the lipid ozonation products in the ozone oils can also get absorbed through tissues in the mouth and deliver some whole-body benefits similar to ozone saunas. 

Ozone oil pulling has a broad scope of usage centered around promoting oral hygiene and the maintenance of proper oral flora. Some use cases include:

Bad Breath (halitosis)

Bad breath (halitosis) often stems from bacteria in the mouth producing foul-smelling sulfur compounds, such as Porphyromonas gingivalis. Poor oral hygiene, dry mouth, or infections can exacerbate it. [20]. 

Even oil pulling without ozonation can help with bad breath. Ozonation makes it even more powerful as the ozonated oil has strong antimicrobial properties, effectively reducing the bacteria responsible for bad odors. This method promotes a healthier oral microbiome, which may help reduce bad breath. So, we’re including these clinical trials of regular oil pulling to support the benefits of ozone oil pulling.

A meta-analysis of nine randomized clinical trials (RCTs) investigated the effects of oil pulling on dental health and oral hygiene, focusing on salivary bacterial colony counts, plaque index, and gingival index. Oil pulling significantly reduced salivary bacterial count compared to controls (mean difference: 17.55). There was a non-significant reduction in plaque and gingival index scores with oil pulling. This suggests oil pulling may effectively reduce oral bacteria, although its impact on plaque and gingivitis remains inconclusive [2].

A randomized control trial of 20 adolescents investigated the effects of sesame oil pulling on halitosis outcomes compared to chlorhexidine mouthwash, a standard dental practice to combat bad breath. Oil pulling significantly reduced plaque and modified gingival index scores (p = 0.005), organoleptic breath assessment (ORG 1), self-assessment of breath (ORG 2), and BANA test from tongue coating (a test that detects plaque-forming pathogens). Results were comparable to chlorhexidine mouthwash [21]. 

A double-blinded randomized trial involving 75 adolescents compared the effectiveness of sesame oil (SO), ozonated sesame oil (OSO), and chlorhexidine (CHX) mouthwash on oral health. After 15 days and one month of use, all treatments significantly reduced debris index, calculus index, oral hygiene index, plaque index, and Streptococcus mutans count. This study demonstrates that oil pulling with SO and OSO significantly improves oral hygiene, comparable to CHX mouthwash. The authors concluded that oil pulling could be a viable option for enhancing oral health in adolescents [22].

Tooth decay, caries, and cavities

Tooth decay is the damage to your tooth’s enamel that can lead to dental caries and cavities. Several factors can contribute to tooth decay, such as:

• Acid-producing bacteria, such as Streptococcus mutans, that break down sugars and create acids [23]
• Acid reflux
• Low saliva production 
• Poor oral hygiene
• High sugar intake and frequent snacking
• Dry mouth, such as caused by mouth breathing at night or smoking
• Low capacity to buffer acidity in the saliva
• Mechanical damages, such as teeth grinding or chipped teeth
• Low minerals in the saliva
• Deficiencies of calcium, magnesium, zinc, iron, protein vitamins A, D, and K

Perspective: Early stages dental caries and cavities can arrest (stop progressing) and reverse (self-repair). Most dentists suggest immediately drilling and filling cavities as soon as they see one. However, the cavity-filling materials are weaker than your natural teeth, so once you have a filling, you may have to redo them every 3 - 7 years. Each dental filling can expose you to some toxic effects of the raw materials in the fillings–there is no-zero toxicity dental filling. Understandably, fillings can sometimes be the right choice in the right circumstances.

The good news is that your teeth can remineralize and early-stage cavities can self-repair. However, unlike dental fillings, this requires disciplined daily action. 

1. Correcting the root causes above. Many people will just keep getting more cavities if they don’t fix the root causes.
2. Providing the mineral building blocks in your saliva
3. Supporting an overall regenerative environment, such as with regular ozone oil pulling

Here is published evidence of how ozone oil helps with dental caries. 

