Mohamed A. Galal ; Mushira A. Dahaba, ; Basma M. Zaki and Hanaa M. Elshenawy. CLINICAL EVALUATION OF THE EFFECT OF OMEGA-3 FATTY ACIDS ON OSTEOPOROTIC FEMALES HAVING CHRONIC PERIODONTITIS. Cairo Dental Journal (30)Number (1), 1:10January, 2014.

1. Cairo (40)
E-mail: hph_cdj@yahoo.com
.. INTRODUCTION
Osteopenia and Osteoporosis are systemic
skeletal disorders characterized by compromised
bone strength and mass, with a consequent increase
in bone fragility and susceptibility to fracture.
Osteopenia is associated with reduction in the
amount of bone in addition to the presence of
microarchitectural changes without the occurrence
of clinical fracture. Osteoporosis on the other hand is
associated with high incidence of clinical fracture.
Cairo Dental Journal (30)
Number (1), 1:10
January, 2014
CLINICAL EVALUATION OF THE EFFECT OF
OMEGA-3 FATTY ACIDS ON OSTEOPOROTIC
FEMALES HAVING CHRONIC PERIODONTITIS
Mohamed A. Galal (1)
; Mushira A. Dahaba, (2)
; Basma M. Zaki(3)
and Hanaa M. Elshenawy (3)
1. Researcher Assistant of Oral Radiology, Department of Oral Medicine & Surgery, National
Research Centre, Cairo, Egypt.
2. Professor & Head of Oral Radiology Department, Faculty of Oral & Dental Medicine, Cairo
University, Egypt.
3. Researcher of Oral Medicine and Periodontology, Department of Oral Medicine & Surgery,
National Research Centre, Cairo, Egypt.
e-mail: afgalal@yandex.com
.. ABSTRACT
T
he aim of the present study is to assess the effect of Omega-3 fatty acids, as an
adjunctive therapy in management of chronic periodontitis in postmenopausal
osteoporotic females. Twenty four postmenopausal females having osteopenia or
osteoporosis and chronic periodontitis were included in this study. These patients were divided
into two groups: The Omega-3 group (O3) which included 13 subjects. They were given 1gm
omega-3 daily, plus Rutin-C and vitamin C (50 mg Rutin + 100 mg vitamin-C) once daily. The
second group which is the control group (C): 11 subjects were given Rutin-C and vitamin C
once daily. These medications were given for 9 months. Scaling and root planing was done
to all patients before starting the medical treatment. Periodontal Indices measured at 6 and 9
months were: Plaque Index (PI), Papillary Bleeding Index (BPI), Pocket depth (PD) and Clinical
Attachment Loss (CAL). The results showed that all the periodontal indices improved in both
groups after 6 and 9 months intervals, some were significant favoring omega-3 group (PI after
9 months), some were significant favoring control group (PBI after 6 & 9 months, and pocket
depth after 9 months), meanwhile, others were non-significant for the two groups (CAL after 6
& 9 months, plaque index and pocket depth after 6 months). It can be concluded that the use of
Omega-3 is a beneficial nutritional supplementation in chronic periodontitis cases.
KEYWORDS: Omega-3 Fatty Acids, Rutin-C, Vitamin-C, Osteoporotic/osteopenic females,
Periodontal Indices.

2. Mohamed A. Galal, et al.(2) C.D.J. Vol. 30. No. (1)
It is characterized by reduction in bone mineral
density to below the minimum level required to
ensure sufficient mechanical support. There is
also deterioration of bone tissues due to imbalance
between bone resorption and formation, favoring
resorption (Koduganti et al., 2009 and Passos et
al., 2010).
Osteoporosis occurs mainly in postmenopausal
females; although younger women and men can
be also affected. It was estimated that one in four
women during menopause and one in three women
> 65 years of age are affected by osteoporosis
(Passos et al., 2010).
