ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Dietary Omega-3 Fatty Acids and Aspirin are Effective as Adjunctive Therapy During Non-Surgical Treatment of Chronic Periodontitis
Clinical Question In patients with chronic periodontitis, does combined dietary omega-3 fatty acids and aspirin reduce the symptoms of periodontitis when compared to a placebo?
Clinical Bottom Line Dietary omega-3 fatty acids and aspirin with or without scaling and root planing have been shown to improve clinical parameters of periodontitis, such as reducing probing depths and increasing clinical attachment, in patients with chronic periodontitis. While more long-term studies with comparison to the gold-standard (scaling and root planing) are needed, this combination of drugs shows potential to arrest this disease short-term.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 20572767El-Sharkawy/201080 adults 30-70 years old with advanced chronic periodontitis and no other medical conditionRandomized Controlled Trial
Key resultsOmega 3-fatty acids (900 mg) and aspirin (81 mg) given daily for 6 months as adjuncts to scaling and root planing decreased symptoms of periodontitis when compared to placebo in patients who received scaling and root planing therapy at 3 months. Probing depths for test were significantly lower than placebo following 6 months of treatment (2.2 mm +/-1.0 versus 3.0 mm +/- 0.8, P<0.05). Gain in clinical attachment levels was higher in test subjects than placebo following 6 months of treatment (3.4 mm +/- 1.3 versus 2.5 mm+/- 1.1, P<0.05). Frequency of probing depths less than 4 mm were also higher in test subjects than placebo (79.4 % versus 54.7 %, P<0.05).
#2) 24970858Naqvi/2014Adults (n=46) older than 40 years old with moderate periodontitis (>5mm) in 4 or more teeth. Randomized Controlled Trial
Key resultsOmega-3 fatty acids (2000 mg) and aspirin (81 mg) showed beneficial results compared to a placebo for omega-3 fatty acids and aspirin (81 mg) with no other therapy given after a period of 3 months. The mean pocket depth was significantly reduced with the omega-3 supplementation (-0.29 mm +/- 0.13, p = 0.3) as well as the mean gingival index (-0.26 +/- 0.13, p = 0.04). The number of sites with a probing depth of greater than or equal to 5 mm was significantly reduced when compared to placebo (OR = 0.62, 95% CI = 0.43-0.90, p=0.01).
Evidence Search ("periodontitis"[MeSH Terms] OR "periodontitis"[All Fields]) AND ("fatty acids, omega-3"[MeSH Terms] OR ("fatty"[All Fields] AND "acids"[All Fields] AND "omega-3"[All Fields]) OR "omega-3 fatty acids"[All Fields] OR "omega 3 fatty acids"[All Fields])
Comments on
The Evidence
Validity: In each of the studies, groups were similar at the beginning of the trials and were treated the same in a double-blinded manner. Following the study, there was adequate follow up for each study and all had near an 80% completion rate or higher. There were no competing interests in any of the studies. Perspective: Based on the evidence, there is a clear relationship between systemic intake of omega-3 fatty acids and aspirin and the symptoms of periodontitis due to the anti-inflammatory properties of each. It is unknown if the combination of omega-3 fatty acids and aspirin has an additive/synergistic effect or if omega-3 fatty acids alone would be effective. Regardless of scaling and root planing therapy, both studies showed significant decrease in probing depths, clinical attachment level, and gingival indexes. However, the exact quantity of omega-3 fatty acids required to see the desired decrease in symptoms is not clearly known. The studies here gave between 0.9 and 2.0 grams per day, while The World Health Organization suggests a daily intake between 0.3 and 0.5 grams for added health benefit. Additionally, the studies only monitored up to 6 months of use. A long-term longitudinal study on this topic is needed in order to compare it to conventional nonsurgical techniques and to observe patient compliance.
Applicability Omega-3 fatty acids have been shown in recent years to be beneficial to health through their anti-inflammatory properties. In combination with aspirin it has been shown to reduce or prevent symptoms associated with chronic periodontitis in adult patients. This systemic therapy can be easily applied in any practice with minimal risk. Furthermore, access to “fish oils” and aspirin does not require a prescription.
Specialty/Discipline (Periodontics)
Keywords periodontitis, omega-3 fatty acids, docosahexaenoic acid, aspirin
ID# 2871
Date of submission: 03/30/2015spacer
E-mail quintanillat@livemail.uthscsa.edu
Author Travis Quintanilla
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Yong-Hee Chun, DDS, MS, PhD
Faculty mentor/Co-author e-mail chuny@uthscsa.edu
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