Need Dear Doctor I have an opportunity to sponsor Lamberto Re, MD from Ancona, Italy to speak 2 days, May 18,19

about the medical and dental value of oxygen Ozone therapy for our patients, ourselves and our families. For those who know me, I have been utilizing Oxygen/Ozone therapy in dentistry for over 15 years with great success as an adjunct therapy. Oxygen/ozone is used all over the world and some limited use in the United States for many health issues successfully. In dentistry I have utilized it for sensitive teeth, perio, endo, deep decay, sinus, extractions, oral pathology, craniofacial pain, in short all aspects of dentistry. This is an application that you can utilize every day in any dental and medical practice. Dr. Re will be speaking on the pharmacological aspects, the medical theory and medical applications from topical application, bagging for wounds, minor auto heme treatments such as for allergies and some medical conditions, and major auto heme such as for autoimmune, mitochondrial insufficiencies, systemic immune problems, and chronic pain. I will also speak and demonstrate on the dental applications, but the majority of the 2 days will be Dr. Re. There will be 14 hours of AGD credit. It is a coup to have an international speaker and practitioner come to speak in the Durango area. I hope I have peaked your interest. If you have any questions, you can email me or call me on my cell: 847-812-5695. I have attached information on the course, Dr. Res CV, and an article that I wrote that was published in the International Journal of Ozone Therapy a couple of years ago. Dr. Re will in be in Durango for the rest of the week to treat patients if you are interested. This is a wonderful opportunity to meet a master in this field! Durango Colorado is a mountain town that is in the Four Corners Region of the country. This is an awesome time of year, the sun is always out and the Animas river is running fast (for rafting)! I hope you will join me for this conference. Sincerely, John A. Rothchild, DDS

HOLISTICDENTISTRYDURANGO.COM
PRESENTS:

Lamberto Re, MD And John A. Rothchild, DDS

OXYGEN/OZONE THERAPY IN MEDICINE AND DENTISTRY

MAY 18-19, 2013 DURANGO, COLORADO HOSTED BY: JOHN A. ROTHCHILD, DDS
This will be the first time in 5 years that Dr. Re has taught in the United States

Dr. Re is world renown on the subject of Oxygen/Ozone medical therapy and lectured throughout the world on the subject

Since 1996 he has produced 55 scientific contributions on the pharmacology characterization of ozone and its clinical applications. (see attached CV)

Dr. Rothchild has written several articles on oxygen/ozone dental therapy and practices holistic general dentistry with practical applications of oxygen/ozone therapy

Detailed Program
Detailed Program
Introduction Personal Experience and Scientific Background The needing of Integrative Medicine: Holistic Concept Ozone Therapy Chemistry of Ozone Toxicology of Ozone Pharmacokinetics of Ozone Pharmacodynamics of Ozone Animal Models Human Models Clinical Administration of Ozone including demonstrations Oral Topic Ozonized Oil Plastic Bag Injection Systemic Clinical Uses of Ozone in Dentistry Conclusion Remarks and Comments

Dr. Re will be in Durango the week following his presentation to treat patients so if you have patients who would like to be treated let Dr. Rothchilds office know

COURSE IS LIMITED TO 25 STUDENTS

Credits: 14 AGD subject code 162 14 medical cat. 1 through Mercy Medical (pending) FEES INCLUDE LUNCH BOTH DAYS AND RECEPTION SATURDAY AFTER THE LECTURE, AND DIGITAL MATERIALS OF THE 2 DAY PRESENTATION

LOCATION OF THE PRESENTATION WILL BE MERCY REGIONAL MEDICAL CENTER, DURANGO, COLORADO COURSE FEE: $800 Call Dr. Rothchilds office for reservations and information regarding accommodations: 970-382-7780

