# Application of Ozone Therapy in Paediatric Density
## 3 Clinical Use in Paediatric Density
### Deep Dental Caries and ECC (Early Childhood Caries) Management  
Today, dental caries and early loss of primary teeth are the most common childhood diseases affecting the quality of life in kids in the world. Studies have found cavity lesions of teeth of very young patients being left untreated as a cause of difficulty in management. Paediatric dentists need standardized efficient protocols to improve the approach and prognosis [10; 17]. As first step, treatment of caries implicates the removal of carious tissue, with manual instrumentation or rotative burs, until sound dentin is found. The second step is the substitution of the missing tooth part with restorative materials. When the process is at an advanced stage, an endodontic treatment may also be required, removing the pulp tissue. This treatment induces an additional tooth weakening, which may involve more invasive conservative or prosthetic restorations [8]. The main aim of preventive dentistry and of the minimally invasive approaches of caries in paediatric dentistry is to avoid early loss \begin{table}
\begin{tabular}{c c} \hline \hline
**Other Possible Uses of Ozone in Paediatric Density** & **References** \\ \hline Sensitivity of enamel developmental defects & [1; 40] \\ \hline Acceleration of healing (dental fistula or surgery extraction) & [26; 30; 31] \\ \hline Herpes simplex infection or candida infection & [9; 32; 33] \\ \hline Aphthous stomatitis & [34] \\ \hline Pain management & [16; 35; 36] \\ \hline Dental injuries or regenerative endodonticprocedures & [37; 38] \\ \hline \hline \end{tabular}
\end{table} 
Table 2: Suggested fields of application of ozone therapy in paediatric dentistry that should be further investigated and the related references. of primary teeth, to preserve the development of the facial-skeletal system, and to arrest caries progression of primary tooth. It is desirable that teeth remain in the mouth until the natural exfoliation, in order to guarantee the integrity of primary dentition without causing the child pain and infection or risk of re-currant caries and, therefore, failure of dental restoration [6; 10; 11]. [PERSON] and [PERSON] [6] suggest ozone therapy as part of a possible ultra-conservative atraumatic treatment of deciduous teeth with deep carious lesions, with a partial excavation of dentin. They introduced an excellent alternative for deep caries treatment in primary teeth to be clinically performed in one appointment. The essential advantage of this procedure is the removal of dental tissue avoiding the invasion of the pulp chamber and the progression of caries infection, as minimally as possible. The protocol proposed starts with dental isolation using a rubber dam; then, the clinician can clean the teeth and the cavity margin of enamel can be definitized. The top layer of carious dentin is removed using rosette burs, without exposing the pulp tissue. Gas ozone is then applied on the infected dentin that remains in the cavity for 60 s with a single-patient silicone cup of different sizes (Heal Ozone, Kavo(r), Biberach, Germany). The objective of this procedures is to kill bacteria involved in the carious process like _S. mutans_, _L. acidophilus_, and _E. faecalis_[12]. The protocol executes with a three-step technique bonding and restoration of the decayed tooth with the composite. The American Academy of Pediatric Dentistry (AAPD) defines early childhood caries (ECC) as the presence of one or more decayed deciduous teeth, missing (as a result of caries) or restored before 71 months of age [12]. Studies have found ECC to be more prevalent among children with a lower socio-economic background and high percentages of the cavitated carious primary teeth in preschool children are left untreated [10]. Ozone therapy is a health-safe, simple, painless, and very conservative approach that might be suitable for monitoring caries progression in unco-operative children with traditional dental treatments until appropriate cooperation and compliance can be attained [13].