Biofilm disruption and bactericidal activity of aqueous ozone coupled with ultrasonic dental scaling

Background: The COVID-19 pandemic has heightened the awareness of a common hazard encountered in the dental clinic: aerosol transmission of pathogens. Treatment of sources of infection before or during dental procedures is one means of decreasing pathogen load and aerosol transmission. Methods: An ultrasonic scaler supplied with aqueous ozone was used to examine the effect of its viability on planktonic cultures and biofilms formed by 2 model bacteria: Rothia mucilaginosa and Escherichia coli. Results: Both organisms showed susceptibility to aqueous ozone alone (97% and 99.5% lethality, respectively). When combined with manual scaling using an ultrasonic scaler, a greater than 99% reduction in colony-forming units (CFUs)/mL could be reached with an aqueous ozone concentration of approximately 2 mg/L (R. mucilaginosa) or 0.75 mg/L (E. coli) after 5 through 6 seconds of scaling. Conclusions: Aqueous ozone coupled with ultrasonic scaling exhibited a higher efficiency of microbial kill than either method used alone. Both gram-positive and gram-negative species were affected by this treatment. Studies on other oral microbiota constituents, including fungi and viruses, will provide information on the efficacy of this method on a greater biological scale. Studies to verify concomitant reduction of microbial load in dispersed aerosols in clinical settings should be completed to support practical applications of this treatment.