Comparison of effectiveness of low-dose aspirin versus omega-3 fatty acids as adjuvants to nonsurgical periodontal therapy in Type II diabetic patients with chronic periodontitis

Abstract

Context: Periodontitis and diabetes are universally prevalent diseases which are interlinked with each other. Inflammatory products released both by the microorganisms, and the host plays a pivotal role in causing both the diseases. Pentraxins are acute-phase proteins which are often found to be elevated in inflammatory states. Anti-inflammatory agents have a very important role to play in curbing infection of which, aspirin and omega-3 fatty acids (O3FAs) are being administered often nowadays. Nonsurgical periodontal therapy (NSPT) remains the gold standard of treatment, and other agents have been used as adjuvants only, to increase the efficacy of treatment. Aims: This study compares the effects of low-dose aspirin versus O3FAs when used as adjuvants to NSPT in patients with diabetes and chronic periodontitis. Settings and Design: A total of 42 patients (mean age of 30–65 years) from a diabetic center who were diagnosed with Type II diabetes and chronic periodontitis were included in the study. Materials and Methods: This study was done in the department of periodontics of a tertiary referral care hospital in Hyderabad, in collaboration with a reputed diabetic center. Statistical Analysis Used: Intragroup comparison was done using the paired t -test for continuous data and Wilcoxon signed-rank test for score data. Intergroup comparison was compiled using independent t -test. All P < 0.05 were considered statistically significant. Results: Intragroup comparison at baseline and 3 months after NSPT showed statistically significant results ( P < 0.001) in all the three groups pertaining to the clinical (gingival index, probing pocket depth, and clinical attachment level) and biochemical (glycosylated hemoglobin and pentraxin) parameters. However, the intergroup comparison showed a significant improvement in Group II related to pentraxin levels only ( P < 0.001). Conclusions: O3FAs proved to be better than low-dose aspirin and placebo after NSPT.

Systematic review and meta-analysis on the adjunctive use of host immune modulators in non-surgical periodontal treatment in healthy and systemically compromised patients

“…When combining data from healthy 31 , 32 and diabetic type 2 patients 33 , no significant improvement in GI were observed between the test and the control groups (Table 2 ).…”

“… Primary outcomes No significant differences in PPD and CAL at 3 months of healing were observed when omega-3 or a placebo were administered together with NSPT 33 . Secondary outcomes In diabetic patients, plasma level of pentraxin (PTX3) improved significantly more when omega-3 rather than low-dose aspirin or placebo were combined with NSPT 33 . …”

“…Another study not included in the meta-analysis in healthy subjects reported that dietary supplementation of Omega-3 had no benefit on clinical parameters. Secondary outcomes When combining data from healthy 31 , 32 and diabetic type 2 patients 33 , no significant improvement in GI were observed between the test and the control groups (Table 2 ). Plaque levels, reported in the study by Deore et al 31 , improved significantly in both groups, without any significant difference between them.…”

“…Omega-3 (PUFA n-3) were tested in four studies 31 – 34 , where the host modulator was administered with different prescriptions and doses (EPA 180 mg / DHA 120 mg once a day for 3 months; EPA 6.25 mg + DHA 19.19 mg twice a day for 6 months; Omega-3 fatty acids 500 mg twice a day for 90 days; PUFAs 300 mg once a day for 2 weeks). Three studies were in systemically healthy patients and one in diabetic type 2 patients taking metformin 33 .…”

“… Primary outcomes Owing to the limited number of studies, meta-analysis combined data from healthy patients 31 , 32 and patients affected by type 2 diabetes 33 and results are presented in Table 2 . The differences between the test and the control groups were not statistically significant for PD and CAL.…”