The evaluation of the relationship between
osteoporosis and periodontitis is complicated by
the fact that both diseases are multifactorial in the
etiology. Multiple systemic factors influence the
progression of osteoporosis, including age, race,
diet, gender, hormone therapy, smoking, genetic
factors, exercise, and body weight. Several of these
factors are also risk factors for periodontal disease
(Al Habashneh et al., 2010).
Several researches support the idea that
osteoporosis independently influences alveolar bone
height loss. Strategies for reducing osteoporosis
risk also may help retard alveolar bone loss, which
can be easily fulfilled by meeting dietary intake
recommendations (Kaye 2007; Koduganti et al.
2009 and Otomo-Corgel et al. 2012).
Omega-3 fatty acids (FA) are a subset of
polyunsaturated fatty acids found in marine sources
aseicosapentaenoicacid(EPA)anddocosahexaenoic
acid (DHA) and in some leafy vegetables, nuts,
and oils as α-linolenic acid (ALA) (DeFilippis &
Sperling 2006).
Porphyromonas gingivalis (Pg) infected rats
treated with omega-3 FA had significantly less
alveolar bone resorption. These results demonstrated
the effectiveness of omega-3 FA supplemented diet
in modulating alveolar bone resorption following
Pg infection, and supported that omega-3 FA may
be a useful adjunct in the treatment of periodontal
disease (Kesavalu et al. 2006).
Omega-3 fatty acids in another study also
slowed the orthodontic incisor separation even after
buccal movement of the maxillary first molars,
which indicates their effect over bone enforcement
(Bartzela et al. 2009).
Another nutritional supplements were also
beneficial to periodontal health and affects
bone density as well. Rutin and Vitamin C are
a common and low-priced combination. Rutin
(RT), a quercetin-3-rutinosid or vitamin-P, is
considered as one of flavonoid glycosides, which
is found in onions, apples, tea and red wine. Rutin
is well known to exhibit multiple pharmacological
activities including antibacterial, antitumor,
anti-inflammatory, anti-diarrheal, antiulcer, anti-
mutagenic, vasodilator and immunomodulator.
Furthermore, rutin showed an inhibitory effect
against membrane lipid peroxidation, as well as
antioxidant activities which suggest its protective
role in oxidative stress-mediated diseases. Vitamin
C is a water-soluble enzyme, abundantly present in
different plants and some animals. Ascorbic acid is
the most predominant form in the human body and is
involved in tissue growth and repair. Ascorbic acid
has a potent antioxidant activity and is well known
to protect tissues from oxidative injury through
efficiently quenching the damaging free radicals
produced by many biological processes (Al-Rejaie
et al. 2012). Periodontitis is associated with a low
concentration of vitamin C in plasma (Pussinen et
al. 2003).
The aim of the present study is to assess the
effect of omega-3 fatty acids in management of
osteoporotic females with chronic periodontitis.
.. SUBJECTS AND METHODS
The research was conducted on a selected group
of postmenopausal women (≥ 50 years of age) who
attended the outpatient clinic in the medical unit
of the National Research Center (NRC), Cairo,

3. CLINICAL EVALUATION OF THE EFFECT OF OMEGA-3 FATTY ACIDS (3)
Egypt for bone densitometry testing in the routine
yearly check up. Only women who experienced
natural menopause (no menstruation for at least one
year) were chosen and invited to participate in this
study. They received systemic bone mineral density
(BMD) assessment as an initial screening using dual
energy x-ray absorptiometry (DXA) of the femur
and spine (Norland XR46 version 3.9.6).
Systemic BMD was classified according to the
WHO criteria, where osteoporosis was defined
as BMD ≥ 2.5 SD (standard deviation) below the
optimal mean BMD of young healthy individuals of
the same race and gender. Postmenopausal females
with BMD T-score less than -2.5 SD, where T-score
is the expression of BMD values in terms of standard
deviations from the normal value of a female young
adult mean were considered osteoporotic and were
included in this study. Women with a history of a
systemic condition or medication intake that might
influence the BMD or periodontal disease severity
were excluded i.e., women with a history of diabetes
mellitus, thyroid diseases, chronic renal problems,
and connective tissue diseases. Postmenopausal
females on corticosteroids, chemotherapy, recent
peptic or esophageal disorders were also excluded.