Curriculum Vitae Lamberto Re Lamberto Re was born in Ancona, Italy, September 24th, 1950 1973 - 1983 Student in the Pharmacological Department of the University of Ancona, Medical School. Medical Doctor Degree in 1983. State Certificate in November 1983. 1989 ... Included in the Disciplinary Group n. 70 (BIO 14) by the Official National Commission since 22nd June, 1989. Professor of "Molecular and Cellular Pharmacology" in the Medical Faculty of the University of Ancona. Professor of "Pharmacological Biotechnology" and Pharmacology in the Science Faculty of the same University. Expert of basic experimental techniques in Pharmacology such as in-vitro assays and in-vivo experimental Toxicology. In collaboration with Dr Walter Sthmer and Dr. Erwin Neher of the Max Plank Institute in Gottingen, is expert in the techniques of the Loose Patch Clamp and Patch Clamp for the characterization of the synaptic transmission in neuronal synapses. Participated at a "Working Stage Training" held at the FIDIA-Georgetown Institute for the Neuroscience, Georgetown University Medical School of Washington (USA) in the year 1990. Invited by the Editorial Board of the Archives of Medical Research to be included in the International Editorial Committee since July 1994. Referee of the following international journals: Life Sciences (Pharmacology Letters), Pharmacological Research, General Pharmacology, Archives of Medical Research, Toxicology Mechanisms and Methods, Chemical Biology & Drug Design. Invited at the III International Symposium on Receptors held at the University of Chile, Medical School of Santiago, April 23rd 25th , 1996. Participated to the Congress on the definition of the guidelines in ozone-therapy held in Padua, IT, from 21st to 22nd September, 2001. Invited at the 15th International Congress of the International Ozone Association held in London, UK, 10th 15th September 2001 participated as Chairman and with an oral presentation to the Workshop. Invited by the DOHMS of Dubai, UAE, where participated to an epidemiological pilot study for the evaluation of the therapeutic potential of oxygen-ozone mixtures. The study started in September 2002 at Rashid Hospital, P.O. Box : 4545, Dubai, United Arab Emirates. Invited as Senior Expert at the Complementary and Alternative Medicine Evidence Based Medicine, held in Dubai October 6th 2004 at the Al Amal Hospital, Jumeira, Dubai. Invited as Chairman at the Arab Health 2005 Congress, Complementary Medicine Conference, held in Dubai February, 12nd 13rd 2005. Invited as Honorary Member of the Cuban Pharmacology Society at the VI Congress of Pharmacology and Therapeutics held in Santiago de Cuba from 21 till 25 of November 2005. Invited as Speaker at the 4 European Course ECM Chirurgia miniinvasiva del rachide: impieghi dellozono (minimally invasive surgery of the spine : ozone challenge) Treviso February, 24-25 2006. Professor and Lecturer on Ozone Therapy and its Medical Uses in Sport and other Pain related disorders performed Courses in the USA (Phil Mollica ODS Center January 2008) and in Dubai (CAM service of Minister of Health, 2005-2008).

Invited as Expert International in Ozonoterapie at the Casa Adam Muller, Guttembrunn Timisoara , Rumania to take part at a conference on Ozone Application in October 26th 2006. Invited as Chairman at the International Congress on Ozone in Medicine, European Cooperation of Medical Ozone Societies, Baden-Baden, November 1st 2008. Invited as Speaker at the Primer Congreso Internacional de Aepromo Nuevos Horizontes Para la Ozonoterapia, Pontevedra, Spain, June 5th 2009. Participated as Lecturer at the last IOA international Congress of Tokyo, September 2009. Invited from the Medical Committee of the Egyptian Navy Alessandria, to the 4th Annual Scientific Conference of Naval & Hyperbaric Medicine, Ozone as helpful agent (November 2009). Invited to be part of the Scientific Committee, and as a speaker at the International Encounter of Ozone Therapy Schools held at the headquarters of the National Royal Academy of Medicine (RANM for its acronym in Spanish) located in the capital of the Kingdom of Spain, on Thursday the 3 rd and Friday the 4th of June 2010. Event declared of Health Interest he has been one of the active Promoting Members of the Madrid Declaration on Ozone Therapy towards the aim of setting worldwide measures how to practice ozone therapy to prevent its misuse and fulfilling the maximum benefit. In the last years participated upon invitation as speaker and chairman to the most important international events in the field of Ozone application included Mexico 2010, Brescia 2011, Istanbul 2011, Rio de Janeiro 2011. Invited in the year 2011 from the Court of Arbitration of Sport in Losanna to clarify the effects of ozone in the Sport and in the doping context. The question was discussed at the Court of Lausanne where we clarify to the Judges and to the experts of the Italian Committee (CONI) the scientific data concerning ozone therapy with the conclusion sentence that so far ozone could not be included into the forbidden substances as seen in the Art. 3 of the WADA Code. Invited to the Advances in Evidence Based Integrative Medicine Held in Dubai, Dubai Healthcare City, 17 May 2012. Invited as Lecturer at the first international symposium on ozone therapy held at the Medical Faculty of the University of Chile, Santiago, October 12-13, 2012.

Member of the Italian Pharmacological Society since 1978. Member of the Latino American Society of Natural and Traditional Medicine since 1994. Member of the Italian Medical Ozone Association since November 1999. Member of the Italian Federation of Ozone (FIO) was included since 2005 in the Scientific Committee of the same Society. Member of the AEPROMO Spanish Association since 2008. Member of the ISCO3 Board since its Foundation in 2010.

Author of 199 publications in extenso; among these 129 on international journals and cited in the Journal Citation Reports with a mean impact factor of 2.85. Since 1996 produced 55 scientific contributions on the pharmacology characterization of ozone and its clinical applications. Languages: English, written and spoken; Spanish, spoken.

