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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 12  |  Issue : 1  |  Page : 11-16

Comparative clinical evaluation of supplementation with omega-3 fatty acids, given for different time period, in chronic periodontitis patients


Department of Periodontology and Implantology, M.G.V's K.B.H. Dental College and Hospital, Nashik, Maharashtra, India

Date of Submission27-Jun-2019
Date of Acceptance10-Oct-2019
Date of Web Publication24-Jan-2020

Correspondence Address:
Shruti Shankarrao Lendhey
Department of Periodontology and Implantology, M.G.V's K.B.H. Dental College and Hospital, Panchavati, Nashik, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jorr.jorr_24_19

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  Abstract 


Aim: The aim of the study was to evaluate the effects of supplementation with omega-3 (ω-3) polyunsaturated fatty acids (FAs) as host modulating agent, given at varying interval, in patients with chronic periodontitis.Materials and Methods: This study was carried out in the Department of Periodontology and Implantology of Mahatma Gandhi Vidyamandir's K.B.H. Dental College and Hospital, Nashik, Maharashtra, India. Forty-five patients with chronic periodontitis were selected. The patients were randomly allotted into one of the following groups: Group A (15 patients): Scaling and root planning (SRP) + ω-3 FAs for 1 month, Group B (15 patients): SRP + ω-3 FAs for 2 months, Group C (15 patients): SRP + ω-3 FAs for 3 months. Plaque index (PI), gingival index (GI), probing pocket depth (PPD), and clinical attachment level (CAL) were assessed pre-SRP (baseline), 1 month, and 3 months, respectively, after the treatment. Results: In the present study, in the intra-group comparison; PI, GI, PPD, and CAL were significantly reduced in all three groups (P < 0.001). There was no statistically significant difference in PI, GI, PPD, and CAL in Group A, B, and C (P > 0.05) after 1 month, 2 months, and after 3 months, respectively. Conclusion:ω-3 FAs are equally effective as far as periodontal therapy is concerned when given for short duration of 1 month.

Keywords: Chronic periodontitis, host modulating agent, omega-3 fatty acid


How to cite this article:
Bhartiya G, Kale T, Mahale S, Lendhey SS. Comparative clinical evaluation of supplementation with omega-3 fatty acids, given for different time period, in chronic periodontitis patients. J Oral Res Rev 2020;12:11-6

How to cite this URL:
Bhartiya G, Kale T, Mahale S, Lendhey SS. Comparative clinical evaluation of supplementation with omega-3 fatty acids, given for different time period, in chronic periodontitis patients. J Oral Res Rev [serial online] 2020 [cited 2020 Jul 7];12:11-6. Available from: http://www.jorr.org/text.asp?2020/12/1/11/276705




  Introduction Top


Periodontitis is a common, chronic inflammatory disease characterized by gingival tissue separation from the tooth, which forms a periodontal pocket and can lead to bone and tooth loss. Traditional therapies for periodontitis focus on targeting the bacterial infection, which may be the initiating event responsible for the ensuing inflammation and tissue destruction.[1]

More recent therapeutic strategies have targeted the host response to the bacterial infection, which may play a more crucial role in the pathogenesis of periodontitis and its associated systemic effects.[2],[3],[4],[5],[6],[7]

Polyunsaturated fatty acids (PUFAs) are FAs with ≥1 carbon–carbon double bond, including omega 3 (n-3), omega 6 (n-6), and omega 9 (n-9) FAs. The adequate intake for alpha-linolenic acid is 1.6 g/day for men and 1.1 g/day for women.[3]

The beneficial actions of ω-3 PUFAs were attributed; at first, to a decrease in the production of classic inflammatory mediators such as arachidonic acid-derived eicosanoids (PGE2) and inflammatory cytokines. There are also several studies that demonstrated that dietary supplementation with ω-3 FAs led to a reduction in the progression of periodontitis when given for 3–6 months.[4]

Importantly, the regimen is essential without risk, because the compounds are natural components of fish oil. However, as it is food supplement, it is costly becoming out of reach for the common man.[5]

The goal of the present study was to test an innovative strategy, to our knowledge, in patients affected with generalized chronic periodontitis. Our hypothesis was that dietary supplementation with ω-3 PUFAs has the potential to induce a measurable clinical outcome and pharmacologically interrupt the inflammatory cascade within a time interval of 3 months.

