ОЗОН и вялотекущие гнойные воспалительные процессы

[Leffirty]

Кто ещё не знает: ИМХО - это от английского IMHO (In My Humble Opinion) - По моему скромному мнению.



А.Ш.

[nastya_1234]

Мы не нервничаем, когда говорим, что вскрытый гнойник дренирован резиновой полоской или турундой с фурациллином, но то, что гнойная рана подвергнута продуванию озоном - нас напрягает, всё время чудится, что предлагают очередную панацею. Ну если резиновая полоска выполняет своё назначение - дренировать рану, то как озон это же сделает? А если он не для дренирования - то зачем "продувку" сравнивать с резинкой? И, кстати, я очень нервничаю, когда гнойник "дренируют" турундой, да ещё с фурациллином.

Повбивав би... (укр.)



Озон - метод выбора наряду с марганцовкой или облучением кожи ультрафиолетом. При таком подходе это не будет никого напрягать.Вот именно это меня и напрягает.



С приходом озона революции в медицине не произошло. Главное правильно обозначить сферы применения. Точна! Ведь помагает Чабрец при пневмонии, хоть чуть-чуть, медленно, но помагает, а антибиотик лучше. Вот и "обозначение сфер применения". Чабрецу исторический стенд, антибиотику пока ещё жизнь...

[dina5]

Про стенд я конечно утрировал. Антибиотик не панацея. И хватит про озон. Это не его сфера

[Elliv]

Про стенд я конечно утрировал. Антибиотик не панацея. И хватит про озон. Это не его сфера



Правильно, мы не быки, а озон не красная тряпка.

[zerik]

An in vitro evaluation of the ability of ozone to kill a strain of Enterococcus faecalis

R. S. Hems, K. Gulabivala, Y.-L. Ng, D. Ready & D. A. Spratt

Unit of Endodontology, Eastman Dental Institute for Oral Health Care Sciences, University College London, London, UK



Abstract

Hems RS, Gulabivala K, Ng Y-L, Ready D, Spratt DA. An in vitro evaluation of the ability of ozone to kill a strain of Enterococcus faecalis. International Endodontic Journal, 38, 22–29, 2005.



Aim To evaluate the potential of ozone as an antibacterial agent using Enterococcus faecalis as the test species.



Methodology Ozone was produced by a custommade bench top generator and its solubility in water determined by ultraviolet (258 nm) spectrophotometric analysis of solutions through which ozone was sparged for various time-periods. The antibacterial efficacy of ozone was tested against both broth and biofilm cultures. Ozone was sparged for 30, 60, 120 and 240 s, through overnight broth cultures of a strain of E. faecalis (E78.2) and compared with those that were centrifuged, washed and resuspended in water. Enterococcus faecalis (E78.2) biofilms were grown on cellulose

nitrate membrane filters for 48 h and suspended in water through which ozone gas was sparged with stirring for 60, 120 and 240 s in a standard fashion. In a separate test, biofilms were also exposed to gaseous ozone. Sodium hypochlorite (NaOCl) was used as a positive control. All experiments were repeated four times.



Results There were significant (P < 0.05) reductions of bacteria in the unwashed (2 log10 reductions) and washed (5 log10 reductions) broth cultures following 240 s applications. Biofilms incubated for 240 s with ozonated water showed no significant reduction in cell viability attributable to ozone alone, whereas with NaOCl no viable cells were detected over the same time. Gaseous ozone applied for 300 s had no effect on these biofilms.



Conclusions Ozone had an antibacterial effect on planktonic E. faecalis cells and those suspended in fluid, but little effect when embedded in biofilms. Its antibacterial efficacy was not comparable with that of NaOCl under the test conditions used.

Keywords: antibacterial, Enterococcus faecalis, ozone. Received 13 May 2004; accepted 13 September 2004



Introduction

The treatment of apical periodontitis involves elimination of root canal infection by a combination of mechanical and chemical means. Mechanical instrumentation alone may only reduce the numbers of bacteria from the root canal system by 50% (Bystro¨m &Sundqvist 1981). This is at least partly because even in maxillary anterior teeth, only a proportion of the root canal surface is planed by the action of files (Mannanet al. 2001). As a result, antibacterial irrigants have to be relied upon to penetrate to the noninstrumented surfaces (Bystro¨m & Sundqvist 1983).