Antimicrobials in the caries

Ozone oil pulling can help by reducing the bacterial load in the mouth and disrupting the environment that allows these cariogenic (decay-causing) bacteria to thrive. This could potentially slow the progression of tooth decay and promote oral health. In the test tube, ozone olive oils are significantly more effective against S. mutans than olive oil alone [24].

Stimulating caries’ arrest and reversal

Most studies of ozone therapy for dental caries focus on ozone’s capacity to disinfect the caries. However, the studies also observe some arresting and reversal of the caries, suggesting that ozone exposure may go beyond antimicrobial to stimulate the teeth’s own damage repair [25, 26].

Remineralize, smoothens, and hardens teeth

Another test tube study examined how various treatments remineralized 40 extracted molar teeth. They compared fluoride toothpaste and ginger and honey paste with ozone oil. Treated molars were compared to the recorded characteristics before the treatment as a control. After 21 days, all treatment groups became smoother and harder, indicating remineralization. No significant differences existed between treatments, although ozonated olive oil showed the greatest change in roughness and microhardness. Therefore, ozone oil could be used as a viable alternative to fluoride for remineralizing teeth, regenerate tooth structure, and manage caries noninvasively [27].

Gum Health and Gingivitis

Gingivitis is inflammation of the gums. It’s the mildest form of periodontal disease. An estimated 90% of people have some gingivitis, suggesting that most people who have it don’t even know they have it [28]. It can progress to become more severe or deeper periodontal diseases. However, the bigger problem with gingivitis (and all inflammatory conditions of the mouth) is that it can create whole-body inflammation and elevate your disease risks. Several studies have linked gingivitis with elevated cardiovascular risk [29]!

Gingivitis can arise from the accumulation of debris, bacteria, and plaque under the gum, leading to irritation, redness, swelling, and bleeding during brushing. Standard treatments usually involve better oral care, deep teeth cleaning, antibiotics, and teeth removal.  

Ozone oil pulling can uniquely and non-invasively address gingivitis by:

• Antimicrobial properties
• Breaking down plaque biofilm
• Stimulating healing and regeneration of the damaged gum tissues 
• Stimulating immune function in the gum

A randomized controlled trial compared the efficacy of ozone oil and chlorhexidine gel (control) on plaque-induced gingivitis among 20 subjects. Subjects were tasked with massaging either control or ozonate oil on their gingiva three times a day for three weeks. After three weeks, both chlorhexidine gel and ozonated oil significantly improved gingival health (p < 0.001) by reducing plaque and gingival index scores compared to pre-treatment baselines. Although there was a higher reduction in plaque and gingival scores with ozone oil treatments, there was no significant difference between treatments. Therefore, ozone oil can be as effective as chlorhexidine gel in managing gingival health, providing an alternative treatment option [30].

Periodontitis

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Periodontitis is an advanced stage of gum disease characterized by the destruction of the structures supporting the teeth, including the alveolar bone, leading to tooth loss if untreated. 

Ozone oil pulling may assist by:

• Treating the bacterial infections that contribute to periodontal breakdown
• Improving gum health and supporting regeneration
• Normalizing the excess inflammation and oxidative stress that cause more tissue damages
• Stimulating effective immune response to the infections

A randomized trial compared the efficacy of chlorhexidine (CHX) and ozonated olive oil as adjuncts to scaling and root planing (SRP) for treating chronic periodontitis. The split-mouth trial compared the effects of these treatments within the same mouths of 30 participants. After 3 months, both CHX and ozonated olive oil significantly improved periodontitis parameters, including probing pocket depths, relative attachment level, and sulcus bleeding index. No adverse effects were observed. However, CHX and ozonated olive oil were not significantly different, indicating that both comparably supported periodontal health post-SRP [31].