CV in extenso at the web site www.lambertore.com

Publications 12345678910L. Re, A. Valli, S. Barocci, Giammarchi V., Serresi, M., Faini, T., Ricci, M., Morales, M.A. and Len-Fernndez, O.S, Effects of low oxygen-ozone concentrations on the acetylcholine release at the mouse neuromuscular junction, Gen. Pharmacol., 32 (2), 245-250, 1999. L. Re, Ossigeno-Ozono terapia in un paziente sofferente di Lupus Eritematoso Sistemico: Case Report, in Lozonoterapia nel 2000, Eds. Libreria Cortina Torino, pagg. 137:13 9, 1999. L. Re, Effetti di basse concentrazioni di ossigeno-ozono sul rilascio di acetilcolina nella placca neuromuscolare, in Lozonoterapia nel 2000, Eds. Libreria Cortina Torino, pagg. 113:118, 1999. L. Re, Molecular basis of the ozone-oxygen therapy: perspectives and therapeutic potential, PhleboLymphology, Special Issue, November 18-20, 1999, pag. 108. S. M. Al-Dalain, G. M. Snchez, E. Candelario-Jalil, S. Menendez, L. Re, A. Giuliani, O. S. Len-Fernndez, Ozone treatment reduces biomarkers of oxidative and endothelial damage in an experimental diabetes model in rats, Pharmacol Res, Vol 44(5), 391-396, 2001. H Ajameh, N Merino, E. Candelario-Jalil, S. Menendez, G. M. Snchez, L. Re, A. Giuliani, O. S. LenFernndez, Similar protective effect of ischemic and ozone oxidative preconditioning in liver ischaemia/reperfusion injury, Pharmacol Res, Vol. 45 (4), 333-339, 2002. Lamberto Re e Francesca Rossini, Ossigeno-Ozono Terapia nello Sport: Case Report , LAllenatore, FIGC, Vol. 6, 29-30, 2003. Ajamieh HH, Menndez S, Martnez-Snchez G, Candelario-Jalil E, Re L, Giuliani A and Olga Sonia Len Fernndez. Effects of ozone oxidative preconditioning on nitric oxide generation and cellular redox balance in a rat model of hepatic ischaemia- reperfusion. Liver International, 24, 55-62, 2004. Hussam Hassam Ajamieh, Silvia Menndez, Nelson Merino, Gregorio Martinez-Sanchez, Lamberto Re, Olga Sonia Len, Ischaemic and Ozone Oxidative Preconditioning in the Protection Against Hepatic Ischaemia-Reperfusion Injury, OSE/NG/01-35, Ozone Science & Engineering, 2004. Hussam H Ajamieh, Jorge Berlanga, Nelson Merino, Gregorio M. Snchez, Eduardo C. Jalil, Silvia M. Cepero, Attilia Giuliani, Lamberto Re, Igor Popov, Olga S. Len, Role of Protein Synthesis in the Protection Conferred by Ozone-Oxidative-Preconditioning in Hepatic Ischaemia/Reperfusion, Transplant International, 18, 604-612, 2005. S. M. Al-Dalain, G. Martnez, S. Menndez , L. Re, A. Giuliani, E. Candelario-Jalil, H. lvarez, J. I. FernndezMontequn and O. S. Len. Therapeutic Efficacy of Ozone in Patients with Diabetic Foot, Eur J Pharmacol, 523, 151-161, 2005. Lamberto Re , Mohamed N. Mawsouf, Silvia Menndez ,Olga S. Len , Gregorio M. Snchez , Frank Hernndez. Ozone Therapy: Clinical and Basic Evidence of its Therapeutic Potential, Archives Med Res, 39: 17-26, 2008. Olga S. Len Fernndez, HH Ajamieh, Jorge Berlanga, Silvia Menndez, Renate Viebahn-Hansler, Lamberto Re, Anna M Carmona. Ozone Oxidative Preconditioning is Mediated by A1 Adenosine Receptors in a Rat Model of Liver Ichemia/Reperfusion, Transpl Int. Jan; 21(1):39-48, 2008. Silvia Mndez,Leopoldina Falcn, Mayulin B. Argote, Ivonne Menndez, Dignora Fernndez, Brbara-Elas Calle, Magdalena Valero, Lamberto Re. Safety of Topical Oleozon in the Treatment of Tinea Pedis: Phase IV Clinical Trial, Int Journal of Ozone Therapy, 7, 1, 55-59, 2008. Lamberto Re, Giuseppe Malcangi, Alessandra Mercanti, Virginia Labate and Gregorio M. Snchez, Ozone Therapy: A Clinical Study on the Pain Management, Int Journal of Ozone Therapy, 7, 1, 37-44, 2008. A.M. Sheata, L. Re, O.M. Yousef, Ozone Preconditioning protects against rotenone-induced neurodegeneration in rats, Int Journal of Ozone Therapy, 7, 2, 114-120, 2008. T. Tanbouli, M.N. Mawsouf, L. Re, G. Martnez-Snchez, G. Saaed, S.M. El Badry and A.B. Nashed. Effect of Ozone Therapy on Foetoplacental Blood Flow in Hypertensive Pregnant Women . International Journal of Ozone Therapy 8, 2009: 211-216. Silvia Daz-Llera, Yanela Gonzlez-Hernndez, Jorge E. Gonzlez Mesa, Gregorio Martnez-Snchez and Lamberto Re. Induction of DNA primary damage in peripheral blood leukocytes and exfoliated colorectal epithelial cells in rats treated with ozone. International Journal of Ozone Therapy 2009 8:217-221. Re, Lamberto; Martnez-Snchez, Gregorio; Sirito, Mario. Role of ozone/oxygen in fibroblast growth factor activation. Discovering the facts. Ozonoterapia, 2010. G. Martnez- Snchez, L. Re, A. Giuliani, and G. Prez-Davison. Ozone as U-Shaped Dose Responses Molecules (Hormetins). 10-001-DR. Dose Response, 9:32-49, 2011. Re, Lamberto and Martinez-Sanchez, Gregorio. Clinical Evidences of Ozone Interaction with Pain Mediators. Saudi Med J, 32 (12), 1363-1367, 2011. Nabil Mawsouf, Maha M. El-Sawalhi, Gregorio Martnez-Snchez, Hebatalla A. Darwish, Amira A. Shaheen, Lamberto Re. Effect of ozone therapy on redox status in experimentally induced arthritis , Revista Espaola de Ozonoterapia Vol 1, No 1 (2011): 32-43. Adriana Schwartz, Gregorio Martnez-Snchez, Lamberto Re. Factores de crecimiento derivados de plaquetas y sus aplicaciones en medicina regenerativa. Potencialidades del uso del ozono como activador. Revista Espaola de Ozonoterapia Vol 1, No 1 (2011): 54-73.