Exclusion criteria also included postmenopausal
females treated with drugs that inhibit gastric acid
secretion for more than 2 weeks in the last 6 months;
chronic treatment with NSAIDs (non-steroidal
anti-inflammatory drugs), hormone replacement
therapy or any other drug known to alter bone
calcium metabolism were not included. Smoking
females were not allowed to participate in the
study. All patients were systemically reviewed. The
participants were chosen to be of the same socio-
economic level. The postmenopausal females who
accepted the participation in the study were then
referred to the dental clinic at the NRC medical
services unit after making prior appointments for
evaluation of their oral condition. All participants
received further information about the study protocol
and objectives at the dental clinic. Participants
diagnosed as having chronic periodontitis according
to the criteria of the American Academy of
Periodontology (2000) were chosen. Each patient
presented with probing depth (PD) ≥ 5 mm in at
least three teeth or clinical attachment level (CAL)
≥ 4 to 6 mm and vertical bone loss ≥ 3 mm with no
history of periodontal therapy or use of antibiotics
in the preceding 6 months was selected to be part
of the study. The study included forty non-smoking
females, 50-65 years old, who were at least one year
postmenopausal, osteopenic or osteoporotic and
have not undergone hysterectomy or ovariectomy.
All patients were also diagnosed as having chronic
periodontitis.
Twenty four postmenopausal osteoporotic
or osteopenic females with age ≥50 years were
included in the study. Subjects were age-matched
into 2 groups:
The Control Group (C); this group comprised
eleven patients who were given Rutin C (Rutin
100 mg + Vitamin C 50 mg) once daily, for nine
months.
The Omega-3 group (O); this group comprised
thirteen patients who underwent took fish-oil gelati-
nous capsules rich in omega-3 fatty acids for nine
months twice daily (A daily dose of 1000mg Ome-
ga-3 PUFA), in addition to Rutin-C ( Rutin 100 mg
+ Vitamin C 50 mg) once daily as a common medi-
cation between Control group and Omega-3 group.
For both groups detailed oral hygiene
instructions were given and full mouth scaling
and root planing (initial therapy) using ultrasonic
scalers and periodontal curettes under local
anesthesia completed before starting the dietary
supplementations. Scaling and root planing was
performed for each patient in two sessions, one
session for half and completed over one week.
Occlusal adjustment was done whenever indicated.
Periodontal Assessment
Periodontal assessment was carried out at
baseline before starting the initial therapy and
the dietary supplementations, at 6 and 9 months
intervals.

4. Mohamed A. Galal, et al.(4) C.D.J. Vol. 30. No. (1)
At the baseline evaluation, all clinical parameters
were measured and mechanical treatment including
removal of all supra and subgingival calcified
deposits to obtain a smooth, hard surface was done.
Scaling and root planing was carried out by one of
the investigators in two successive sessions. Patients
were taught and encouraged to maintain their dental
health and plaque control through brushing and
flossing. All assessment measurements were taken
by the same investigator. The condition of all teeth
was assessed and recorded. The mean was taken for
the following measurements:
Plaque index (PI) according to Silness & Loe
(1964) and gingival index (GI) according to Loe
and Sillness (1963). Whole mouth probing depth
and clinical attachment level and Pocket depth (PD)
was measured according to the standard procedure
described by Glavind and Loe, 1967 using a
periodontal probe with Williams’ calibrations at the
free gingival margin and recorded at six locations
(mesiobuccal, distobuccal, midbuccal, mesiolingual,
distolingual and midlingual) on each tooth parallel
to the long axis of the examined tooth. The total of
the mean probing depth at the six locations on each
tooth for each patient was calculated in millimeters.