In a randomized clinical trial, 96 (48 experimental, 48 control) subjects with periodontitis received either scaling and root planing (SRP), or SRP and ozonated olive oil mouthwash. The trial measured levels of salivary metalloproteinase (MMP-8), an enzyme that damages periodontal tissue in periodontitis. After 3 months, both groups had significantly improved periodontitis measures including plaque index, bleeding on probing, probing pocket depth, and salivary MMP-8 levels. The ozonated olive oil + SRP group had less MMP-8 than SRP alone. Therefore, the ozonated olive oil addition was more effective for periodontitis than conventional scaling and root planing alone [32].

Plaque Formation 

Plaque formation is a process where bacteria accumulate on the teeth, forming a sticky, colorless biofilm that can lead to dental caries and gum disease if not removed. 

Ozone oil can reduce plague by [33]:

• Chemically disrupting this biofilm by oxidizing the sticky components, preventing plaque from hardening into tartar
• Significantly reducing the bacterial load 

In the clinical trial that tested ozone oil pulling for gingivitis, there was a reduction in plaque and gingival index scores compared to pre-treatment baselines. Ozone oil treatment reduced plaque and gingival scores more than chlorhexidine, although the difference wasn’t statistically significant [30].

Teeth Whitening

Teeth whitening (bleaching) involves removing stains and discoloration from teeth to improve their appearance [34]. 

Ozone oil pulling could potentially aid this process by:

• Reducing plaque and the bacteria that contribute to tooth staining
• Oxidizing (i.e. bleach) substances that stain teeth
• Supporting oral health, which is foundational for maintaining a brighter smile.

Chronic Inflammation, oral lesions, and oral mucosal disease

Chronic inflammation in the mouth can lead to significant oral health issues, including tooth loss, pain, and sensitivity. 

Ozone oil pulling may help by:

• Normalizing the excess inflammation
• Stimulating healing
• Inhibiting inflammatory microbes in the mouth

In various clinical trials, ozone oil treatment reduced bleeding, pain, and overall sensitivity even more so than standard treatments such as chlorhexidine, scaling, and planing [35].

A longitudinal study enrolled 50 patients with oral mucosal disease from recurrent canker sores and various infections, such as candida, oral lichen planus, herpes, and more. The patients received ozone oil applications to their lesions twice daily for up to 6 months until the lesion resolved. All patients were cured of their conditions within 1 - 5 days [36].

Teeth Sensitivity

Sensitive teeth refer to the pain or very uncomfortable sensations when exposed to heat, cold, acid, sweet foods, or even sound or vibration. The sensitive teeth or dentin could arise from worn tooth enamel, exposed roots, gum recession, cavity, cracks, or even recent dental procedures. In theory, ozone oil pulling should help with sensitive teeth over time given that it helps with gum repair, although sensitivity may go down very slowly. A test tube study suggests that ozone oil treatment helps improve the dentin structure, which may help with dentin hypersensitivity [37].

A randomized controlled trial involving 11 subjects compared the effectiveness of extra virgin olive oil with ozone oil after a single treatment. The trial topically applied the oil to the sensitive area with a microbrush. The ozone oil group experienced a significant reduction in teeth hypersensitivity and an improvement in quality of life [26]. 

Dental Procedures

With every dental procedure comes the concern of infection, pain and discomfort during healing, and other complication risks. Ozone has long been a companion to dentistry as it noninvasively delivers unique benefits without creating antibiotic resistance. 

Ozone oil pulling may be uniquely beneficial as an antimicrobial and healing accelerator. In addition, ozone oils can penetrate tissues and incisions to microbes in hard-to-reach areas such as in a root canal.

Ozone oils synergizes with other antimicrobials

In an in vitro study, ozone oil combined with silver nanoparticles synergistically reduced microbes for up to 6-log (1,000,000-fold) reduction in mature biofilm.The results indicate a potent and safe potential for root canal treatment [38].

A randomized controlled trial examined 90 non-vital primary molars from children aged 4 to 8. As a root canal antimicrobial filling material, zinc oxide-ozonated olive oil was compared with zinc oxide-olive oil and zinc oxide-eugenol. After 12 months of observation and followup, ozonated olive oil treatment had the most significant improvements in clinical and radiographic outcomes, such as a decrease in periodontal ligament space. Zinc oxide-ozonated olive oil has potential as an effective filling material in pediatric root canal procedures [39].