Sodium hypochlorite (NaOCl) is the current irrigant of choice due to its antibacterial (Bystro¨m & Sundqvist 1983, 1985) and tissue-dissolving effects (Moorer & Wesselink 1982). Although NaOCl is a potent antibacterial agent, it is toxic at high concentrations (Spa°ngberg et al. 1973). It also weakens dentine by reducing its flexural strength and resilience, therefore rendering the tooth more susceptible to deformation (Grigoratos et al. 2001, Sim et al. 2001) and possibly fractures. Furthermore, the principles of current root canal treatment protocols, which have existed for almost a century, have a failure rate of 16% (Lewsey et al. 2001). There is therefore a need to develop new and more effective treatment strategies. A number of different approaches to eliminating infection from root canal systems have been proposed including; the noninstrumentation technique (Lussi et al. 1995), laser technology (Kimura et al. 2000, Seal et al. 2002), irrigation with electrochemically activated water (Marais & Williams 2001, Gulabivala et al. 2004) and application of ozone (Deltour et al. 1970, Chahverdiani & Thadj-Bakhche 1976).

Ozone (O3) is a powerful oxidizing agent (Broadwater et al. 1973) and has been used in the water industry for many years to kill bacteria. It has also been tested in medicine to decontaminate hospital side rooms (Dyas

et al. 1983), rooms contaminated with methicillinresistant Staphylococcus aureus (Berrington & Pedlar 1998) and in auto-haemotherapy (Bocci 1992). In the dental field ozone has been advocated for treatment of gum infections, during surgery, for failed implant cases (Sandhaus 1969), root caries (Baysan et al. 2000), root canal treatment (Deltour et al. 1970, Chahverdiani & Thadj-Bakhche 1976) and for its potential application in reducing bacterial counts in dental unit water delivery systems (Filippi 1997). The aim of this study was to investigate the antibacterial effectiveness of ozone using a single strain of Enterococcus faecalis as the test organism in laboratory planktonic and biofilm test models, in order to establish its potential as a root canal disinfectant.

[Zorin Oleg]

Discussion

Ozone is a selective oxidant and affects only certain compounds but when it dissolves in water, it becomes

highly unstable and rapidly decomposes through a complex series of chain reactions (Hoigne´ & Bader 1976, Shin et al. 1999). As a result, hydroxyl (OH) radicals are generated, which are amongst the most reactive oxidizing species. Ozone reacts with various chemical compounds in aqueous systems in two different and coexisting modes; one involving direct reactions of molecular ozone and the other a free radical-mediated reaction (Staehelin & Hoigne´ 1985). Both these mechanisms may be involved in the destruction of bacteria by ozone. Escherichia coli cells

however, have been found to be inactivated primarily by molecular ozone (Hunt & Marin´ as 1997). The absorbance of ozone in the water increased almost linearly with time, from 5 to approximately 60 s (data not shown). The stability of the ozone in the water was low and the ozone dissipated very quickly in ozone demand-free water at room temperature over 5 min, in agreement with Shechter (1973).

Enterococcus faecalis, a Gram-positive facultative anaerobe, was chosen as the test microorganism because it has significant implication in treatment resistant cases (Molander et al. 1998, Sundqvist et al. 1998), and is difficult to kill (Ørstavik & Haapasalo 1990). The hardy nature of this bacterium is such that it can grow and survive as a monoculture under diverse conditions including; in nutrition depleted root canal systems, the gastrointestinal tract and the genitourinary tract (Felmingham et al. 1992). The organic matter in the nutrient broth for culturing E. faecalis may protect the cells by providing a large number of suitable targets for the ozone to react with, thereby shielding the bacteria from the ozone (Restaino et al. 1995). Therefore, ozone demand-free water was also used as the medium for testing and as a comparison. Neutralizing broth was used prior to determination of the number of viable bacteria as it contains sodium thiosulphate that instantly reduces the dissolved ozone and inactivates it (Farooq & Akhlaque 1983).