Aims and Objectives

The aim of the study was to evaluate the effects of supplementation with omega-3 (ω-3) PUFAs as host modulating agent, at varying time interval, in patients with chronic periodontitis.

Objectives

The main objectives of the study were as follows:

  1. To evaluate the efficacy of ω-3 PUFAs as an adjunct to scaling and root planning (SRP)
  2. To evaluate ω-3 PUFAs has the potential to induce a measurable clinical outcome and pharmacologically interrupt the inflammatory cascade within a time interval of 3 months.



  Materials and Methods Top


A randomized clinical study was carried out in 45 patients at the Department of Periodontology. Prior approval for the study was obtained from the Institutional Ethical Committee.

Inclusion criteria

  1. Patients within the age group of 18–65 years
  2. Systemically healthy individuals
  3. Patients with chronic generalized periodontitis (probing depth ≥5 mm)
  4. Mobility Grade I or II only.


Exclusion criteria

  1. Patients with systemic disease
  2. Patients having any systemic antibiotic therapy in the past 6 months
  3. Pregnant and lactating females
  4. Patients allergic to omega-3 FAs
  5. Aggressive periodontitis
  6. Smokers.


Consent

After the study was explained, including the benefits, risks, and alternative treatments, the patients signed an informed consent form indicating their agreement to participate in the study.

Sample size

The study was powered (80%) to detect a mean difference of 0.8 mm for probing pocket depth (PPD), assuming 30% change in primary outcomes including PD and clinical attachment level (CAL) within groups after treatment. Fifteen patients were recruited, respectively, in each group.

Groups

After screening through inclusion and exclusion criteria patients were divided into three groups through randomization. Fifteen patients were included in each group.

The patients were randomly allotted into one of the following groups:

  • Group A (15 patients) – SRP + ω-3 FAs for 1 month (capsule containing 300 mg ω-3 FAs once a day)
  • Group B (15 patients) – SRP + ω-3 FAs for 2 months (capsule containing 300 mg ω-3 FAs once a day)
  • Group C (15 patients) – SRP + ω-3 FAs for 3 months (capsule containing 300 mg ω-3 FAs once a day).


Randomization, blinding, and intervention

Randomization was done according to the CONSORT 201082 explanation and elaboration: updated guidelines for reporting parallel group randomized trials. A single study coordinator (hygienist/nurse) randomized patients into three groups.

Primary investigator prepared separate packets of ω-3 FAs and served them to patients according to randomization done. Capsules were given containing 300 mg ω-3 FAs once a day.

For Group A, only 30 capsules were given throughout the study continuously for 1 month, and then recalls were done.

For Group B, 60 capsules were given to each patient continuously 1 capsule/day for 60 days, and then regular recalls were done.

Moreover, for Group C, each patient was given 90 capsules 1 capsule/day for 90 days, and then regular recalls were done.

SRP was performed by primary investigator under local anesthesia if required using Magnetostrictive ultrasonic scaler (MAYBORN ELECTRONICS model 700 sr no. 1608), Hand Scalers, and Gracey Curettes at each recall, that is, after 1-month, 2-month, and 3-month recall. Clinical parameters were recorded at baseline, 1st month, 2nd month, and 3rd month.

Assessment of patients

Assessment of patients was done based on various clinical parameters. Thorough SRP was done at baseline, 1, 2, and 3 months. Clinical parameters were measured at baseline, 1, 2, and 3 months, and during each recall patients were advised plaque control measures.

Periodontal status evaluation/clinical parameters

  1. Plaque index (PI) – Loe and Silness (1964)
  2. Gingival index (GI) – Silness and Loe (1963)
  3. Sulcus bleeding index (SBI) – Muhleman's (1971)
  4. Probing pocket depth (PPD)
  5. CAL.