Another randomized controlled trial examined 90 primary molar root canals. The root canals were obturated with mixtures of zinc oxide + holy basil extract, zinc oxide + ozonated oil, and Eugenol (ZOE). Clinical and radiographic success was evaluated over 12 months. Zinc oxide+ ozonated oil exhibited the highest success rates, both clinically (95.7%) and radiographically (91.3%), suggesting it is a superior choice due to its effective antibacterial action and lower toxicity to the cells compared to the traditional ZOE and zinc oxide-O sanctum extract. [40].

Ozone oils accelerates dental surgery recovery

In a randomized controlled trial, 18 patients undergoing gingival graft surgery were assigned to either the ozonated oil or the control group. The subjects received 2 mL of ozonated or control oil daily for one week post surgery. Compared to the control group, the ozone oil group had a statistically significant reduction in wound size and better healing. Therefore, ozone oil treatment could improve dental surgery outcomes [41].

Peri-implant mucositis is the inflammation of the gums surrounding a dental implant, serving as a preliminary stage of peri-implant disease without affecting the underlying bone or tissue at the implant area [42]. 

In a randomized controlled trial involving 50 patients with peri-implant mucositis aged 25-50 years, the efficacy of ozonated olive oil gel was compared to chlorhexidine gel. Both treatments significantly reduced plaque index (PI) and gingival index (GI) after 4 weeks (p <0.05), with no significant difference between the two groups. This suggests ozonated olive oil gel is as effective as chlorhexidine gel in managing peri-implant mucositis, and can supplement or replace traditional methods of mucositis management [43]. 

Conditions not helped by ozone oil pulling (based on evidence)

Many people and even Ayurvedic texts claim these health benefits of oil pulling or ozone oil pulling, although there is no scientific evidence supporting these benefits. We did a literature search and did not find evidence for these benefits. However, this lack of proof isn’t proof against–we simply need more well-conducted studies to confirm these anecdotes. It’s also possible that these anecdotal benefits arose from placebo effects.

• Supporting detoxification or full-body cleansing
• Clearing or improving the skin, such as helping with acne (however, ozone oil application to the face can help with acne.)
• Pulling toxins from the body
• Pregnancy complications
• Dolores de cabeza
• Asma
• Diabetes

Side Effects of Ozone Oil Pulling

Ozone oil pulling is generally considered safe with minimal side effects, which may include:

• Irritation of the mouth tissue for some individuals
• An unpleasant taste during or after pulling
• A temporary increase in tooth and gum sensitivity
• Nausea or stomach upset

In most cases, these problems could be solved by:

• Diluting the ozone oil 
• Oil pulling less often
• Oil pulling for a shorter duration
• Switching to a different type of oil 

Contraindications for ozone oil pulling may include [44]:

• Swallowing disorders or inability to refrain from swallowing the oil
• Dental appliances that may react with the ozonated oils
• Allergies or any severe reactions to the oil
• Muscle pain disorders
• Active bleeding in the mouth, since ozone may break down blood clots and increase circulation
• Embarazo

If you have a medical condition or are receiving any treatment, it’s wise to check with your doctor before starting ozone oil pulling.

Perspective: Ozone oil pulling is less invasive and has fewer side effects than most conventional dental care methods such as:

• Chemical Mouthwashes can cause chemical burns, dry mouth, or altered taste sensation. Mouthwashes may change the oral flora in a way that adversely affects your health.
• Antibiotics: Risk of antibiotic resistance and potential impact on gut microbiota.
• Mechanical Treatments (Scaling): Is a very uncomfortable, often anxiety-provoking, procedure that may lead to sensitivity or gum recession.

