Locally delivered ozonated oil in necrotizing ulcerative gingivitis treatment. A case report.

Necrotizing ulcerative gingivitis (NUG) is a destructive inflammatory disorder of the gingiva characterized by gingival interproximal necrosis resulting in a “punched-out” papillae, with gingival bleeding and pain. Fetid malodour, yellow/gray pseudomembrane, local lymphadenopathy, fever and malaise may be secondary diagnostic features. Prevotella intermedia, fusiform bacteria and spirochetes have been associated with NUG. Conventional NUG therapy is based on removal of bacteria and nonattached deposits with ultrasonic scaling and OHI. An antibiotic regimen of amoxicillin 500 mg PO TID for 10 days plus metronidazole 250 mg PO TID for 10 days is suggested in case of swelling of the local lymph nodes or fever/malaise. Recently, ozonated oils (O3-Oil) have been introduced in the market for their antimicrobial activity as antiseptics and their potential bio-stimulation to wound healing process. The present study describes a case of NUG successfully treated with topical application of O3-Oil. In November 2011, a 31-year old man was referred to the Department of Periodontology and Implantology - University of Bologna with the chief complaint of gingival pain, halitosis and local lymphadenopathy. Clinical oral examination revealed: interdental gingival necrosis with punched-out papillae, submandibular lymph nodes with positive palpation and foetor ex ore. Diffuse gingival bleeding in absence of pathological probing depth was recorded. The subject was an 18 cigarettes/day smoker in general good health. A diagnosis of NUG was made. The patient was discharged with the only instruction of local application of an O3-Oil (Novox®) TID for 10 days. No OHI were given to the subject. Twenty-three days after the first visit (re-evaluation) a complete remission was observed. Proper OHI were given for maintenance of periodontal health. A periodontal microbiological examination by mean of real-time PCR was performed at first and at re-evaluation visits. Compared to baseline, a 37% reduction in the overall bacterial load was observed (from 8,03x105 to 5,03x105). Three periodontal pathogens were detected at both first and final examinations, but with a general amount reduction. The data recorded were respectively: Fusobacterium nucleatum ssp from 2740 to 1295 (53% decrease), Treponema denticola from 2220 to 1996 (10% decrease) and Eikenella corrodens from 568 to 374 (34%). Within the limitations of this study, the results suggest that O3-Oil (Novox®) could be a clinical effective antiseptic reducing the general bacterial load and specifically the NUG associated species. The complete clinical remission suggests a potentially direct influence on healing process. The promising results obtained for the O3-Oil suggest its applicability for NUG, pursuing the advantages of limiting antibiotic treatment. Further preclinical and clinical investigations are warranted.