The distance from the cemento-enamel junction
(CEJ) to the free gingival margin and the distance
from the free gingival margin to the bottom of the
pocket/sulcus were measured at the mesiobuccal and
mid-buccal surfaces using also a calibrated probe.
From these two measurements, individual subject
mean attachment level (the distance from the CEJ to
the bottom of the pocket or sulcus) was calculated
in millimeters. All the measurements were taken at
baseline, 6 and 9 months intervals.
Ethical Consent:
The study protocol was approved by Medical
Research Ethical Committee (MREC) at the
National Research Center. A written informed
consent was signed by all subjects participating in
the study.
Statistical Analysis:
Data were presented as mean and standard
deviation (SD) values. Improvements after 6
months and after 9 months were also calculated, and
presented as mean and (SD) values as well. T-test
were done to compare between the improvements
after6monthsofthetwogroups(GroupO)&(Group
C), and to compare between the improvements
after 9 months of the two groups. The significance
level was set at P ≤ 0.05. Statistical analysis was
performed with Microsoft Excel 2007 for Windows.
.. RESULTS
All Periodontal Indices improved in all groups
with different criteria. In Plaque Index Omega-3
Fig. (1): Sheet of Periodontal Chart used in the experiment.

5. CLINICAL EVALUATION OF THE EFFECT OF OMEGA-3 FATTY ACIDS (5)
improvement was less than Control improvement at
the two intervals, while in the latter indices; Gingival
Index, Pocket depth & Clinical Attachment
Loss CAL; Control improvement was less than
Omega-3 improvement at the two intervals. These
improvements were related by t-test at 6 months
and 9 months. For Plaque Index the p-values at
6 months and 9 months respectively = 0.09513 &
0.03121*, which is only a significant difference
between the two groups at 9 months interval. For
Gingival Index, the p-values at 6 months and 9
months respectively = 0.00605* & 0.00119*, which
is a significant difference between the two groups
at 6 months and at 9 months intervals, with a favor
to control group. For Pocket depth the p-values
at 6 months and 9 months respectively = 0.11065
& 0.0245*, which is only a significant difference
between the two groups at 9 months interval, with
a favor also to control group. Finally, for CAL,
the p-values at 6 months and 9 months respectively
= 0.27183 & 0.12036, which are non-significant
difference between the two groups at 6 months and
at 9 months intervals. (Significant at P ≤ 0.05). See
Table (1) & Fig (2).
Fig. (2): Improvement in Plaque Index, Gingival Index, Pocket Depth and CAL (means) in 2 groups with time at 6 months and 9
months
TABLE (1): Means and SDs of improvements of all the results after 6 months and after 9 months, and P- value
of T-Tests between the two groups:
Index Change
Control Group Omega-3 Group
P-value
Mean SD Mean SD
Plaque
Index
After 6 months 0.24 0.17 0.33 0.15 0.09513
After 9 months 0.30 0.19 0.46 0.19 0.03121*
Gingival Index
After 6 months 0.286 0.22 0.075 0.11 0.00605*
After 9 months 0.399 0.27 0.068 0.095 0.00119*
Pocket Depth
After 6 months 0.41 0.32 0.27 0.21 0.11065
After 9 months 0.51 0.27 0.31 0.2 0.0245*
CAL
After 6 months 0.43 0.34 0.34 0.39 0.27183
After 9 months 0.54 0.27 0.39 0.34 0.12036
CAL=Clinical Attachment Loss. *: Significant at P ≤ 0.05

6. Mohamed A. Galal, et al.(6) C.D.J. Vol. 30. No. (1)
.. DISCUSSION
Women are more susceptible to certain chron-
ic diseases as they age, which may be affect their
periodontal health (Hughes 2010). Osteoporosis is
three times more common in women than in men,
and bone loss occurs as levels decline, usually from
around the age of 50 years (WHO Scientific Group
2003). Consequently, the study sample in our study
included postmenopausal female subjects 50 years
and older, suffering from osteoporosis, or osteope-
nia and chronic periodontitis. In the present work,
twenty four subjects were included, and divided ran-
domly into two groups: Group O: taking omega-3
supplements twice daily (500 mg) as well as one
Rutin-C daily (Rutin 50mg + ascorbic acid (vitamin
C) 100 mg), while the control group: (group C) was
taking only a single dose of Rutin-C daily.