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2425-

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Livan Delgado-Roche, Gregorio Martnez-Snchez, Arqumides Daz-Batista, Lamberto Re. Effects of ozone therapy on oxidative stress biomarkers in coronary artery disease patients. In J Ozone Research 2011, 10(2):99-104. Schwartz Adriana, Claudia Nikolaevna Kontorschikova, Oleg Vitorovich Malesnoko, Gregorio Martnez Snchez, Lamberto Re, Irina Avenerovna Gribkova. Gua para el uso mdico del ozono - Fundamentos teraputicos e indicaciones", AEPROMO, 2011, 315 p. + XVIII + 11 p. lminas de color. ISBN: 978-84615-2244-6. Re L, Malcangi G, Martinez-Sanchez G. Medical ozone is now ready for a scientific challenge: current status and future perspectives. Journal of Experimental and Integrative Medicine 2012; 2(3):193-196. Gregorio Martnez-Snchez, Livan Delgado-Roche, Arqumides Daz-Batista, Gema Prez-Davison, Lamberto Re. Effects of ozone therapy on haemostatic and oxidative stress index in coronary artery disease. European Journal of Pharmacology, 691(2012)156162. Gregorio Martnez-Snchez, Silvia Menndez-Cepero, Mirta Copello, Silvia Daz-Llera, Lamberto Re. Rectal insufflations is a valid way in ozone therapy. Feedback on the Oxygen-Ozone Therapy is at a Cross-Road Rev. Esp. Ozono. 1(1):74-86. Rev. Esp. Ozono. (in press) 2012. Livan Delgado-Roche, Gregorio Martnez-Snchez, Lamberto Re. Ozone Oxidative Preconditioning Prevents Atherosclerosis Development in New Zealand White Rabbits. Atherosclerosis Supplement. Accepted, 2012. Gregorio Martnez-Snchez, Lamberto Re. Rectal administration and its application in ozone therapy. Journal of alternative medicine. On submission, 2012. G. Martnez- Snchez, L. Re. Las aplicaciones mdicas de los aceites ozonizados, actualizacin. Rev. Esp. Ozono. On submission 2012. Lamberto Re, Gregorio Martinez Sanchez and Armando Rojas, Is ozone conditioning effect bind to Nrf2 pathway and hARE? An ongoing Study. In preparation, 2012.