The antibacterial nature of ozone was tested on E. faecalis in planktonic as well as biofilm forms. The use of planktonic cultures alone would not represent a clinically relevant test (Shih et al. 1970, D’Arcangelo et al. 1999) as bacteria also exist as biofilms on the walls of root canals (Nair 1987). Moreover, the susceptibility of bacterial phenotypes in biofilms is different to those of the planktonic phenotype (Wilson 1996). The most realistic in vitro model would be to grow bacterial biofilms on the root canal surfaces of extracted teeth but the test results may be confounded by the variation in root canal anatomy. The natural variation in anatomy results in both differential growth and variable exposure to the antimicrobial agent (Shih et al. 1970, Siqueira et al. 1997), consequently resulting in a greater statistical spread of results and the need for a much larger sample size to demonstrate significant differences (Gulabivala et al. 2004). The use of a bacterial biofilm grown on a simple membrane eliminates the variable of root canal anatomy and reduces the variations in quantity of growth and contact of the biofilm with the antimicrobial agent. It is therefore a

useful and convenient method for rapid preliminary testing of new antimicrobial agents (Spratt et al. 2001).

The biofilm was stirred to enhance ozone contact with its entire surface. In order to rule out the possible antibacterial effect of the physical nature of sparging alone, E. faecalis cells suspended in broth or ozone demand-free water were treated with air sparging as a control.

The bactericidal effects of 0.05% NaOCl on planktonic bacteria were used as the positive control and compared with the effects of ozone. Although 0.5–5% NaOCl are commonly used for chemomechanical cleaning of root canals (Bystro¨m & Sundqvist 1985), a much lower concentration (0.05%) was used in the studies on planktonic bacteria based on the inhibitory concentration reported for NaOCl when used against planktonic E. faecalis (Ghori et al. 2001). It was impossible to make direct comparisons between ozone and NaOCl because the concentration of ozone changes

constantly during continuous sparging. In contrast, the higher concentration of 2.5% NaOCl was used as a positive control for the studies on E. faecalis biofilms based on a previous study (Spratt et al. 2001), although no previous data were found on biofilm inhibitory concentration.

When E. faecalis cells were treated with ozone over the time-periods 30–240 s using nutrient broth as the medium, there was a 1–2 log10 reduction of bacterial counts. A significant reduction could only be detected after 240 s of treatment. The duration of action was therefore an important consideration in its antibacterial

effect. When using ozone demand-free water as a suspension medium for testing the antibacterial effect of ozone (in place of nutrient broth), a significant reduction of bacterial counts was again achieved at 240 s. There were no significant differences in bacterial kills when either nutrient broth or ozone demand-free water were used as the suspension medium at any of the timepoints of treatment. This may be in contrast to previous studies where the presence of organic matter has been shown to deplete ozone (Broadwater et al. 1973, Restaino et al. 1995). The antimicrobial effect of NaOCl is also reduced in the presence of organic matter in the test medium (Moorer & Wesselink 1982). Therefore, NaOCl (0.05%) was less effective at killing E. faecalis cells in nutrient broth (no viable cells detected after 240 s) compared with ozone demand-free water (no viable cells detected after 30 s).

The results from the biofilm study show that stirring alone and stirring together with air sparging, both reduced the number of bacteria on the biofilm. This was probably because the shear generated during these processes removed the cells from the biofilm and into the surrounding medium. Stirring and ozone (together) did not increase the loss of viable E. faecalis cells from the biofilm compared with the controls (stirring alone, stirring with air sparging); implying that ozone had no effect on E. faecalis cells in the biofilm. In contrast, the E. faecalis cells displaced into the surrounding medium by stirring were killed by sparging with ozone (together with stirring) (Table 2). The inference appears to be that the biofilm phenotype does not have an inherent resistance to ozone. The resistance of the bacterial cells in the biofilm must be attributed to the depletion of ozone as it diffuses into the biofilm by virtue of its organic composition. The biofilm extracellular polysaccharide matrix therefore probably protects against ozone.

When 2.5% NaOCl was tested on the biofilm, no viable cells were detected after 120 s without stirring (Table 2), confirming its efficacy as a root canal irrigant against E. faecalis. The concentration of reactive molecules

in the 2.5% NaOCl is far higher than that in the ozonated water and is therefore a biased comparison;

the reactive molecules cannot approach such concentrations in ozonated water, as far as it is known. Nevertheless, a direct comparison is still valid from a clinical perspective.

Gaseous ozone had no significant antibacterial effect on the biofilms. This was predictable considering that the effectiveness of ozone is highest in solution and given the previous results with biofilms, gaseous ozone would not be expected to exert any great antibacterial effect. At the termination of the experiments, it was noted that the biofilms were desiccated yet the bacterial count was similar to the controls that did not appear desiccated. This observation reiterates the resistance of E. faecalis to adverse conditions.

