Knowledge Center › Protocols › Mouth sores
Practitioner protocol · Dentistry
Dental Ozone Protocol: Mouth Sores, Lichen Planus and Ulcers
Settings published human studies used for gas on aphthous ulcers, oral lichen planus and chemotherapy or post-extraction ulcers.
Quick answer: Published human studies used gas for 1 minute on an aphthous ulcer with an 8 mm cup. Lichen planus was treated for up to 10 sessions, twice a week.
Warning
Requires training in ozone dentistry
Dental ozone should only be performed by a dental professional trained in ozone dentistry. Gas applied in the mouth carries a higher risk of breathing ozone, which is why devices seal over the tooth and use suction (vacuum) to pull the gas away. Never let the patient inhale ozone gas.
This sheet summarizes what published human studies used. It is not a self-treatment guide and not medical advice. Settings are printed as each study reported them, by device family, and cannot be compared across devices.
What are the basics of ozone for mouth sores?
- Soft-tissue lesions are one of the stronger dental uses. Aphthous ulcers (canker sores) were treated for 1 minute with a small sealed cup, and oral lichen planus with twice-weekly sessions over several weeks.
- Chemotherapy-induced ulcers and post-extraction gum ulcers are single case reports.
Among the stronger dental uses, but device and setting differ study to study.
What dose and settings are used for ozone for mouth sores?
One row per use. Settings are exactly as the studies printed them; "not stated" means the paper did not give it.
| Device family | Setting as printed | Time and schedule | |
|---|---|---|---|
| Recurrent aphthous ulcer | Sealed-cup (vacuum) device | 2,350 ppm, small 8 mm cup | 1 min on the ulcer |
| Oral lichen planus (protocol A) | High-frequency tip generator | 10–100 µg/mL in the field | 10 s per application at 60% intensity; up to 10 sessions, twice a week |
| Oral lichen planus (protocol B) | Medical generator | 60% intensity | 1 min, 8 sessions |
| Oral lichen planus (protocol C) | Probe-tip device | 2,100 ppm | 4 min, twice a week for 3 weeks |
| Chemotherapy-induced ulcer | Probe-tip device | Power level 5–9 (10–100 µg/mL range) | 22 days (single case report) |
| Post-extraction gum ulcer (child) | Probe-tip device | Level 6 rising to 8 | 1–2 min cycles, 3 cycles (single case report) |
Madrid's dental addendum: Madrid (section 9) favors ozonated bidistilled water and ozonated oil over gas for minor soft-tissue sores and ulcers, and gives no gas setting for mouth sores. The gas studies on this sheet are an option, not Madrid's first choice. Device settings in the table (ppm, power level, seconds) are not directly comparable to Madrid's µg/mL values.
Unit key: 1 g/m³ equals 1 µg/mL. 2,100 ppm is about 4.2 µg/mL and 2,350 ppm about 4.7 µg/mL. Power levels and percent settings have no µg/mL value.
What are the best tips when using ozone for mouth sores?
- The aphthous ulcer trial used a small 8 mm cup on the ulcer.
- Lichen planus protocols ran for weeks: plan a block of twice-weekly visits.
- Settings are device-specific (ppm, power level, seconds). Use your own device's program and do not convert one family's setting into another's.
- Most single-tooth uses were one application. Where the studies gave a schedule, it is in the table.
What are the precautions for ozone for mouth sores, and who should avoid it?
- Device families used in this sheet (generic descriptions). Sealed-cup (vacuum) device: a silicone cup seals over the tooth and holds a vacuum. Probe-tip device: a handpiece with a tip, usually a fixed concentration or a power level. High-frequency tip generator: ozone is made at the tip and set by power percent. Timed-burst handpiece: a preset dose set by seconds. Medical generator: a standard medical ozone generator giving a dose in µg/mL, with a syringe or custom sealed tray.
- Use high-volume suction or an ozone destruct unit at the mouth, and ventilate the room.
- Screen the patient first. Review pregnancy, heart or bleeding conditions and blood thinners with the patient's physician before gas is used.
- The Madrid Declaration on Ozone Therapy, 4th edition (ISCO3, 2025) dentistry addendum (Addendum A, section 2.1) sets the safety rules for gas in the mouth: stop at the first smell of ozone and check for leaks; use the dental unit's high-volume suction even when the handpiece has its own suction line; seal custom trays at every edge and test the seal before use; and keep 1 g of vitamin C and medical oxygen with a mask (3 L/min) in the office in case the patient breathes in ozone. For cup or tray gas on tooth surfaces (section 4.1), Madrid lists as contraindications: a tooth or mouth shape that stops a full seal, no high-volume suction, and a tooth with an apical lesion (endodontic treatment or extraction fits better). The full contraindication list in section 2.1 of the main text is written for ozone given through the body. How MediSkill handles contraindications is explained in the contraindications article.
- Use medical oxygen to make the gas. Madrid says generators that run on room air also make harmful nitrogen compounds, and industrial oxygen must not be used. Many of the dental studies here used such devices, so their settings may not match a medical-oxygen generator. Madrid's dentistry addendum allows an oxygen concentrator of 95% or higher purity for topical dental use and calls for medical-grade oxygen (99.9%) for any injection. MediSkill's rule is medical oxygen.
- Check your licensing board and that your device is cleared for dental use where you practice.
More detail
Equipment
- Dental ozone device matching the family in the table, with a small cup or tip suited to the lesion
- Suction or an ozone destruct unit at the mouth
What the studies used
Study doses are listed as printed in each paper. They are not Madrid dosing; see the Madrid line under the dosing table. "RCT" means randomized controlled trial (people were assigned to groups by chance).
- Aphthous ulcers, 1 min: non-randomized controlled study of 138, favors ozone (Sci Rep 2016).
- Oral lichen planus A: RCT of 120 with four arms (ozone, laser, steroid mouthwash, placebo): ozone and steroid did better than laser and placebo; ozone and steroid were not compared (Ann Dermatol 2015). B: RCT of 66, combined topical ozone and steroid, partly favors ozone (Mostafa 2018). C: non-randomized controlled study of 30, partly favors ozone (Shete 2017, Eur J Biomed Pharm Sci).
- Chemotherapy-induced palatal ulcer in a leukemia patient: case report (Eur J Case Rep Intern Med 2020). Post-extraction gum ulcer in a child: case report (Children (Basel) 2025).
Evidence is moderate for aphthous ulcers and lichen planus (one large controlled study each) and thin for the two ulcer case reports.
Learn more
Background, benefits and research on dental ozone: Ozone in dentistry, full article.
Related protocols: Dental Ozone Protocol: Medication-Related Osteonecrosis of the Jaw (MRONJ), Dental Ozone Protocol: Tooth Decay and Sensitivity, Dental Ozone Protocol: Gum Disease, Peri-Implantitis and Implant Stability.
Other dental protocols
For licensed practitioners. Educational reference only, not medical advice. Follow your scope of practice and local regulations.