Periodontal disease is common, and treatment typically involves subgingival debridement and effective supragingival biofilm control. In addition to this traditional approach a number of additional measures can be employed including those that modify the inflammatory response. Bisphosphonates, certain non-steroidal anti-inflammatory drugs, and tetracycline have been tested and more recently omega-3 fatty acids have been examined.
The aim of this review was to assess the adjunctive effect of omega-3 (ω-3) fatty acids and non-surgical periodontal therapy (SRP) on probing pocket depth (PPD) and the clinical attachment level (CAL).
Methods
The review protocol was registered with PROSPERO. Searches were conducted in the Cochrane Central Register of Controlled Trials (CENTRAL) and Medline/PubMed. Randomised controlled trials (RCTs) in patients aged ≥18 years of age comparing SRP and adjunctive ω-3 with SRP and placebo were considered. Two reviewers independently screened and selected studies extracted data and assessed study quality. Meta-analysis was conducted were possible. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) was used to rank the evidence and certainty.
Results
- 10 RCTs were included
- All studies included patients in generally good health with 8 studies excluding smokers.
- 8 studies were considered to be at low risk of bias, one at high risk and one at moderate risk.
- 3 studies found no significant differences for both outcomes PPD and CAL, with one other study showing no significant effect for PPD.
- 5 studies showed a statistically significant improvement for both the PPD and CAL with ω-3 fatty acids.
- Meta-analysis showed a significant mean difference (MD) in favour of SRP + ω-3 fatty acids for both PPD and CAL
- PPD = 0.51 (95% CI; 0.85 to 0.17) [9 studies].
- CAL = 0.43 (95% CI; 0.74 to 1.19) [8 studies].
- The overall GRADE certainty of the evidence was assessed as ‘moderate’.
Conclusions
The authors concluded: –
The collective evidence emerging from this systematic review and MA shows a positive effect of the use of ω-3 fatty acids (potentially combined with ASA) as an adjunct to non-SRP. In patients with periodontitis, dietary supplementation with ω-3 fatty acids as an adjunct to SRP is more effective in reducing the PPD and improving the CAL than SRP alone. If SRP is indicated, the use of ω-3 fatty acids can be considered for a moderate extra added effect on PPD reduction and CAL gain. The strength of this recommendation is moderate. The direction of the recommendation emerging from this review is that supplementation with ω-3 fatty acids could be an effective adjunctive therapy for an additional effect in the management of periodontal treatment.
Comments
We have previously looked at another review on this topic (Dental Elf -27th May 2022) which also included 10 RCTs with 8 of the 10 RCTs being common to both reviews. As with the earlier review this review also preregistered a protocol on PROSPERO although their search strategy involved a smaller number of databases. Both reviews come to a similar conclusion finding that the use of adjunctive ω-3 fatty acids provides an additional benefit in relation to PPD and CAL over SRP alone. This new review quantifies the benefit of adjunctive ω-3 fatty acids as, “an improvement of 0.39 mm of PPD reduction and 0.41 mm CAL gain after a dosage (≥2 g/day)”. Whether this is a clinically important level of benefit is open to discussion. The included studies range in size from 15 to 80 patients and there was some variation in the dosage schedules and further clarification of dosages should be undertaken before wider use. While none of the included studies reported any side effects or adverse events future studies should actively gather information on this.
Links
Primary Paper
Van Ravensteijn MM, Timmerman MF, Brouwer EAG, Slot DE. The effect of omega-3 fatty acids on active periodontal therapy: A systematic review and meta-analysis. J Clin Periodontol. 2022 Oct;49(10):1024-1037. doi: 10.1111/jcpe.13680. Epub 2022 Jul 21. PMID: 35713248.
Other references
Dental Elf -27th May 2022
Dietary omega-3 fatty acids as an adjunct to non-surgical periodontal treatment
