Clinical Paper Oral Surgery Effects of ozone therapy on pain, swelling, and trismus following third molar surgery H. O. Kazancioglu, E. Kurklu, S. Ezirganli: Effects of ozone therapy on pain, swelling, and trismus following third molar surgery. Int. J. Oral Maxillofac. Surg. 2014; 43: 644–648. # 2013 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved. H. O. Kazancioglu 1 , E. Kurklu 2 , S. Ezirganli 1 1 Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Bezmialem Vakif University, Istanbul, Turkey; 2 Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Istanbul University, Istanbul, Turkey Abstract. The aim of this study was to evaluate the efficacy of therapeutic ozone application in the management of pain, swelling, and trismus associated with the surgical removal of impacted mandibular third molars. Sixty consecutive patients with asymptomatic bilateral impacted mandibular third molars were recruited into the study. Randomly, by use of envelops, the molar on one side was extracted and ozone therapy was given (study side); the molar on the other side was extracted 2 weeks later and sham ozone therapy was given (negative control side). The mean age of the 60 patients was 22.6 2.3 years (range 18–25 years). No differences were found between the two sides for mouth opening or swelling. The degree of pain and the number of analgesic tablets taken was significantly lower for the study side. This study showed ozone therapy to have a positive effect on OHIP-14 questionnaire results. Key words: ozone therapy; pain; third molar; oral surgery; quality of life. Accepted for publication 4 November 2013 Available online 11 December 2013 Surgical extraction of the third molars, or wisdom teeth, is widely carried out in dental practice. 1 The extraction may be range from relatively easy to extremely difficult, depending on the location, depth, and angulation of the tooth, and the den- sity of the bone. 2 This procedure is usually associated with postoperative pain, swelling, and restricted mouth opening due to muscle spasm. 3 The pain reaches maximum intensity at 3–5 h after surgery, continu- ing for 2–3 days, and gradually diminish- ing until the 7th day. 4,5 Swelling reaches peak intensity within 12–48 h, resolving between the 5th and 7th days postopera- tively. 6 The impact of third molar surgery on quality of life has been reported to show a three-fold increase in patients who experi- ence pain, extraoral swelling, and trismus, alone or in combination, compared to those who are asymptomatic. 7 Therefore, many clinicians have emphasized the necessity for better control of pain, swel- ling, and trismus in patients who undergo third molar surgery. 8,9 The use of local or systemic corticos- teroids and non-steroidal anti-inflamma- tory drugs is often recommended. 1,6 However, the majority of these may man- ifest side effects such as a tendency to systemic bleeding, gastrointestinal irrita- tion, and allergic reactions. 7 These observations justify efforts to find a new method of postoperative pain control that does not induce side effects. Non-medication methods have been used to minimize tissue injury after third molar extraction include compression, cryother- apy, and the application of lasers. 7,8 Ozone therapy in dentistry is gaining a place in everyday dental practice 9,10 and is used in almost all dental applications. Ozone is a naturally occurring compound consisting of three oxygen atoms. It is found in nature in the form of a gas in the stratosphere of the earth, at a concentration of 1–10 ppm, being continually created from and broken down into molecular O 2 . 10,11 Ozone can react with blood components Int. J. Oral Maxillofac. Surg. 2014; 43: 644–648 http://dx.doi.org/10.1016/j.ijom.2013.11.006, available online at http://www.sciencedirect.com 0901-5027/050644 + 05 $36.00/0 # 2013 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.