New Study: Omega-3 Combined with Low-Dose Aspirin May Be as Effective as Antibiotics in Treating Severe Periodontitis

Source: Immunomodulators, associated or not with systemic antibiotics, to treat periodontitis: A 1-year multicenter, placebo-controlled, double-blind, randomized clinical trial

DentalGoodNews｜A multicenter, placebo-controlled, double-blind randomized clinical trial (n=109) published in the Journal of Periodontology recently showed that Omega-3 (3 g/day) combined with low-dose aspirin (ASA, 100 mg/day, for 6 months) as an adjunct to subgingival scaling and root planing (SRP) achieved a treatment endpoint success rate of 57.7% at the 1-year follow-up, comparable to the 58.6% observed with the traditional antibiotic regimen (metronidazole + amoxicillin), with both significantly outperforming the SRP-only control group (23.1%, p=0.023). The study suggests that, at the predefined endpoint, the Omega-3 + ASA regimen demonstrates efficacy similar to the antibiotic regimen, potentially offering an alternative therapeutic option for patients unable to use antibiotics.

The one-year study was conducted in collaboration with the Albert Einstein Israelite Hospital in Brazil, Guarulhos University (UNG), University of Taubaté (UNITAU), the Ribeirão Preto School of Dentistry at the University of São Paulo (FORP-USP), and the Harvard School of Dental Medicine in the United States. A total of 109 adult patients with stage III/IV severe periodontitis were enrolled and randomly assigned to four groups: a placebo control group receiving SRP only, an SRP plus antibiotic group (metronidazole 400 mg + amoxicillin 500 mg, three times daily for 14 days), an SRP plus immunomodulator group (Omega-3 3 g daily + low-dose ASA 100 mg daily for 6 months), and a combined group receiving SRP with both antibiotics and immunomodulators.

Source: Immunomodulators, associated or not with systemic antibiotics, to treat periodontitis: A 1-year multicenter, placebo-controlled, double-blind, randomized clinical trial

Trial results showed that at the 1-year follow-up, 58.6%, 57.7%, and 57.1% of patients in the antibiotic, immunomodulator, and combined groups, respectively, achieved the treatment endpoint (defined as ≤4 sites with probing depth PD ≥5 mm), all higher than the SRP-only control group (23.1%, p=0.023). Each adjunctive therapy demonstrated statistically significant clinical benefits over SRP alone (p<0.05), yet the combination of antibiotics and immunomodulators produced no additive effect, which researchers attribute to the possibility that the clinical contributions of both mechanisms may have approached saturation at this stage.

The researchers also explained this phenomenon from a mechanistic perspective. First author Nídia Cristina Castro dos Santos, a dentist at the Albert Einstein Israelite Hospital, noted that unlike conventional anti-inflammatory drugs that work by blocking inflammatory pathways, Omega-3 promotes the body's production of molecules involved in the natural resolution of inflammation and tissue repair, while low-dose aspirin further enhances the generation of these mediators. Since this mechanism does not rely on direct antibacterial action, corresponding author Magda Feres, a professor at the Harvard School of Dental Medicine, believes the regimen holds potential reference value for patients allergic or intolerant to metronidazole or amoxicillin.

However, the research team also emphasized that these findings do not warrant immediate changes to clinical practice. The study population primarily consisted of patients without significant systemic diseases or other oral conditions, and the applicability of this regimen to broader populations, as well as the specific patient groups most likely to benefit, still requires further validation. The research team is currently conducting microbiological analyses to investigate the therapy's impact on bacterial composition within periodontal pockets.