Serum level changes of long chain-polyunsaturated fatty acids in patients undergoing periodontal therapy combined with one year of omega-3 supplementation: a pilot randomized clinical trial

Abstract

PurposeWe aimed to investigate the impact of nonsurgical periodontal treatment combined with one-year dietary supplementation with omega (ω)-3 on the serum levels of eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), docosapentaenoic acid (DPA), and arachidonic acid (AA).MethodsFifteen patients with chronic generalized periodontitis were treated with scaling and root planing. The test group consisted of seven patients (43.1±6.0 years) supplemented with ω-3, consisting of EPA plus DHA, three capsules, each of 300 mg of ω-3 (180-mg EPA/120-mg DHA), for 12 months. The control group was composed of eight patients (46.1±11.6 years) that took a placebo capsule for 12 months. The periodontal examination and the serum levels of DPA, EPA, DHA, and AA were performed at baseline (T0), and 4 (T1), and 12 (T2) months after therapy.ResultsIn the test group, AA and DPA levels had been reduced significantly at T1 (P<0.05). AA and EPA levels had been increased significantly at T2 (P<0.05). The ΔEPA was significantly higher in the test compared to the placebo group at T2-T0 (P=0.02). The AA/EPA had decreased significantly at T1 and T2 relative to baseline (P<0.05).ConclusionsNonsurgical periodontal treatment combined with ω-3 supplementation significantly increased the EPA levels and decreased the AA/EPA ratio in serum after one year follow-up. However, no effect on the clinical outcome of periodontal therapy was observed.Graphical Abstract

Impact of Docosahexaenoic Acid Therapy on Subgingival Plaque Microbiota

“…In the presence of aspirin, acetylated cyclooxygenase‐2 converts DHA into 17‐hydroxy‐DHA, which leads to aspirin‐triggered resolvins with enhanced proresolution effects. Neither supplementation of n‐3s nor aspirin by itself significantly impacts periodontitis in humans 28–30 . Cumulatively, these studies suggest that n‐3s + aspirin have clear and potentially clinically important anti‐inflammatory actions 8,10,31‐33 …”

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

“…In the studies where omega-3 PUFAs were used alone, no significant differences in clinical parameters between the study and control groups have been demonstrated, [26] or significant improvement of probing depth (PD), CAL, gingival index (GI), and bleeding on probing (BOP) has been shown. [9] Furthermore, in the patients receiving omega-3 PUFAs a ratio of AA to EPA decreased significantly, reaching the level of 7:1, whereas in the control group this ratio remained high (18:1). [10,26] Long-term administration of omega-3 PUFAs resulted also in increased plasma level of EPA.…”

“…[26] Omega-3 PUFA administration resulted in the reduction of inflammatory mediators such as TNF-α or C-reactive protein (CRP). [9] For maintaining health, an optimal ratio of omega-6 fatty acids to omega-3 fatty acids was set at 4:1-5:1 and not exceeding 10:1. [9] Furthermore, in the patients receiving omega-3 PUFAs a ratio of AA to EPA decreased significantly, reaching the level of 7:1, whereas in the control group this ratio remained high (18:1).…”

“…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.…”

Effects of host modulation by nonsteroidal anti-inflammatory drugs on periodontal disease: a systematic review and meta-analysis

“…8,9 In order to provide a better treatment modality to patients who are highly susceptible to periodontal diseases, host modulation using various therapeutic agents targeting the manipulation of the inflammatory pathway has been proposed as an adjunctive treatment with conventional periodontal therapy. [10][11][12][13] Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most potent agents due to their direct inhibition of cyclooxygenase, which is responsible for the production of arachidonic acid metabolites. These metabolites are involved in tissue breakdown in periodontal diseases 14 via the activation of the secretion of matrix metalloproteinase and osteoclasts.…”