ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Essential Fatty Acids and Fat-Soluble Vitamins May Increase Salivary Flow in Patients with Primary Sjogren's Syndrome
Clinical Question In patients with Sjogren’s Syndrome, does taking essential fatty acid supplements and fat-soluble vitamins, compared to no supplements, alleviate dry mouth symptoms?
Clinical Bottom Line Omega-3 and fat-soluble vitamins may have an immunoregulatory role and supplements may be effective in alleviating oral dryness in patients with Sjogren’s syndrome. These supplements have potential and can be considered for use alongside stronger xerostomia medications such as sialagogues.
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) 21044101Singh/201061 patients with Sjogren’s Syndrome split into 2 groups: wheat germ oil supplement (n=23) or omega-3 supplement (n=38).Randomized Clinical Trial
Key resultsOmega-3 supplements significantly increased both unstimulated and stimulated salivary production from baseline at 3 months (p=0.029 and p=0.026, respectively). Wheat germ oil (vitamin E) supplementation did not significantly increase unstimulated and stimulated salivary production from baseline at 3 months (p=0.135 and p=0.316, respectively). In the comparison of Omega-3 to wheat germ oil supplementation, Omega-3 was not found to be significantly better than wheat germ oil in unstimulated saliva production (p=0.38). Similarly, Omega-3 supplementation was not found to be significantly greater than wheat germ oil in stimulated saliva production (p=0.346).
#2) 19946023Szodoray/200925 patients with primary Sjogren’s Syndrome and 15 healthy patients.Prospective Cohort Study
Key resultsVitamin A levels were significantly decreased in primary Sjogren’s Syndrome (pSS) patients with extra glandular manifestations (p=0.005). Vitamin E levels were increased in pSS patients as compared to control subjects (p=0.004). These results suggest an immunoregulatory role of fat-soluble vitamins in primary Sjogren’s Syndrome, and that in pSS there is altered metabolism of these vitamins.
Evidence Search “Xerostomia”[MeSH] AND “Fatty Acids”[MeSH]; “Xerostomia”[MeSH] AND “Vitamins”[MeSH]; “Xerostomia”[MeSH] AND “Fatty Acids, Omega-3”[MeSH]
Comments on
The Evidence
Validity: The study by Singh et. al., is an RCT funded by Advanced Vision Research, a for-profit company that markets TheraTears Nutrition® (omega-3 supplement), indicating competing interests. This study also did not provide a control group in the RCT. Both studies would have benefited from a larger patient group. Perspective: The results of these studies show that there may be a link between nutritive supplements and sjogren’s syndrome, but the link is weak and not well supported. More research is needed before any definitive treatment plans are made.
Applicability Sjogren’s Syndrome is an autoimmune disease that affects up to 3% of the population, and it is likely that future patients will present with this disease, of which xerostomia is a prominent manifestation. Supplementing with omega-3 and fat-soluble vitamins is a low-risk, low-harm, and low-cost treatment that is completely feasible in the dental setting. However, because not much research currently exists to strongly support the benefits of nutritional supplementation, it would be advised not to guarantee results or elevate patient expectations.
Specialty/Discipline (Public Health) (Oral Medicine/Pathology/Radiology) (General Dentistry) (Basic Science)
Keywords Xerostomia, Nutrition, Fatty Acids, Omega-3, Vitamins, Sjogren’s Syndrome
ID# 2629
Date of submission: 02/25/2014spacer
E-mail xiaj@livemail.uthscsa.edu
Author Jessica Xia
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Georgiana Gross, MPH
Faculty mentor/Co-author e-mail grossg@uthscsa.edu
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