In the GISSI Prevenzione study 1999 (a large
intervention trial of secondary prevention after
myocardial infarction) researchers identified a
substantial reduction in all-cause and cardiovascular
mortality with 1 g per day of n-3 PUFA
supplementation. In our study, the same dose was
used to test its efficacy in improving alterations
in alveolar bone density due to osteoporosis and
chronic periodontitis. The same dose was previously
recommended by Saravanan et al. 2010.
Salari Sharif et al. 2010 and McMahon 2012
who evaluated the effect of Omega-3 FA on bone
biomarkers in osteoporotic postmenopausal women
ingesting 900 mg of Omega-3 FA per day for 6
months. Tartibian et al. 2011 examined the effects
of long-term aerobic exercise and Omega-3 (O3)
supplementation on serum inflammatory markers,
bone mineral density (BMD), and bone biomarkers
in postmenopausal women. Subjects taking O3
supplementations consumed 1000 mg/d for 24
weeks, similar to the dose applied in our work.
Several researchers suggested increase of
this dose especially in chronic periodontitis; as
Martinez et al. 2013 constructed their study by
selecting a test group composed of 10 patients with
generalized chronic periodontitis (mean age 44
± 6.4 years) treated with scaling and root planing
associated with 4 months of ω-3 supplementation
Eicosapentaenoic acid (EPA) + Docosahexaenoic
acid (DHA), 3 g/d. Rosenstein et al. 2003 made
a clinical trial on thirty adult human subjects with
periodontitis who were administered either fish oil
3000 mg daily; borage oil 3000 mg daily; fish oil
1500 and borage oil 1500 mg daily, or placebo. The
gingival index, the plaque index (PI), periodontal
probing depths and beta-glucuronidase levels in
gingival crevicular fluid were measured at baseline
and after 12 weeks of treatment.
Vanlint & Ried in 2012 studied BMD and bone
turnover at baseline and 12 months, of 40 osteopenic
patients, who were randomized to either algal oil
containing 400mg docosahexanoic acid (DHA)
daily or placebo.
In accordance with these doses and follow-
up periods, the participants in the current work
were given 1000 mg/d of omega-3 supplements
and were followed- up after 6 and 9 months from
administration period.
Rutin-C (Rutin 50 mg +Ascorbic acid 100
mg) was applied in our work. Rutin is a common
medication for decreasing capillaries fragility
and gingivitis in the dental field. Ascorbic acid is
Vitamin C with good properties on gingival tissues.
McAnulty et al. 2011 recommended its use in
a study which examined the effects of 1,000 mg
quercetin + 1,000 mg vitamin C, and 400 mg O3
fatty acids ; taken each day for 2 weeks before and
during 3 days of cycling at 57% Wmax
(Maximal
Power Output) for 3 hours on plasma antioxidant
capacity, oxygen-radical absorbance capacity
(ORAC), plasma oxidative stress, and plasma
quercetin and vitamin C levels.
Since periodontal probing is such an important
aspect of the periodontal examination, the
technique must be systematic and consistent.
Bleeding at the gingival margin or sulcus is often

7. CLINICAL EVALUATION OF THE EFFECT OF OMEGA-3 FATTY ACIDS (7)
the first indicator of gingivitis or periodontitis.
Bleeding, pocket depths, and radiographs are used
together to determine periodontal condition. These
measurements are significant for two different types
of periodontal disease and their future treatment.
