Introduction:
Periodontal disease is an inclusive term used to describe an inflammatory condition of the gums (gingivitis) and/or support structures (periodontitis). The periodontal disease path typically progresses from gingivitis to periodontitis.
Periodontal disease may be a manifestation of a more systemic condition, such as diabetes, anemia, vitamin deficiency states, leukemia or other disorders of white blood cell function. In addition, it is associated with hardening of the arteries (atherosclerosis) and an elevation in C-reactive protein (CRP)– which is an important marker for systemic inflammation and an independent risk factor for heart disease.
Long chain omega-3 fatty acids EPA and DHA found in fish and fish oil supplements have been shown to be protective against atherosclerosis, as well as being useful in the treatment of a wide range of inflammatory mediators. It seems only natural that a recent double-blind study would show significant benefit with fish oil supplementation in patients with periodontal disease.
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Background Data:
In addition to proper oral hygiene, the therapeutic goals in treating periodontal disease from a natural medicine perspective are:
- Decrease wound healing time (the timespan for wound healing is longer in patients who are more susceptible to periodontal disease).
- Improve the integrity of collagen and other support structures.
- Enhance immune status (defects in the immune system, particularly white blood cells—especially neutrophils—are catastrophic to oral health).
- Decrease inflammation (inflammation can induce a vicious cycle and promote periodontal disease)
Although there are many nutritional considerations in the goals listed above, supplementation with fish oils would appear warranted based upon the possibility of achieving some of these goals – especially the ability to reduce inflammation.
New Data:
Sixty otherwise healthy subjects with moderate and severe chronic periodontitis were enrolled in a double-blind, placebo-controlled trial to test the ability of fish oil supplementation to improve this condition. The control group was treated with the standard dental treatment of scaling and root planing (SRP) and given a placebo; the treatment group was treated with SRP and dietary supplementation of omega-3 fatty acids (providing 180 mg of EPA and 120 mg DHA daily for 12 weeks).
A significant reduction in the gingival index, sulcus bleeding index, pocket depth, and clinical attachment level was found in the treatment group compared to the control group at the 12-week exam. However, no statistically significant changes in serum CRP levels were found.
The pocket depth improved from 4.26 mm at baseline to roughly half that value at 2.15 mm. These results show that fish oil supplementation is very much indicated in the treatment of periodontal disease.
Commentary:
These results are impressive given the rather modest dosage of EPA+DHA. For general health the standard recommendation is to take enough of a fish oil supplement to provide a total of 1,000 mg EPA+DHA. For therapeutic purposes, the usual dosage is 3,000 mg EPA+DHA daily.
A higher dosage of EPA+DHA may be necessary to lower CRP levels – a key marker in systemic inflammation.
For more information on natural approaches to periodontal disease, please consult the 3rd edition of The Encyclopedia of Natural Medicine.
Reference:
Deore GD, Gurav AN, Patil R, et al. Omega 3 fatty acids as a host modulator in chronic periodontitis patients: a randomised, double-blind, palcebo-controlled, clinical trial.
J Periodontal Implant Sci. 2014 Feb;44(1):25-32.