Among all these parameters, PD and CAL were primary outcome measures, whereas PI, GI, and SBI were secondary outcome measures. PD and CAL were measured from fixed reference point, that is, cementoenamel junction.

Assessment of capsules taken by patients was done by giving 30 capsules at a time to each patient and recalling them after each month with the packet given to them, and capsules were counted if remaining.


  Results Top


Forty-five patients comprising 24 males and 21 females with an age range of 18–65 years (mean age: 44.933 ± 5.035 years) were included in this study. Patients were classified into three groups (15 patients in each group),

  • Group A – Patients received 300 mg omega-3 FA capsules (omega 3), one capsule/day for 1 month
  • Group B – Patients received 300 mg omega 3 FA capsules (omega 3), one capsule/day for 2 months
  • Group C – Patients received 300 mg omega 3 FA capsules (omega 3), one capsule/day for 3 months.


None of the patients had any known history of systemic conditions or infections. None of the patients reported of any change in their general health or medical status during the study. As stated earlier, all the clinical parameters were assessed in all groups at the baseline, after 1, 2, and after 3 months.

Intergroup comparisons

With a thorough SRP therapy followed by regular maintenance, the plaque control in all the patients was satisfactory. Throughout the study, plaque accumulation was at a minimum with no significant differences between the three groups. At baseline, the PI, GI, probing pocket depth, and CAL in Group A, B, and C were noted. No significant difference (P > 0.05) was found in the PI, GI, probing pocket depth, and CAL between the groups at baseline. There was no statistically significant difference in PI, GI, PPD, and CAL in Group A, B, and C (P > 0.05) after 1, 2, and after 3 months, respectively, which is shown in [Graph 1], [Graph 1]2, [Graph 1]3, [Graph 1]4, [Graph 1]5. When ANOVA test is applied for PI to see intergroup comparison, it was found that there was a statistically nonsignificant difference seen with inter-group comparison of PI, GI, PPD, and CAL across the three groups (P > 0.05).



Intragroup comparison

With a thorough SRP therapy followed by regular maintenance, the plaque control in all the patients was satisfactory. Throughout the study, there was a significant reduction seen in PI, GI, SBI, PPD, and CAL in all the three groups.

When ANOVA test is applied for Group A, B, and C, it was found that there was highly statistically significant difference in each parameter in Group A, B, and C (P > 0.05) after 1, 2, and 3 months. There was a statistically highly significant difference seen between various time intervals with respect to all four variables such as PI, GI, PPD, and CAL (P< 0.01) with means highest on baseline followed by follow-ups 1, 2, and least for follow-up 3 as shown in [Table 1]. There was a statistically highly significant difference seen between various time intervals with respect to all four variables such as PI, GI, PPD, and CAL (P< 0.01) with means highest on baseline followed by follow-ups 1, 2, and least for follow-up 3 shown in [Table 2]. There was a statistically highly significant difference seen between various time intervals with respect to all four variables such as PI, GI, SBI, PPD, and CAL (P< 0.01) with means highest on baseline followed by follow-ups 1, 2, and least for follow-up 3 shown in [Table 3].
Table 1: Group A ANOVA

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Table 2: Group B ANOVA

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Table 3: Group C ANOVA

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  Discussion Top


In the present study, in the intra-group comparison; PI and GI were significantly reduced in all three groups (P< 0.001**). Throughout the study, plaque accumulation was at minimum. There was no statistically significant difference in PI in Group A, B, and C (P > 0.05) after 1, 2, and after 3 months.

In the present study, GI and SBI, which are standard clinical indices indicating inflammatory progress of chronic periodontitis, were significantly reduced in all three ω-3 FAs groups (P< 0.001**). It was seen that there was again highly significant reduction in all the three groups when intragroup comparison was done for SBI. While intergroup comparison was done, it was found that there was no statistical difference between each group. It was found that each group showed ≥35% at 1 month, ≥65% at 2nd-month follow-up, and ≥70% reduction in SBI score at the end of 3rd month.