Keep in mind, however, that ozone oil pulling does not replace daily oral hygiene such as brushing and flossing, or routine dental care. While some studies have demonstrated the ability of ozone oil to replace some dental procedures, regular checkups and dental procedures may still be necessary. Using ozone oil under proper guidance minimizes adverse effects, making it a safer alternative in many cases.

Referencias

1 Thanomsub, B., Anupunpisit, V., Chanphetch, S., Watcharachaipong, T., Poonkhum, R. and Srisukonth, C. (2002) Effects of ozone treatment on cell growth and ultrastructural changes in bacteria. J. Gen. Appl. Microbiol. 48, 193–199

2 Peng, T.-R., Cheng, H.-Y., Wu, T.-W. and Ng, B.-K. (2022) Effectiveness of Oil Pulling for Improving Oral Health: A Meta-Analysis. Healthcare (Basel) 10 https://doi.org/10.3390/healthcare10101991

3 Ugazio, E., Tullio, V., Binello, A., Tagliapietra, S. and Dosio, F. (2020) Ozonated Oils as Antimicrobial Systems in Topical Applications. Their Characterization, Current Applications, and Advances in Improved Delivery Techniques. Molecules 25 https://doi.org/10.3390/molecules25020334

4 Zhang, J., Xie, M., Huang, X., Chen, G., Yin, Y., Lu, X., et al. (2021) The Effects of Porphyromonas gingivalis on Atherosclerosis-Related Cells. Front. Immunol. 12, 766560

5 Lendhey, S. S., Kale, T., Seth, T., Bhartiya, G. and Hudwekar, A. (2020) 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. Journal of Oral Research and Review 12, 63

6 Morou-Bermúdez, E., Torres-Colón, J. E., Bermúdez, N. S., Patel, R. P. and Joshipura, K. J. (2022) Pathways Linking Oral Bacteria, Nitric Oxide Metabolism, and Health. J. Dent. Res. 101, 623–631

7 Маллаева Р.М. Влияние озонотерапии на состояние микробиоты кишечника https://svbskfmba.ru/arkhiv-nomerov/2018-1/mallaeva

8 Zhang, Q.-Q., Zhang, L., Liu, Y., Wang, Y., Chen, R., Huang, Z.-Y., et al. (2019) Effect of ozonated water on normal vaginal microecology and Lactobacillus. Chin. Med. J.  132, 1125–1127

9 Rath, S., Bal, S. C. B. and Dubey, D. (2021) Oral Biofilm: Development Mechanism, Multidrug Resistance, and Their Effective Management with Novel Techniques. Rambam Maimonides Med J 12 https://doi.org/10.5041/RMMJ.10428

10 Silva, V., Peirone, C., Amaral, J. S., Capita, R., Alonso-Calleja, C., Marques-Magallanes, J. A., et al. (2020) High Efficacy of Ozonated Oils on the Removal of Biofilms Produced by Methicillin-Resistant Staphylococcus aureus (MRSA) from Infected Diabetic Foot Ulcers. Molecules 25 https://doi.org/10.3390/molecules25163601

11 Suh, Y., Patel, S., Kaitlyn, R., Gandhi, J., Joshi, G., Smith, N. L., et al. (2019) Clinical utility of ozone therapy in dental and oral medicine. Med. Gas Res. 9, 163–167

12 Xiao, W., Tang, H., Wu, M., Liao, Y., Li, K., Li, L., et al. (2017) Ozone oil promotes wound healing by increasing the migration of fibroblasts via PI3K/Akt/mTOR signaling pathway. Biosci. Rep. 37 https://doi.org/10.1042/BSR20170658

13 Satapathy, A., Balani, A., Kharsan, V., Karan, A., Mazhar, H. and Awasthy, A. (2023) Topical-Ozonized Olive Oil - A Boon for Post-Extraction Cases: A Randomized Controlled Trial. Cureus 15, e34478

14 Liu, L., Zeng, L., Gao, L., Zeng, J. and Lu, J. (2023) Ozone therapy for skin diseases: Cellular and molecular mechanisms. Int. Wound J. 20, 2376–2385