Gingival recession is important to the periodontal
examination because it accurately indicates the total
amount of attachment loss.Attachment loss can vary
from tooth to tooth. Any tooth can have attachment
loss without having a pocket. All these indices are
established in the literature for diagnosing existing
disease, determine the prognosis of individual teeth,
and monitor disease progression that tends to be
episodic and specific to the tooth and site (ADAA
Council on Education 2011).
Hence, in our study we performed a
comprehensive clinical examination and measured
four parameters or indices of periodontitis which
are: plaque index (PI), gingival Index (GI), pocket
depth (PD) and clinical attachment loss (CAL) to
assure accuracy of collected data in proving the
outcome of the proposed medication.
Many experimental studies were done to detect
Omega-3 effect on periodontitis and alveolar bone
loss. Dietary supplementation with high dose
docosahexanoic acid tuna oil caused a marked
elevation of O-3 FA levels in oral soft tissues. This
diet reduced the amount of alveolar bone loss in a
murine experimental periodontitis model compared
to a control diet containing no Omega-3 FAs (by an
average of 54-72% less alveolar bone resorption in
response to the different bacterial infections was
detected) (Bendyk 2008).
Indahyani et al. 2008, tested the hypothesis that
fish oil alters lipopolysaccharide (LPS)-induced
hydroxyapatite loss in rat alveolar bone, and found
that the hydroxyapatite contents of alveolar bone
in rats treated with fish oil at the same day with or
before LPS injection were significantly higher than
those in rats injected with LPS alone, but still lower
than those in untreated animals.
Kesavalu et al. 2006 have done a study on rats.
Rats were fed fish oil (O3 FA) or corn oil diets
for 22 weeks and were infected with Pg. Rats on
the O3 FA diet exhibited elevated serum levels of
eicosapentaenoic acid (EPA) and docosahexaenoic
acid (DHA), documenting diet-induced changes. Pg-
infected rats treated with O3 FAhad significantly less
alveolar bone resorption.These results demonstrated
the effectiveness of an O3 FA-supplemented diet in
modulating alveolar bone resorption following Pg
infection, and supported that O3 FA may be a useful
adjunct in the treatment of periodontal disease.
These experimental animal studies are in line
with our results that proved that partial improvement
occurred due to omega-3 FAin chronic periodontitis
patients.
Dietary human surveys were done to confirm
this relation. “To date, the treatment of periodontitis
has primarily involved mechanical cleaning
and local antibiotic application. Thus, a dietary
therapy, if effective, might be a less expensive and
safer method for the prevention and treatment of
periodontitis” (Naqvi et al. 2010 and Snider 2010).
Using data from the National Health and
Nutrition Examination Survey (NHANES),
investigators from Harvard Medical School and
Harvard School of Public Health, Boston, found that
dietary intake of docosahexaenoic acid (DHA) and
eicosapentaenoic acid (EPA) was associated with a
decreased prevalence of periodontitis (by 20%), but
linolenic acid (LNA) did not exhibit this association.
The cross-sectional study involved more than 9,000
adults between 1999 and 2004 (Naqvi et al. 2010
and Snider 2010).
Iwasaki et al. 2011 studied the longitudinal
relationship between two types of O3 dietary intake
in presence of periodontal disease in 235 Japanese
subjects for whom data were available for the years
2003–2006. O3 intake was assessed at baseline
with a brief-type self-administered diet history

8. Mohamed A. Galal, et al.(8) C.D.J. Vol. 30. No. (1)
questionnaire. Full-mouth periodontal status,
measured as the clinical attachment level (CAL),
was recorded at baseline and once a year for 3 years.
Still we need confirmation from human clinical
trials which are very little in the literature; up to our
knowledge.
