The standard treatment for periodontitis involves subgingival debridement and effective supragingival biofilm control. Treatment failures are thought to stem from a failure to reverse biofilm dysbiosis and to control inflammation so adjunctive antimicrobial agents and immune modulates have been examined. In recent years omega-3 polyunsaturated fatty acids have been investigated for potential roles in health promotion and disease risk reduction including as an adjunctive therapy to periodontal treatment.
The aim of this review was to assess the impact of dietary omega-3 fatty acids as an adjunct to non-surgical periodontal treatment when compared with periodontal treatment alone in periodontitis patients
Methods
The review protocol was registered on Prospero and searches undertaken in the Medline/PubMed, Embase and LILACS databases Randomized controlled trials (RCTs) comparing the use of dietary omega-3 fatty acids as an adjunct to non-surgical periodontal treatment compared to non-surgical periodontal treatment alone With at least 3-months follow-up were considered. The primary outcomes were changes in clinical attachment level (CAL) and periodontal probing depth (PPD). Two reviewers independently screened and selected studies extracted data and used the Cochrane risk of bias tool to assess study quality, disagreements were resolved with a third reviewer. Random-effects meta-analyses were conducted with data being pooled as weighted mean difference (WMD). andthe Grades of Recommendation Assessment, Development and Evaluation (GRADE) approach used to assess overall certainty of the evidence.
Results
- 10 studies involving a total of 467 patients were included.
- 7 studies were considered to be at low risk of bias at 3 at high risk.
- All 10 studies showed a significant benefit in the periodontal clinical parameters with the use of omega-3 supplementation compared with SRP alone/placebo.
- 8 studies contributed to the meta-analyses with a significant effect being seen in favour of omega-3 on PPD reduction CAL gain and bleeding on probing (BOP).
- PPD reduction WMD = 0.42 (95%CI: 0.15 to 0.68).
- CAL gain WMD = 58 (95%CI: 0.24 to 0.92).
- BOP WMD = 4.55 (95% CI: 2.00 to 7.10).
- No adverse effects were reported in 7 studies, one study reported nausea, abdominal upset and fish-scented halitosis in 13 patients and 2 studies made no mention of adverse effects.
Conclusions
The authors concluded: –
In individuals with periodontitis, the use of omega-3 supplementation as an adjunct to SRP can provide additional benefits in CAL gain and PPD reduction, compared with SRP alone.
Comments
The authors published a protocol on the Prospero database and undertook searches of 3 databases following a standard systematic review approach. While 10 studies were included, they are generally small with follow up periods ranging from just 2-6 months although a majority were assessed as being at low risk of bias. The findings show a statistically significant improvement for PPD, CAL and BOP but not for the gingival index (WMD = 0.22 (95%CI: -0.0 to 0.39) however whether this a clinically important benefit is a matter of debate. The authors note that a clinical outcome of the percentage of patients who achieved the clinical endpoint of ≤4 sites with PD ≥ 5 mm has been suggested as a potential objective clinical outcome which may be helpful in future if more widely adopted.
Links
Primary Paper
Castro Dos Santos NC, Furukawa MV, Oliveira-Cardoso I, Cortelli JR, Feres M, Van Dyke T, Rovai ES. Does the use of omega-3 fatty acids as an adjunct to non-surgical periodontal therapy provide additional benefits in the treatment of periodontitis? A systematic review and meta-analysis. J Periodontal Res. 2022 Jun;57(3):435-447. doi: 10.1111/jre.12984. Epub 2022 Mar 3. PMID: 35243637.
Review protocol on PROSPERO
Other references
Dental Elf – 8th Oct 2021
Periodontitis: Locally delivered anti-microbials as an adjunct to surgical periodontal treatment
Dental Elf – 23rd Nov 2020
Periodontitis: Systemic antimicrobials as an adjunct to non-surgical treatment
Dental Elf – 6th Jul 2018
