Long chain omega-3 fatty acids as an adjunct to non-surgical periodontal therapy: a randomised double-blind placebo controlled trial.

Abstract

Background and Aim: Animal studies and early clinical trials suggest a role for long chain omega-3 fatty acids (LCn3PUFAs) in the treatment of periodontal disease due to their anti-inflammatory and pro-resolution actions. The aim of this study was to evaluate the clinical efficacy of fish oil supplementation as an adjunct to non-surgical periodontal therapy in the treatment of advanced chronic periodontitis. Specific objectives were to establish the relative benefit of docosahexaenoic acid (DHA) versus eicosapentaenoic acid (EPA) compared with a placebo. Materials and Methods: Thirty-four subjects (10 male, 24 female; mean age 50.1) with advanced chronic periodontitis were recruited for this parallel group double-blind placebo-controlled randomised trial. All participants received non-surgical periodontal therapy and were randomly allocated to receive either adjunctive dietary fish oil supplements (equivalent of 2g LCn3PUFA per day) or placebo. Clinical parameters were recorded at baseline, 4, 7, 10 and 13 months. Additionally, erythrocytes were isolated from fasting blood samples to allow assessment of fatty acid biomarkers including EPA, DHA, Omega-3 Index and total LCn3PUFAs. Data for the 4 month follow-up is presented in this initial report. Results: One participant was lost to follow-up (placebo group), reporting poor compliance with their allocated capsules. Both treatment groups were effective at improving clinical outcomes, demonstrating significant reduction of full-mouth bleeding scores, probing pocket depth reduction and clinical attachment gain. At the 4 month follow-up, no significant difference was seen between groups for the percentage of sites that had ≥2 mm gain of clinical attachment (P = 0.229) or reduction in probing pocket depth (P = 0.264). The mean number of sites with residual pocket depth ≥5 mm at follow-up were not significantly different for the test group (6.6%) or placebo group (5.3%) (P = 0.264). Additionally, there were no statistically significant differences in clinical parameters for subjects that received supplements containing EPA, DHA or placebo. Conclusion: Within its limitations, the findings of this study do not support an additional benefit of adjunctive LCn3PUFA supplementation for the treatment of advanced chronic periodontitis. Additionally, no correlation was found between clinical periodontal parameters and fatty acid profiles, and there was no significant difference between EPA and DHA subgroups. There is a need for further research to establish the clinical efficacy of LCn3PUFA as a host modulatory therapy for the treatment of periodontitis, particularly larger multi-centre randomised controlled trials.