Omega 3 fatty acids as a host modulator in chronic periodontitis patients: a randomised, double-blind, palcebo-controlled, clinical trial

Abstract

Purpose: Periodontitis is an infectious disease caused predominantly by gram-negative anerobes. The host inflammatory response to these bacteria causes alveolar bone loss that is characterized as periodontitis. Omega-3 fatty acids (ω-3 FAs) have anti-inflammatory properties, thus have been used to treat some chronic inflammatory diseases such as cardiovascular disease and rheumatoid arthritis. We aimed to evaluate the effect of dietary supplementation with ω-3 FAs as a host modulating agent in patients with chronic periodontitis. Methods: Sixty otherwise healthy subjects with moderate and severe chronic periodontitis were enrolled in our randomised, double-blind, placebo-controlled trial. The control group (CG, n = 30) was treated with scaling and root planing (SRP) and given a placebo; the treatment group (TG, n = 30) was treated with SRP and dietary supplementation of ω-3 FAs (one 300 mg tablet daily for 12 weeks). Periodontal clinical parameters and serum C-reactive protein (CRP) levels were evaluated in all patients at baseline, a 6-week and 12-week period after treatment. Results: A significant reduction in the gingival index, sulcus bleeding index, pocket depth, and clinical attachment level was found in the TG compared to the CG at a 12-week period. However, no statistically significant changes in serum CRP levels were found. Conclusions: Our findings suggest that ω-3 FAs can successfully reduce gingival inflammation, pocket depth, and attachment level gain. Dietary supplementation with ω-3 FAs may have potential benefits as a host modulatory agent in the prevention and/or adjunctive management of chronic periodontitis.

Higher Intakes of Fruits and Vegetables, β-Carotene, Vitamin C, α-Tocopherol, EPA, and DHA Are Positively Associated with Periodontal Healing after Nonsurgical Periodontal Therapy in Nonsmokers but Not in Smokers

“…In this study, FA supplements that include EPA and DHA appeared to benefit patients because dietary intakes alone were not significantly associated with PD. In a recent clinical trial, patients undergoing SRP taking a supplement with 300 mg/d of EPA + DHA had a lower mean PD, compared with those taking placebo (31). In vitro, resolvin D1, a downstream metabolite of DHA, has been shown to optimize healing of periodontal biopsies through downregulation of inflammatory mediators (50).…”

“…For example, 1 study has demonstrated an association between vitamin D sufficiency and improved healing after periodontal surgery (30). Preliminary clinical trials using dietary supplements including fish oil (31) and encapsulated fruit and vegetable concentrate (32) have also shown to be effective in optimizing periodontal outcomes after SRP. However, there still remain relatively few studies that have investigated the association between diet and periodontal healing.…”

Docosahexaenoic acid attenuates oxidative stress and protects human gingival fibroblasts against cytotoxicity induced by hydrogen peroxide and butyric acid

“…These findings may clarify the results of the double-blind, placebo-controlled, randomised trial carried out in India and published in this year which confirmed n-3 PUFA benefit in chronic periodontitis. 61 These findings indicate that these bioactive fatty acids could act as potential therapeutic adjuncts for the clinical management of periodontal diseases. However, further investigations are required to elucidate the specific roles of individual n-3 fatty acids, DHA and eicosapentaenoic acid (EPA).…”

Omega‐3 Polyunsaturated Fatty Acids as an Adjunct to Non‐Surgical Treatment of Periodontitis

“…Some unfavorable conditions that lead to homeostasis breakdown must be present. [9,10] Unfortunately, the immune system is not always able to compensate the ongoing inflammatory process, hence the wider interest is presently focused on the concept of treatment through the modulation of host response (host modulatory therapy, HMT), a therapy based on the pharmacological modulation of immune system. [8] There is also an increase in matrix metalloproteinases, which are actively involved in the destruction of periodontal ligament and connective tissue of the gingiva.…”

“…When periopathogens start to proliferate (dysbiosis), immune system is potently activated, mainly by bacterial lipopolysaccharide (LPS) resulting in an increase in the production of pro-inflammatory factors, such as prostaglandin (PG) E 2 , interleukin (IL) 1β, IL-6, and tumor necrosis factor (TNF). [10] Recently, there is a growing interest in products containing polyunsaturated fatty acids (PUFAs) omega-3, including docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). [8,9] In addition, the ongoing inflammatory process stimulates osteoclastogenesis by modifying the level of kappa B nuclear factor receptor ligand, which is responsible for the activation of osteoclasts, while also competes with osteoprotegerin (OPG) that possesses antagonistic activity.…”