15 Karim, S., Pratibha, P. K., Kamath, S., Bhat, G. S., Kamath, U., Dutta, B., et al. (2012) Superoxide dismutase enzyme and thiol antioxidants in gingival crevicular fluid and saliva. Dent. Res. J.  9, 266–272

16 Weismann, D. and Binder, C. J. (2012) The innate immune response to products of phospholipid peroxidation. Biochim. Biophys. Acta 1818, 2465–2475

17 Cenci, A., Macchia, I., La Sorsa, V., Sbarigia, C., Di Donna, V. and Pietraforte, D. (2022) Mechanisms of Action of Ozone Therapy in Emerging Viral Diseases: Immunomodulatory Effects and Therapeutic Advantages With Reference to SARS-CoV-2. Front. Microbiol. 13, 871645

18 Kholy, K. E., Genco, R. J. and Van Dyke, T. E. (2015) Oral infections and cardiovascular disease. Trends Endocrinol. Metab. 26, 315–321

19 Deshpande, N. C. and Amrutiya, M. R. (2017) Obesity and oral health - Is there a link? An observational study. J. Indian Soc. Periodontol. 21, 229–233

20 Jo, J.-K., Seo, S.-H., Park, S.-E., Kim, H.-W., Kim, E.-J., Na, C.-S., et al. (2021) Identification of Salivary Microorganisms and Metabolites Associated with Halitosis. Metabolites 11 https://doi.org/10.3390/metabo11060362

21 Asokan, S., Kumar, R. S., Emmadi, P., Raghuraman, R. and Sivakumar, N. (2011) Effect of oil pulling on halitosis and microorganisms causing halitosis: a randomized controlled pilot trial. J. Indian Soc. Pedod. Prev. Dent. 29, 90–94

22 Vadhana, V. C., Sharath, A., Geethapriya, P. R. and Vijayasankari, V. (2019) Effect of sesame oil, ozonated sesame oil, and chlorhexidine mouthwash on oral health status of adolescents: A randomized controlled pilot trial. J. Indian Soc. Pedod. Prev. Dent. 37, 365–371

23 Forssten, S. D., Björklund, M. and Ouwehand, A. C. (2010) Streptococcus mutans, caries and simulation models. Nutrients 2, 290–298

24 Nardi, G. M., Fais, S., Casu, C., Mazur, M., Di Giorgio, R., Grassi, R., et al. (2020) Mouthwash Based on Ozonated Olive Oil in Caries Prevention: A Preliminary In-Vitro Study. Int. J. Environ. Res. Public Health 17 https://doi.org/10.3390/ijerph17239106

25 Baysan, A. and Lynch, E. (2006) The use of ozone in dentistry and medicine. Part 2. Ozone and root caries. Prim. Dent. Care 13, 37–41

26 Almaz, M. E. and Sönmez, I. Ş. (2015) Ozone therapy in the management and prevention of caries. J. Formos. Med. Assoc. 114, 3–11

27 Kade, K. K., Chaudhary, S., Shah, R., Patil, S., Patel, A. and Kamble, A. (2022) Comparative Evaluation of the Remineralization Potential of Fluoride-containing Toothpaste, Honey Ginger Paste and Ozone. An In Vitro Study. Int J Clin Pediatr Dent 15, 541–548

28 Gasner, N. S. and Schure, R. S. (2023) Periodontal Disease, StatPearls Publishing

29 Carrizales-Sepúlveda, E. F., Ordaz-Farías, A., Vera-Pineda, R. and Flores-Ramírez, R. (2018) Periodontal Disease, Systemic Inflammation and the Risk of Cardiovascular Disease. Heart Lung Circ. 27, 1327–1334

30 Indurkar, M. S. and Verma, R. (2016) Effect of ozonated oil and chlorhexidine gel on plaque induced gingivitis: A randomized control clinical trial. J. Indian Soc. Periodontol. 20, 32–35