Communications 12345678910L. Re, P. Lattarulo, R. Vaccari Subcutaneous and intracavernous O2/O3 therapy in erectile dysfunction due to microvascular damage. Comparison with T.E.B. therapy, , Int. Journal of Impotence Res., San Francisco, CA, USA, 3-7 November, 1996. R. Vaccari, E. Azzolini, L. Re, M. Musillo and F. Pezzoni, Combined O2/O3 therapy and T.E.B. in erectile dysfunction due to microvascular damage, Madrid, Spagna, 1-5 November, 1997. L. Re, Loose Patch Clamp applied to the study of neurorelease: characterization of the oxygenozone mixtures molecular action in some biological functions, Ist Int Congress of the Cuban Society of Pharmacology, 19-23 Ottobre 1998, Habana, Cuba. L. Re, R. Vaccari, F. Pezzoni, Sildenafil (VIAGRA-TM) e O2-O3 terapia nel trattamento delle disfunzioni erettili di natura vascolare, Ist Int Congress of the Cuban Society of Pharmacology, 19-23 Ottobre 1998, Habana, Cuba. Olga Sonia Len Fernndez, L. Re, S. Menndez, N. Merino, S. Sam and H. Ajamieh, Comparative Study Between Ischaemic and Ozone Oxidative Preconditioning in the Protection Against Hepatic IschaemiaReperfusion Injury, Int. Cong. Pharmacol, CPT 2000, Florence, Brit J Clin Pharmaco, July 15-20, 2000. L. Re, S. Barocci, L. Rinaldi, C. Vivani, E. Mosca and G. Paolucci , Ozone as preventive agent of the oxidative cellular damage: an antiageing hypothesis, IOA World Congress, London, Imperial College, 916 September, 2001. Lamberto Re and Ahmed AL-Jaziri, First UAE Pilot Study on the Therapeutic Potential of the OzoneOxygen Mixtures, 4th INTERNATIONAL SYMPOSIUM ON OZONE APPLICATIONS, Havana City, April 6-9 of 2004, Cuba. Lamberto Re, Oxygen-Ozone Therapy in the Sport: Case Report, Arab Health Conference, Complementary Medicine Section Dubai, UAE, February 13-16, 2005. O.S. Len Fernndez, G. Martnez-Snchez, S. M Al-Dalain, E. Candelario-Jalil, A.M. Carmona, S. Menndez, L Re, A Giuliani, Ozone Treatment Reduces Markers of Oxidative and Endothelial Damage in an Experimental Diabetes Model in Rats, (CU), 17th IOA World Congress, Strasbourg 22-25 August 2005. O.S. Len Fernndez, H.H. Ajamieh, G. Martinez-Sanchez, E. Candelario-Jalil, A.M. Carmona, S. Menendez, L. Re, A. Giuliani (CU), Effects of Ozone Oxidative Preconditioning on Nitric Oxide Generation and Cellular Redox Balance in a Rat Model of Hepatic Ischemia/Reperfusion, (CU), 17th IOA World Congress, Strasbourg 22-25 August 2005. Lamberto Re, The Role Of Ozone Therapy In Management of Diabetic Foot, Arab Health Conference, Complementary Medicine Section Dubai, UAE, January 22-25, 2006. Lamberto Re, Minha experiencia clinica, 1st Congresso Internacional de Ozonioterapia, Belo Horizonte , Brasil, April 28-30, 2006. Lamberto Re, Molecular Mechanisms Underlying Ozone Treatments, 5th International Symposium on Ozone Applications, Havana City, Cuba, April 23-26, 2007. Lamberto Re, Baiju Khanchandani, Pelle Daugaard Molecular Mechanisms Underlying Ozone Treatments: An Articular and Back Pain Case Study Series, 6th Interdisciplinary World Congress on Low Back & Pelvic Pain, Catalonia Palace of Congresses, Barcelona, Spain, November 07-10, 2007. L. Re, G. Malcangi, A. Mercanti, V. Labate, M. Bordicchia and G. M. Snchez, Ozone Therapy on the Pain Management, European Meeting of the Society for Free Radical Research, Berlin, Germany, Pag. 67-74, Editor Tilman Grune, Medimond, International Proceedings, July 05-09, 2008. G. Martinez-Snchez and L. Re, Clinical Diagnostic of Redox Balance an Up-Date, European Meeting of the Society for Free Radical Research, Berlin, Germany, Pag. 15-21, Editor Tilman Grune, Medimond, International. L. Re, G. Malcangi, A. Mercanti, L. Di Serafino, O.S. Leon Fernandez, G. Martnez-Snchez. Ozone Therapy in the Management of Sport Pain. Role of Mitochondria. International Journal of Ozone Therapy 2009 8(1): 28-33. M. Sirito, L. Re, G. Martnez-Snchez. Role of Ozone/oxygen in Fibroblast Growth Factor Activation. Potential Use in Clinic and Aesthetic Practice. Discovering the Facts. International Journal of Ozone Therapy 2009 8(1): 46-48. G Martnez-Snchez, G Prez Davison, G Malcangi, A Mercanti, L Re. Ozone as U-shaped dose responses molecules (Hormetin). Free Radical Research 43 Supplement 1, 2009, S45. L. Re; G Martnez-Snchez; G Malcangi; A Mercanti; V Labate. Ozone Therapy: a clinical study on Pain Management. Proceeding of 19th Ozone World Congress of the IOA. Tokyo, Aug 31-Sep 3, 2009: 203-210. Re L, A Randomized Clinical Study on Pain in patients treated with Ozone and NSAIDs, III World Congress Of OT, Brescia, 14-16 April 2011, Int J Ozonetherapy, P 42,Monography, 2011. Re L, The state of art in Ozone Therapy, Congress Istanbul, 29 April-1 May, 2011. Re L, Physiological action of ozone, III Ibero American Congress of Ozone-Therapy, Rio de Janeiro, 7 - 9 October 2011.