This can be explained by referring various clinical trials which have shown that ω-FAs may significantly reduce the inflammatory burden of the body. Such as, in a pilot study on senile osteoporosis, Kruger et al.[8] found significantly lower levels of serum osteocalcin in women taking eicosapentaenoic acid (EPA) capsules than in controls, which indicated a decrease in bone turnover and suggested that EPA has beneficial effects on bone and it is safe to administer for prolonged periods of time.[8]

In the present study, improvement of PPD and CAL was significantly more in each group when intragroup comparison was done at 1-, 2-, and 3-month follow-up. However, when intergroup comparison was done again, there was no significant difference was seen between each group. The results found in our study are similar in comparison with a study done by Woelber et al. (2016),[7] who investigated the effects of 4 weeks of an oral health optimized diet on periodontal clinical parameters in a randomized controlled trial.[7] Hence, it can be said that omega-3 FAs are equally effective as far as periodontal therapy is concerned when given for short duration of 1 month.

SRP is performed regularly at equal interval of 1 month for each patient of all groups. It could be the reason why each group shown insignificant differences for each parameter when intergroup comparison is done because due to SRP therapy it could be easier for the patient to maintain a good oral hygiene.

Limitations

Hence, performing periodic SRP may be seen as a limitation of our study. Furthermore, small sample size and small dosage of the prescribed drugs and inability to assess how regularly patients took capsules are the limitations of the study.

Effect of omega 3 FAs should be checked in both smoker and non smoker. To make any final conclusion, Effect of omega 3 FAs should be checked when it will be given for longer duration and higher dosage. Antimicrobial effects of omega-3 FAs should also be taken into consideration before making any final conclusion.


  Conclusion Top


Hence, within the limitation of this study, it can be said that dietary supplementation with ω-3 PUFAs has the potential to induce a measurable clinical outcome and pharmacologically interrupt the inflammatory cascade within a month.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Sorsa T, Tjäderhane L, Konttinen YT, Lauhio A, Salo T, Lee HM, et al. Matrix metalloproteinases: Contribution to pathogenesis, diagnosis and treatment of periodontal inflammation. Ann Med 2006;38:306-21.  Back to cited text no. 1
    
2.
Jenabian N, Moghadamnia AA, Hamzeh M, Azarakhsh S, Shakoorpour A. Effect of omega-3 fatty acid in treatment of patients with moderate gingival inflammation. J Periodontol Implant Dent 2012;4:73-6.  Back to cited text no. 2
    
3.
Dodington D. Dietary Intakes and Periodontal Outcomes After Sanative Therapy; 2014.  Back to cited text no. 3
    
4.
Salman SA, Akram HM, Husham Ali BO. Omega-3 as an adjunctive to non surgical treatment of chronic periodontitis patients. IOSR J Dent Med Sci 2014;13:8-11.  Back to cited text no. 4
    
5.
Dodington DW, Fritz PC, Sullivan PJ, Ward WE. Higher intakes of fruits and vegetables, β-carotene, Vitamin C, α-tocopherol, EPA, and DHA are positively associated with periodontal healing after nonsurgical periodontal therapy in nonsmokers but not in smokers. J Nutr 2015;145:2512-9.  Back to cited text no. 5
    
6.
Kaur M, Sable DM, Chowdhery A, Chavan M. A review of omega 3 and it's role in oral diseases. Int J Adv Res 2016;4:921-5.  Back to cited text no. 6
    
7.
Woelber JP, Bremer K, Vach K, König D, Hellwig E, Ratka-Krüger P, et al. An oral health optimized diet can reduce gingival and periodontal inflammation in humans – A randomized controlled pilot study. BMC Oral Health 2016;17:28.  Back to cited text no. 7
    
8.
Kruger MC, Coetzer H, de Winter R, Gericke G, van Papendorp DH. Calcium, gamma-linolenic acid and eicosapentaenoic acid supplementation in senile osteoporosis. Aging (Milano) 1998;10:385-94.  Back to cited text no. 8
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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