31 Nambiar, S., Malothu, S., Karmakar, S., Varkey, A., Chandra, D. and Chava, V. K. (2022) Comparison of Ozonated Olive Oil and Chlorhexidine Gel as an Adjunct to Nonsurgical Periodontal Therapy for the Treatment of Chronic Periodontitis: A Randomized Controlled Clinical Trial. J. Pharm. Bioallied Sci. 14, S94–S98

32 Nardi, G. M., Cesarano, F., Papa, G., Chiavistelli, L., Ardan, R., Jedlinski, M., et al. (2020) 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. Int. J. Environ. Res. Public Health 17 https://doi.org/10.3390/ijerph17186619

33 Higa, B., Cintra, B. S., Álvarez, C. M., Ribeiro, A. B., Ferreira, J. C., Tavares, D. C., et al. (2022) Ozonated oil is effective at killing Candida species and Streptococcus mutans biofilm-derived cells under aerobic and microaerobic conditions. Med. Mycol. 60 https://doi.org/10.1093/mmy/myac055

34 Carey, C. M. (2014) Tooth whitening: what we now know. J. Evid. Based. Dent. Pract. 14 Suppl, 70–76

35 Patel, P. V., Patel, A., Kumar, S. and Holmes, J. C. (2012) Effect of subgingival application of topical ozonated olive oil in the treatment of chronic periodontitis: a randomized, controlled, double blind, clinical and microbiological study. Minerva Stomatol. 61, 381–398

36 Kumar, T., Arora, N., Puri, G., Aravinda, K., Dixit, A. and Jatti, D. (2016) Efficacy of ozonized olive oil in the management of oral lesions and conditions: A clinical trial. Contemp. Clin. Dent. 7, 51–54

37 Veena, H. R., Afigith Mathew, C., Daniel, R. A., Shubha, P., Sreeparvathy, R. and Pradhan, N. (2020) An in vitro analysis of the effect of adjunctive use of ozonated oil with a desensitizing agent on dentinal tubule occlusion. J Oral Biol Craniofac Res 10, 727–732

38 Elshinawy, M. I., Al-Madboly, L. A., Ghoneim, W. M. and El-Deeb, N. M. (2018) Synergistic Effect of Newly Introduced Root Canal Medicaments; Ozonated Olive Oil and Chitosan Nanoparticles, Against Persistent Endodontic Pathogens. Front. Microbiol. 9, 1371

39 El-Desouky, S. S., Omer, S. M. M., Ghouraba, R. F., Latif, R. M. A. A., Kabbash, I. A. and Hadwa, S. M. (2023) Zinc oxide-ozonated olive oil as a new root canal filling material in primary molars: a clinical randomized controlled trial. Clin. Oral Investig. 27, 7395–7405

40 Vachhani, K., Rao, D., Panwar, S. and Gupta, S. (2022) An in vivo comparative clinical and radiographic evaluation of a mixture of zinc oxide-Ocimum sanctum extract, zinc oxide-ozonated oil, and zinc oxide-eugenol as obturating materials in primary molars. J. Indian Soc. Pedod. Prev. Dent. 40, 398–403

41 Patel, P. V., Kumar, V., Kumar, S., Gd, V. and Patel, A. (2011) Therapeutic effect of topical ozonated oil on the epithelial healing of palatal wound sites: a planimetrical and cytological study. J. Investig. Clin. Dent. 2, 248–258

42 Heitz-Mayfield, L. J. A. and Salvi, G. E. (2018) Peri-implant mucositis. J. Clin. Periodontol. 45 Suppl 20, S237–S245

43 Choudhary, A. and Rajasekar, A. (2024) Efficacy of Ozonated Olive Oil Gel in the Management of Peri-Implant Mucositis. J. Long Term Eff. Med. Implants 34, 69–73

44 1 Makkar, S., Makkar, Monika. Indian Journal of Stomatology and Jodhpur. (2011) Ozone-Treating Dental Infections