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International Journal of Ozone Therapy 9: 105-108, 2010

Current Concepts of Oxygen Ozone Therapy for Dentistry in the United States
J.A. ROTHCHILD1, R.E. HARRIS2, P.J. MOLLICA3
1 School of Integrative Biologic Dental Medicine, Saddle Brook, NJ; Rush University Medical School, Chicago, ILCapital University of Integrative Medicine, Washington, DC; Private practice, Durango, CO and Hoffman Estates, IL, USA. 2 Integrative Biologic Dentistry, School of Integrative Biologic Dental Medicine, Saddle Brook, NJ; Capital University of Integrative Medicine, Washington, DC. Private practice, Louisville, KY, USA 3 Integrative Biologic Dentistry, School of Integrative Biologic Dental Medicine, Saddle Brook, NJ; Capital University of Integrative Medicine, Washington, DC; Oro-Facial Pain, Hackensack University Medical Center, Hackensack, NJ. Private practice, Saddle Brook, NJ, USA

Key words: oxigen ozone therapy, dentristry, United States

Introduction Oxygen ozone therapy (OOT) has been used successfully in many countries throughout the world for many years. It has been recently gaining interest in the medical community in the wake of an increasing number of scientific and clinical papers published in international peer reviewed medical journals. Many of the basic mechanisms of the action of ozone both ex vivo and in vivo are now well understood. The method by which ozone has affected the modulation of interleukin production and additional biological pathways has been adequately explained by multiple researchers 1,2. This research has resulted in the rationale for the use of ozone in many pathological conditions related to pain, inflammation, oxidative stress, cancer, atherosclerosis, diabetes, acute infections and chronic infections 3. Conventional dentistry in the United States has been very slow to embrace OOT in part because it had not been included in the didactic or clinical curriculum in any School of Dentistry in the United States. However, in December of 2008 the first presentation on Ozone in Dental Medicine was delivered at Tufts School of Dentistry by Dr. Philip Mollica. Prior to this presentation, the institutions had not been receptive to investigating the possible research opportunities that would verify the previous favorable findings from institutions in Germany, Great Britain, Italy, Spain, Brazil, Cuba, Russia, etc. The recent movement to use OOT in the United States was initiated by a small group of dentists. They attended a demonstration and participation class using OOT at Capital University of Integrative Medicine (a post doctoral program

in integrative health) in 1998. Soon after that presentation, a group of eight dentists from that class decided to pursue further research into the possible benefits of OOT. The group obtained the corona discharge type of medical ozone units that utilize medical oxygen as the oxygen source and began limited clinical trials in April 2000. After successful clinical trail results, an IRB approved study was granted by Capital University of Integrative Medicine to further research and define the uses of OOT. The primary researchers, Dr. Philip Mollica and Dr. Robert Harris, decided to utilize the evidence-based research model and establish sub-investigators in a practice-based research network. This model was successful and was repeated by the current research institution, The American College of Integrative Medicine and Dentistry. To satisfy the requests of practicing dentists, Dr. Mollica and Dr. Harris, then began offering a seminar series to teach dentists the theory and clinical applications for infection control utilizing OOT. To date, they have taught OOT to over 2,000 dentists through their seminars and presentations at major meetings, both nationally and internationally. Clinical research is currently being conducted and monitored from multiple practice-based research network clinical centers throughout the United States 4. As a result of the research findings, foundational protocols have been developed to address common oral infections such as periodontal disease, endodontic infections, dental caries, osteomyelitis, biphosphonate induced osteonecrosis, stomatitis and herpetic lesions. Additional therapeutic protocols have been developed for tooth related sinus infections, neuralgia, pulpal hyper105

