A combination of omega-3 and low-dose acetylsalicylic acid (ASA) worked as well as antibiotics in a year-long study in people with severe periodontitis, raising the possibility of an alternative treatment for some patients.
The research was carried out by scientists affiliated with the Hospital Israelita Albert Einstein, the University of Guarulhos (UNG), the University of Taubaté (Unitau) and the Faculty of Dentistry of Ribeirão Preto of USP (FORP-USP), in Brazil, as well as Harvard University, in the United States. The findings were published in the Journal of Periodontics.
The researchers say the results could eventually help reduce antibiotic use in selected patients, an important consideration as bacterial resistance becomes an increasingly serious global health problem.
Severe periodontitis can damage bones and teeth
The clinical study, supported by FAPESP (projects 20/05874-2 and 20/05875-9), included 109 people with advanced periodontitis, who were followed for one year.
Periodontitis is a chronic inflammatory disease that develops when bacteria accumulate below the gum line and damage the tissues that hold the teeth in place. In advanced cases, the disease can destroy supporting bone, loosen teeth, and eventually lead to tooth loss.
“Patients with severe disease have very deep pockets, which act as reservoirs of bacteria associated with the disease. It is a very difficult condition to treat,” says dental surgeon Nídia Cristina Castro dos Santos, first author of the study and professor and researcher at Einstein.
Researchers compared four treatment strategies
The participants were randomly divided into four groups. All received subgingival instrumentation, popularly known as scaling, which is a standard treatment for periodontitis. The procedure removes bacterial deposits and other materials under the gums.
What differed between the groups was the additional treatment they received.
Participants in the control group received placebo versions of the antibiotics, omega-3 and ASA, packaged in capsules that looked like the active treatments.
A second group received the antibiotics metronidazole and amoxicillin. This combination has some of the strongest scientific evidence supporting its use in severe periodontitis. The patients took antibiotics three times a day for 14 days.
A third group received three grams of omega-3 each day along with a daily dose of aspirin for six months.
The fourth group received both approaches: they took antibiotics for two weeks and at the same time followed the omega-3 and ASA regimen for six months.
The researchers retested the participants after three, six and twelve months.
Omega-3 antibiotics and aspirin almost compatible
After one year, about 58% of patients treated with antibiotics had reached the clinical goal set by the researchers. That goal was defined as having no more than four deep periodontal pockets remaining.
The omega-3 and AAS group achieved an almost identical result: 57.7% of the participants achieved the same goal.
The difference compared to standard treatment alone was substantial. Among patients who received escalation plus placebo, only 23.1% met the clinical objective.
Surprisingly, using antibiotics together with omega-3 and ASA did not produce any additional benefit over either strategy alone.
“The use of antibiotics is not considered the gold standard of treatment. Although metronidazole and amoxicillin give good results in the most severe cases, their use should be evaluated on a case-by-case basis, due to the risks related to bacterial resistance and possible adverse effects,” says Castro dos Santos.
Previous research pointed to the potential of omega-3
The findings build on previous work examining omega-3s and inflammation in periodontal disease.
In a previous study supported by FAPESP published in Scientific ReportsThe researchers found that omega-3 supplementation reduced inflammation and bone loss associated with periodontal disease in rats. The effect was particularly notable when supplementation was combined with physical exercise.
Because that research used an animal model, it couldn’t establish whether the same effects would occur in people. However, it provided evidence that omega-3s could influence the inflammatory processes involved in oral diseases.
Help the body resolve inflammation
According to Castro, omega-3 works differently than conventional anti-inflammatory medications.
Rather than simply blocking particular inflammatory pathways, omega-3 may contribute to the production of molecules that help the body naturally end inflammation and promote tissue repair.
AAS was included at low doses because it can improve the production of these inflammation-resolving molecules. Therefore, researchers suspected that combining omega-3 with AAS could help the body better control the persistent inflammation associated with periodontitis.
“We imagined that the combination of antibiotics and omega-3 would be more effective in controlling periodontitis in these patients. We also believed that the results for the group that used omega-3 with ASA would be slightly lower than those of the antibiotic group. The result was surprising because the two therapies worked very similarly, paving the way for it to become a treatment option for these patients,” says Castro.
Benefits continue after treatment ends
The researchers were also surprised by the duration of the apparent benefits.
Participants who had taken omega-3 and AAS continued to show results similar to those seen at the end of treatment even six months after stopping supplementation.
According to Castro, the persistence of the effect raises the possibility that changing the way the body responds to inflammation could produce longer-lasting benefits. Researchers are still investigating exactly how this could happen.
For dental surgeon Magda Feres, lead author of the study and a senior professor at the Harvard School of Dental Medicine and the UNG Graduate Program in Dentistry, the results suggest that targeting the inflammatory response could provide another option for certain patients.
“The combination of omega-3 and low-dose aspirin achieved clinical benefits comparable to those of the metronidazole and amoxicillin protocol, opening a real alternative for those who cannot take antibiotics, especially patients with allergies or intolerance to these medications,” he says.
A possible way to reduce antibiotic use
The possibility of treating some cases without antibiotics is particularly relevant because antibiotic resistance is considered one of the main threats to global public health.
When bacteria are repeatedly exposed to antibiotics, strains that can survive the drugs can spread, making infections more difficult to treat. Therefore, reducing unnecessary antibiotic use is an important public health goal.
“Demonstrating that it is possible to treat severe periodontitis by modulating the body’s own response is new and relevant information that helps preserve antibiotics for when they are truly essential,” says Feres.
More tests are needed
Despite the promising results, the researchers emphasize that omega-3 and aspirin should not yet be considered as routine substitutes for antibiotics in severe periodontitis.
The clinical trial included patients who did not have significant systemic or oral diseases. Additional studies will be needed to determine whether the findings are valid in larger, more diverse populations, and to establish which patients are most likely to benefit from each treatment strategy.
Researchers are also conducting microbiological analyzes to understand what happens to bacteria within periodontal pockets during treatment.
Preliminary findings suggest that the therapies may reduce bacterial species associated with periodontal disease while increasing microorganisms associated with healthier gums.
“It is an important step forward, but not the end of the story. Therefore, the message is one of cautious optimism: we have a promising and scientifically plausible alternative to antibiotics in selected cases. Routine replacement will require more evidence,” he concludes.