On the other hand in a very recent study
by Martinez et al. 2013 who constructed the
methodology of their study that the test group was
composed of 10 patients with generalized chronic
periodontitis (mean age 44 ± 6.4 years) treated with
scaling and root planing associated with 4 months
of O3 supplementation eicosapetaenoic acid (EPA)
plus docosahexaenoic acid (DHA), 3 g/d. The
placebo group was composed of 11 patients (47.9
± 10.5 years) that received scaling and root planing
plus placebo. The periodontal examination included
probing depth, clinical attachment level, bleeding
on probing and plaque index. They presented that
the O3 dietary supplementation had no effect on
clinical outcome of treatment.
In our study only little clinical outcome was
significant regarding the effect of Omega-3 in
comparison to control group since PI improvement
was the only significant outcome reported after 9
months in Omega-3 medicated cases. Periodontal
indices improved in the current work in both groups
after 6 and 9 months, some were significant favoring
Omega-3 group (PI after 9 months), others were
significant favoring control group (GI after 6 & 9
months, PD after 9 months), and others were non-
significant for the two groups (CAL after 6 & 9
months, PI and PD after 6 months).
Also in contrary to our results, Rosenstein et al.
2003 performed a clinical trial on thirty adult human
subjects with periodontitis who were administered
either fish oil 3000 mg daily; borage oil 3000 mg
daily; fish oil 1500 and borage oil 1500 mg daily, or
placebo. The modified GI, the (PI), periodontal PD
and beta-glucuronidase levels in gingival crevicular
fluid were measured at baseline and after 12 weeks
of treatment. Improvement in gingival inflammation
was observed in subjects treated with borage oil,
with a trend apparent in subjects treated with fish oil
or a combination of both. There was no statistically
significant improvement in PI, although a trend was
apparent in those receiving borage oil. Improvement
in PD was seen in those subjects treated with either
fish oil alone or borage oil alone, but statistical
significance was only seen for the comparison of
borage oil and placebo.
Other studies combined Omega-3 with other
NSAIDs, for antagonism as the study done by
El-Sharkawy et al. 2010 who tried to test their
innovative strategy for periodontal treatment using
Omega-3 and low dose aspirin. Eighty healthy
subjects with advanced chronic periodontitis were
enrolled in Mansoura, Egypt, in a parallel-design,
double-masked clinical study. The control group
was treated with (SRP) and a placebo, whereas
the O3 group was treated with SRP followed by
dietary supplementation of fish oil (900 mg EPA +
DHA) and 81 mg aspirin daily. Statistical analysis
demonstrated a significant reduction in PD and a
significant attachment gain after 3 and 6 months in
the O3 group compared to baseline and the control
group. The results of this preliminary clinical study
suggested that dietary supplementation with O3 FAs
and 81 mg aspirin may provide a sustainable, low-
cost intervention to augment periodontal therapy.
Vardar et al. 2005 used another NSAID; i.e.
Celecoxib. The results of the that study indicated
that celecoxib and Omega-3 fatty acid, when
used individually, show a rather partial effect on
the control of the analyzed mediators, but when
combined they show a synergic effect and provide
significant reductions in the gingival tissue levels
of prostaglandin E2 (PGE2), prostaglandin F2α
(PGF2α), leukotriene
B4 (LTB4), and platelet activating factor
(PAF) in LPS-induced experimental periodontitis

9. CLINICAL EVALUATION OF THE EFFECT OF OMEGA-3 FATTY ACIDS (9)
(Experimental periodontitis was induced by
repeated injection of Escherichia coli endotoxin).
These findings may pioneer further clinical human
studies investigating the possible place of celecoxib
and Omega-3 fatty acid in periodontal treatment.
This is in line with our study results which
proved that Omega-3 supplemental medications
have a positive impact on treatment of chronic
periodontitis, but with a weak relation clinically (not
all indices improved significantly), and this relation
even with the high dose given in these studies (3gm
– 6 gm /day), suggest that Omega-3 when used
individually is not effective.
Many of these studies focused on cellular factors
more than clinical indices, which makes Omega-3 in
such ways preventive more than being therapeutic,
rendering it of low grade importance in periodontitis
if compared to antibiotics.
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