Current Concepts of Oxygen Ozone Therapy for Dentistry in the United States

J.A. Rothchild

sensitivity, extractions, and temporomandibular joint (TMJ) symptomology. The International Academy of Oral Medicine and Toxicology has endorsed OOT in dentistry as scientifically valid and is has published a brochure to explain the value of the therapy to dentists and patients. Therapeutic Modalities Therapeutic methods of administration of intraoral Oxygen-Ozone (OO) include: injection of gas, irrigation with ozonated water, insufflation of periodontal pockets with gas, and topical application of ozonated oil. Injection protocols include intraosseous injection of the OO gas mixture, locally into the alveolus, subgingivally, intramuscularly, inferior alveolar nerve area, and into the pterygoid space area. These injection protocols are for treatment of all types of oral infections. Irrigation with ozonated water is also utilized for oral infections including stomatitis, herpetic lesions and periodontal infections (subgingival). Insufflation techniques with OO gas are generally utilized for caries, periodontal infections and endodontic treatment. In addition, a technique utilizing silicone full arch trays has been developed for treatment of periodontal disease, caries and biphosphonate osteonecrosis. Extraoral therapeutic protocols include nasal and ear insufflation, temporomandibular joint injections, trigger point injections and craniofacial lymphatic injections. These modalities are used for both primary and secondary supportive treatment techniques. OO Treatment Goals in Dentistry The therapeutic goals that support established standard of care procedures are as follows: Elimination of pathogens Restoration of proper oxygen metabolism Induction of friendly ecologic environment Increased circulation Immune modulation Stimulation of the humoral anti-oxidant system Treatment of Dental Caries and Operative Dentistry More than 30 studies 5 have been presented showing that low concentrations of OO gas causes inhibition of pit and fissure caries, root surface caries and interproximal carious lesions. These same studies have also shown that reversal of decay in 106

carious lesions occurs with exposure to OO in as little as ten seconds. The protocols developed by the American College of Integrative Medicine and Dentistry encompass utilization of OO for procedures including: pit and fissure sealants, caries removal with subsequent restoration, dentinal hypersensitivity, crown and bridge preparation, carious exposures, etc. The procedure is to isolate the tooth or preparation and flow the gas slowly into the area the area to be treated for 45-60 seconds. This procedure will locally kill the microorganisms which are present in the tooth structure. The use of proper evacuation technique is essential to avoid inhalation of the gas. If inhaled, the oxidant nature of the ozone can cause an irritation to the eyes and the mucosal lining of the respiratory tract because these tissues have very limited antioxidant capacity. Treatment of Root Canals Endodontic (root canal) treatment of infected teeth has long been a treatment of choice and the standard of care in dentistry for an infected tooth. Endodontic treatment involves cleaning out the main canal(s) of a tooth with instrumentation, irrigation and chemicals (sodium hypochloritebleach). These canal(s) are then filled with a material called gutta percha before the tooth is finally restored with a crown. This procedure is intended to sterilize the tooth from all the invading bacteria that caused the tooth and the surrounding bone to become infected. The classical endodontic community feels that this procedure prevents any bacteria from living within the tooth or ever invading the tooth again from the alveolar bone, thus saving the tooth. This is a contested theory that has been disputed by the allopathic and the integrative medical/dental communities. Studies have shown that following endodontic therapy, some bacteria, fungi and viruses remain in the multitude of the very small lateral canals and dentinal tubules that transverse the tooth root and communicate with the periodontal tissue. These studies have shown that the obligate anaerobes (which can include bacteria, virus and fungi) can remain within these canals and are even found all the way to the cementoenamel junction. A Japanese study published in 2004 6 demonstrated that the use of ozonated water had the same antimicrobial activity as 2.5 percent sodium hypochlorite without the tissue toxicity. The study also showed that following ozone therapy there was high metabolic activity of the associated fibroblasts indicating an increase in the healing

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International Journal of Ozone Therapy 9: 105-108, 2010

process. A Brazilian study, performed on dogs, found that the use of ozonated oil was actually slightly more effective than calcium hydroxide as an intracanal medicament for the treatment of enterococcus faecalis infections. The anaerobic bacteria create an infection that results in an area that is acidic with positively charged suppurative fluids. OO gas is the third strongest oxidant. It carries a negative charge and is electrochemically attracted to the positive charge of the infected environment. This results in the death of the pathogens and disinfection of the area. Standard of care endodontic procedures are employed during diagnostics and treatment. Then OOT is used for disinfection of the root canals and dentinal tubules. The following steps should be added before the final fill of the canal(s): The files are coated with ozonated olive oil for lubrication and disinfection. The canals are prepared and then irrigated with ozonated water and dried. Before placing the root canal filling, the canals are provided with a slow insufflation of gas (4560 seconds) with an ozone concentration of 45-50 mcg/ml. The insufflation process allows the OO mixture to travel electrochemically into the lateral canals and tubules killing the positively charged microbes by oxidizing their cell membranes. Treatment of Periodontal Disease Periodontal disease is a multifactorial disease process in the mouth. It has been linked systemically to other diseases such as atherosclerosis, bronchitis, diabetes, preterm and low weight births, pancreatic cancer and others. Traditional treatment has been either conservative treatment by root planing and scaling, surgical intervention with a scalpel or LASER therapy (for example the LANAP procedure with the Periolase, an Nd: YAG LASER). In cases where treatment is by root planing and scaling, the sulci and pockets are initially irrigated with ozonated water by use of a syringe and a maxiprobe type canula. This process will reduce the initial pathogenic load on the patient, both locally and systemically prior to the root planing and scaling procedures. After treatment of a quadrant or half the mouth, each pocket and sulcus is insufflated with OO gas. The gas goes directly into the crevicular fluid and the tissues and sterilizes the area, thus eliminating the pathogenic organisms. For patients undergoing LASER therapy with the Periolase, it is recommended that ozonated water be used during ultrasonic debridement.

