Omega‐3 PUFA and aspirin as adjuncts to periodontal debridement in patients with periodontitis and type 2 diabetes mellitus: Randomized clinical trial

Abstract

Background: Supplementation with omega-3 polyunsaturated fatty acids (-3 PUFA) and low-dose aspirin (ASA) have been proposed as a host modulation regimen to control chronic inflammatory diseases. The aim of this study was to investigate the clinical and immunological impact of orally administered-3 PUFA and ASA as adjuncts to periodontal debridement for the treatment of periodontitis in patients type 2 diabetes. Methods: Seventy-five patients (n = 25/group) were randomly assigned to receive placebo and periodontal debridement (CG),-3 PUFA + ASA (3 g of fish oil/d + 100 mg ASA/d for 2 months) after periodontal debridement (test group [TG]1), or-3 PUFA + ASA (3 g of fish oil/d + 100 mg ASA/d for 2 months) before periodontal debridement (TG2). Periodontal parameters and GCF were collected at baseline (t0), 3 months after periodontal debridement and-3 PUFA + ASA or placebo for TG1 and CG (t1), after-3 PUFA + ASA (before periodontal debridement) for TG2 (t1), and 6 months after periodontal debridement (all groups) (t2). GCF was analyzed for cytokine levels by multiplex ELISA. Results: Ten patients (40%) in TG1 and nine patients (36%) in TG2 achieved the clinical endpoint for treatment (less than or equal to four sites with probing depth ≥ 5 mm), as opposed to four (16%) in CG. There was clinical attachment gain in moderate and deep pockets for TG1. IFN-and interleukin (IL)-8 levels decreased over time for both test groups. IL-6 levels were lower for TG1. HbA1c levels reduced for TG1. Conclusion: Adjunctive-3 and ASA after periodontal debridement provides clinical and immunological benefits to the treatment of periodontitis in patients with type 2 diabetes.

Influence of Micronutrient Intake, Sociodemographic, and Behavioral Factors on Periodontal Status of Adults Assisted by a Public Health Care System in Brazil: A Cross-Sectional Multivariate Analysis

“…Additionally, polyunsaturated fatty acids (PUFAs), such as omega-3, exert osteoprotective functions (promoting the differentiation and activation of osteoblasts), while inhibiting osteoclast activities [ 64 ]. Indeed, a very recent study reported that adjunctive omega-3 and low-dose aspirin provided clinical and immunological benefits to the treatment of periodontitis in patients with type 2 diabetes after periodontal debridement [ 65 ]. Thus, an inadequate pro-resolving response from the host may constitute a mechanism that explains the worse periodontal status in individuals with omega-3 deficiency [ 63 ].…”

Comparison of the Effects of Omega 3 and Probiotics on Alveolar Bone Loss in Rats: An Immunohistochemical Study

“…4,7 A number of studies have been performed investigating the effects of omega 3 and probiotics on periodontal disease. [8][9][10][11][12][13][14][15] In humans, dietary supplementation with omega 3 in addition to scaling and root planning (SRP) had higher decreases in gingival index (GI), probing depth (PD), and clinical attachment level (CAL), than SRP in patients with chronic periodontitis and it was suggested that omega 3 could be used as a modulator in the treatment of periodontitis. 9 In postmenopausal women, omega 3 administration combined with SRP indicated greater improvements in PD and CAL, than SRP.…”

“…4 Similarly, probiotics, live microorganisms which are beneficial on host health, 5 improve immune response 6 and regulate microbiota. 7 Omega 3 [8][9][10] and probiotics [11][12][13][14][15] have been reported to improve clinical periodontal parameters in humans and reduce alveolar bone loss (ABL) in experimental studies, [16][17][18][19][20][21] although some researchers could not indicate a significant difference. [22][23][24][25][26] Nitric oxide synthase (NOS) is an enzyme which takes part in the synthesis of nitric oxide (NO), an important molecule in several biological activities such as regulation of vascular tonus and immune response.…”

Granulation Tissue Enhanced with Aspirin and Omega‐3 PUFAs as a Local Adjunct to the Surgical Treatment of Periodontitis

“…[ 43,44 ] The combination of omega‐3 PUFAs with deep scaling and/or systemic use of aspirin is also reportedly effective in both periodontal therapy and prevention. [ 6,45,46 ] Likewise, surgical treatment of furcation periodontal defects is enhanced by the use of systemic omega‐3 PUFAs and aspirin. [ 47 ] However, local rinsing with omega‐3 PUFAs did not show benefits in the treatment of gingivitis.…”

“…[ 2–4 ] In susceptible patients, the combination of persisting stimuli such as a biofilm or dental calculus with genetic factors that prevent the resolution of inflammation may lead to a chronic inflammatory response and tissue breakdown. [ 5,6 ] The resulting chronic inflammatory diseases include periodontitis, rheumatoid arthritis, inflammatory bowel disease, and atherosclerosis. [ 7–10 ]…”