Table 3.
Omega-3 Fatty Acids and Periodontal Diseases.
| Nutrient(s) | Type of Study | Methodology | Follow-Up Period | Clinical Outcomes | Subclinical Outcomes | Author(s) and Year |
|---|---|---|---|---|---|---|
| Dietary ratio of n-6 to n-3 polyunsaturated fatty acids | Cohort | Dietary intake assessment of 235 eligible older Japanese subjects. | 3 years | A high dietary n-6 to n-3 PUFA ratio was significantly associated with a greater risk of periodontal disease events (number of teeth with periodontal disease progression for three years). | N/A | Masanori Iwasaki et al., 2011 [46] |
| Omega-3 | Systematic Review/ Meta-Analysis | Assessed only RCTs with minimum 3-month follow up of SRP with and without omega-3 supplements. | 3–6 months | Additional PPD reduction and higher CAL gain in patients who received omega-3 fatty acid dietary supplementation with SRP compared to SRP alone. | N/A | Nidia C. Castro dos Santos et al., 2022 [53] |
| Omega-3 and Aspirin | RCT | Subjects with advanced chronic periodontitis (N = 80): The test group received SRP, 3 g of fish oil, and 81 mg of aspirin, while the control group received SRP and placebo capsules. | 6 months | Additional PPD reduction, higher CAL gain, and higher reduction in number of sites with PPD ≥5 mm for test group compared to control. | Significant reduction in salivary MMP-8 and RANKL levels in test group compared to the control. | El-Sharkawy et al., 2010 [48] |
| Omega-3 and Aspirin | RCT | Subjects with moderate periodontitis (N = 46): The test group received 2 g DHA and 81 mg aspirin and the control group received placebo capsules and 81 mg aspirin. No periodontal therapy. | 3 months | Additional PPD reduction of 0.17 mm and higher reduction in number of sites with PPD ≥5 mm for DHA and ASA. | Significant reduction in CRP and IL-1β in GCF but not IL-6 for DHA and aspirin. | Naqvi et al., 2014 [54] |
| Omega-3 and Aspirin | RCT | Patients with moderate to severe chronic periodontitis with grade II furcation (N = 40). Both groups received open-flap debridement with bone graft (DFDBA). The test group received omega-3 (3 g fish oil) +75 mg aspirin for 6 months, while the control group received placebo capsules. | 6 months | Additional PPD reduction of 0.7 mm and CAL gain of 0.4 mm for omega-3 and aspirin group. | Significant reduction in IL-1β in GCF for omega-3 and aspirin group. | ElKhouli AM et al., 2011 [49] |
| Omega-3 and Aspirin | RCT | Chronic periodontitis patients with diabetes mellitus type II (N = 40). The test group received omega-3 (3 g) + aspirin (75 mg) following SRP for 6 months. | 6 months | Significant reduction in PD, CAL, and GI after 3 months and 6 months in the test group compared to control. | Significant reduction in GCF levels of MCP-3 and IL-1β at 3 and 6 months in the test group compared to control. | Elwakeel et al., 2015 [50] |
| Omega-3 and Aspirin | RCT | Patients with type II DM (uncontrolled) and generalized moderate/severe (stage III and IV; grade B and C) periodontitis patients were divided into 3 groups (N = 25/group): control group (CG): placebo; test group 1 (TG1): 3 g of fish oil + 100 mg ASA daily for 2 months after periodontal debridement; test group 2 (TG2): 3 g of fish oil + 100 mg ASA daily for two months before periodontal debridement. | 6 months | A higher number of patients in both test groups (TG1, TG2) achieved the clinical endpoint of treatment (less than or equal to four sites with PPD ≥5 mm) compared to control group. No differences in timing of administration of omega-3 and aspirin. No differences in clinical periodontal parameters among groups. | Significant reduction in HbA1c only in TG1 compared to TG2 and CG. Significant reduction in GCF levels of IFN-γ and IL-8 in both test groups, while IL-6 GCF levels were lower only for TG1. | Nidia C. Castro dos Santos et al., 2020 [47] |
| Omega-3 | RCT | Generalized severe periodontitis subjects (stage III and IV) (N = 30). Test group (n = 16) received SRP and fish oil for 3 months twice a day. Control group (n = 14) received SRP alone. | 3 months | Significant BOP reduction, higher CAL gain, and higher number of sites with closed pockets (PPD ≤ 4 mm) for test group compared to control. | Significantly higher salivary levels of IL-10 and markedly lower levels of IL-8 and IL-17 in test group compared to control. | Mirella Stańdo et al., 2020 [52] |
| Omega-3 | RCT | Chronic periodontitis patients allocated into two groups with equal number of participants (N = 15) and received SRP. The test group was supplemented with low-dose Omega-3 PUFAs 6.25 mg EPA and 19.19 mg docosahexaenoic acid. | 6 months | No additional clinical benefit for PPD reduction and CAL gain for low dose n-3 PUFAs. | Significant reduction in salivary TNF-α for low-dose n-3 PUFAs. | Keskiner I et al., 2017 [55] |
| Omega-3 | RCT | 90 patients with periodontitis. Test group received SRP and omega-3 supplements 500 mg BD daily for 1 month. Control group received only SRP. | 3 months | Significant reduction in PPD and CAL gain in test group compared to control. Significant reduction in GI in test group, but no differences in PI between groups. | N/A | Shirish K. Kujur et al., 2020 [51] |
Abbreviations: RCT: Randomized controlled trial; PPD: Probing pocket depth; CAL: Clinical attachment level; SRP: Scaling and root planing; EPA: Eicosapentaenoic acid; DHA: Docosahexaenoic acid; ASA: Aspirin; PUFAs: Polyunsaturated fatty acids; GCF: Gingival crevicular fluid; BOP: Bleeding on probing; GI: Gingival index; PI: Plaque index; MMP: Matrix metalloproteinase; IL: Interleukin; TNF: Tumor necrosis factor; N/A: Not available.