For certain cases, the silicone tray isolation technique may be utilized. This involves fabrication of appliances made of silicone that fits snugly onto each arch. Each appliance has an inlet and an outlet valve. A low/medium concentration of OO gas flows continuously through the appliance saturating the teeth and periodontium with OO gas. Ozone gas is introduced into the tray through the in port of the tray. The small suction evacuator is attached to the outlet valve allowing the excess gas to be vacuumed away to prevent inhalation of the gas. This treatment requires multiple visits. Routine recall treatment for minor cases, such as gingivitis, utilizes pretreatment rinsing with ozonated water, irrigation of the periodontium and insufflation of any periodontal pockets. In all cases, the patient is given a jar of ozonated olive oil to take home with them and apply topically to the soft tissue. This will insure a continuous dose of OO in the form of ozonide, to the tissues. It also continues to eliminate the microbes that create the biofilm that causes reinfection of the surrounding tissues. Adjunct Therapy for Extractions, Other Surgical Procedures and Biphosphonate Osteonecrosis OO is so versatile that it can be used for almost any type of dental procedure. After a tooth is extracted or any basic surgical procedure it is recommended post-surgically to irrigate and insufflate the area. This reduces the positive electric potential of the wound and potential scarring with the negatively charged gas or water. Healing of the wound is generally much faster, with little or no complications. Biphosphonate necrosis has been extremely difficult to treat medically and surgically. There has been some success with OO utilizing the foundational protocols along with intraosseous injections and intraoral silicone tray treatment of the osteonecrotic lesion. The patient is always sent home with a jar of ozonated olive oil as a postoperative dressing for the wound. Extraoral Techniques Part of the foundational protocol involves ear insufflation and nasal insufflation with low concentrations of OO. Ear insufflation is a technique to deliver the OO into the external, middle and inner ear. The tympanic membrane is vascularized and some ozone can enter the bloodstream by this route. Ozone being a potent oxidant easily perfuses into the blood and reacts immediately with a number of molecules present in the fluids such as antioxidants, proteins, carbohydrates, and 107

Current Concepts of Oxygen Ozone Therapy for Dentistry in the United States

J.A. Rothchild

polyunsaturated fatty acids 3. OO, when administered nasally has to be bubbled through olive oil. This produces triozonides of triolein, which are not oxidants. But when the ozonides are inhaled they have therapeutic effects similar to ozone. The foundational protocols of the American College of Integrative Medicine and Dentistry for ozone therapy also include extraoral injections of small concentrations of OO. These small amounts, usually 1.0 ml per site, are infiltrated either subdermally or subcutaneously along the path of the external jugular chain of lymph nodes, the cervical lymph node system, the thyroid lymph nodes, the right thoracic duct and the left thoracic duct.

Conclusion Ozone is the perfect substance for use in dental procedures. It disinfects the tissues treated and leaves no toxic residues like chlorinated products. It performs this task by oxidizing the cell membranes of pathogenic organisms and killing them. The oxidizing effect of ozone is as follows: it requires one molecule of ozone to kill the same number of bacteria that would require 3,00010,000 molecules of chlorine for the same effect and ozone performs this kill 3500 times faster than chlorine 4.

References
1 Lamberto Re. Medici & Medici, Periodico Trimestrale Ordine Medici-Chirurghi e Odontoiatri della Provincia di Ancona, N. 16 Luglio 2008; 18-20. 2 Wentworth, P. Jr., Wentworth AD, Zhu X, et al., Proc Natl Acad Sci. 2003 Feb. 18; 100(4): 1490-3, Epub, Feb. 7, 2003. 3 V. Bocci. Ozone, A New Medical Drug, Springer Publishing; 2005. 4 Mollica P, Harris R. Dental Economics. September 2007. 5 E. Lynch, et al. Ozone: The Revolution in Dentistry. Quintessence; 2004. 6 Nagayoshi, M., Kitamura C, Fukuzumi T, et al. Antimicrobial effect of ozonated water on bacteria invading dentinal tubules. J Endod. 2004; Nov. 30 (11): 778-81. 7 Vierira Silveira AM, LopesI HP, Siqueira JF, Jr. Periradicular repair after two-visit endodontic treatment using two different intracanal medications compared to single-visit endodontic treatment. Braz Dent J. 2007; 18 (4): 299-304.

John A. Rothchild, MD DDS, 555 Rivergate Lane Suite, B1-106 Durango, CO 81301, USA E-mail: jrothchild@aol.com

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