Adjunctive use of omega-3 fatty acids in combination with low-dose aspirin in periodontitis: Systematic review and meta-analysis

Periodontitis is one of the most common dental diseases with a range of treatment approaches, including pathogenetically reasonable use of various host immune modulators. One such approach is the use of omega-3 polyunsaturated fatty acids (PUFAs) in combination with low-dose aspirin. This systematic review and meta-analysis were performed to compare the standard treatment alone and adjunctive use of omega-3 PUFAs in combination with low-dose aspirin with or without standard treatment in patients with periodontitis. A systematic review of the literature was performed using MEDLINE/PubMed, Cochrane Central and Google Scholar databases. Selection criteria included the following: randomized controlled trials in subjects with periodontitis in the age group above 18 years old, with follow-up periods ranging from 6 weeks to 6 months. The meta-analysis was performed using standard methodological procedures according to Cochrane recommendations, including assessment of risk-of-bias and level of evidence (GRADE). Meta-analysis was performed for such clinical outcomes as plaque index (PI), gingival index (GI), probing depth (PD), clinical attachment loss (CAL), bleeding on probing (BOP) and bleeding index (BI) based on data from seven randomized clinical trials conducted between 2010 and 2020. It was shown that adjunctive use of omega-3 PUFAs in combination with low-dose aspirin results in significant clinical improvement in PD, CAL and GI during both short and prolonged follow-up periods. The use of omega-3 PUFAs and low-dose aspirin in periodontitis patients may be promising as an adjunct therapy, however, due to a limited number of patients and significant heterogeneity, further studies need to be conducted.