Ozone was not significantly less effective in killing planktonic E. faecalis when organic material was present. However, given the resistance of bacterial cells embedded in a biofilm matrix to ozone, there would appear be a limited role for ozonated water as a root canal irrigant. The view is further supported by the need for fresh generation of the solution because of its rapid dissipation and safety considerations. The much higher effectiveness of NaOCl on both planktonic and biofilm cultures of E. faecalis, substantiates the view further.

When considering new techniques, safety is an important issue. Ozone has limitations as it is irritating to the respiratory system (Hazucha et al. 1989). Very low concentrations (0.2–0.5 ppm) may cause headache, and irritation or dryness of the nose, throat and eyes (McDonnell et al. 1983). Higher concentrations (1–10 ppm over a few hours) may cause lung congestion, oedema, haemorrhage, changes to the blood and loss of vital lung capacity. It is irritating to the eyes and can cause redness, pain and blurred vision. These effects are noticeable at about 0.2 ppm. Epidemiological studies (Cody et al. 1992) suggest a possible link between ozone pollution and allergic airway disease, however, the data is limited (Krishna et al. 1995).



Conclusions



Within the limitations of this study, the following conclusions may be drawn about ozone’s ability to kill

E. faecalis:

• Ozone in solution was antibacterial against planktonic E. faecalis after 240 s.

• It was not effective against E. faecalis cells in a biofilm unless they were displaced into the surrounding

medium by agitation.

• The biofilm phenotype was not more resistant to killing by ozone than the planktonic phenotype.

• Gaseous ozone had no effect on the E. faecalis biofilm.

• NaOCl (0.05%) was more effective in planktonic tests in the absence of organic matter in the suspension medium.

[Normund]

Уважаемый доктор Студенцов!



Приведённые Вами исследования убедительно доказывают преимущества антибактериального действия гипохлорита натрия на культуру Ent.faecalis in vitro по сравнению с действием озона.

Озон, насколько я понял, действует на культуру, выращенную в бульоне и малоэффективен против культуры, выращенной на биоплёнках.



Но антибактериальное действие озона не идёт ни в какое сравнение с таковым у гипохлорита натрия, который эффективен против Ent.faecalis, выращенного на обеих средах.



Я не являюсь приверженцем озона и NaOCl при лечении каналов зубов, но заинтересован, чтобы исследования такого рода продолжались, чтобы в арсенале стоматологии было достаточно средств выбора: механических, химических, лазерных и др.



Приведённая мною выше статья из журнала "Стоматология" описывает исследования in vivo, и, кроме того, хочу обратить Ваше внимание на то, что авторы исследовали не бактерицидное действие озона, а его стимулирующее действие на ФАГОЦИТАРНУЮ АКТИВНОСТЬ ЛЕЙКОЦИТОВ(ФАЛ).



Благодарю за участие в работе форума СТОМАТОЛОГИЯ.

Алексей Шишкин

[Созидатель]

Реплика, отнюдь не для защиты (для рассматриваемых в статье целей) озона. Так как, полагаю, что гипохлорит натрия, в целом ряде случаев, более удобен, в качестве наружного антисептического средства, чем озонированная вода (точнее растворенный в воде озон). В первую очередь, из-за значительно большей стабильности водных растворов NaOCl и возможностью создания р-ров с достаточно большой концентрацией гипохлорита. Несмотря на то, что при одинаковой концентрации по активному кислороду, озон обладает более сильной антибактериальной активностью.



Однако проведенная работа сделана методически (химически) безграмотно. Во–первых, некорректно сравнивать составы на один, два и более порядков различающиеся по активному кислороду. Во-вторых, если уж приготовлять озонированную воду, так на основе дистиллированной, лучше бидистиллированной воды. (Период полураспада озона в водопроводной воде – секунды, десятки секунд; в дистиллированной - десятки минут; в бидистиллированной - до нескольких часов). Кроме того, растворимость и стабильность озона зависит от температуры, pH и др.

Опубликовано множество работ, где изучалось бактерицидное действие, как гипохлорита, так и озона на различные штаммы микроорганизмов в различной среде, со значительно более четкой фиксацией переменных параметров, в первую очередь, концентрации по активному кислороду. Большую часть своих данных авторы могли просто почерпнуть, порывшись в литературе.



И, наконец, ещё раз: прямое бактерицидное действие озона к системной озонотерапии имеет отдаленное отношение.

[Teri]

Будет шар. Вы какого цвета предпочитаете?