Discussion
baseline–6, PD, bone damage, periodontitis
GENERALIZED PERIODONTITIS, SUPRAGINGIVAL DENTAL PLAQUE, PERIODONTITIS, DISEASE, CHRONIC DISEASES, PLAQUE, RESIDUAL DISEASE
In this study, we demonstrated that SRP with adjunct supplementation with fish oil rich in omega-3 PUFAs for 6 months had potential to induce measurable clinical and microbiological outcomes in comparison to SRP alone. In our study, patients were supplemented with higher doses of omega-3 PUFAs (2.6 g of EPA and 1.8 g of DHA) compared to previous studies [We revealed beneficial changes in all clinical parameters in both groups at 3 months (after the initial therapy) and at 6 months (after residual pocket therapy) compared to that at baseline. The differences between the groups in favor of the test group were statistically significant mainly at 3 months and in the initially deep pockets (PD ≥ 6 mm). In our previous study assessing an effect of omega-3 PUFAs following the initial periodontal therapy [At 6 months, only BOP scores were statistically different when all pockets in the test and control groups were considered. This indicates that supplementation with high-dose omega-3 PUFA, has detectable but limited clinical effect in the treatment of generalized periodontitis stage III and IV. A deteriorating compliance to the treatment regimen during 6-month period may be a probable explanation that clinical parameters were not significantly better at 6 months in the test group in comparison to the control group. It is well-known that adherence to medical treatment is one of the issues in the treatment of chronic diseases. It was demonstrated that nearly 50% of patients failed to adhere to their medical directives, and that 25% of patients were non-adherent to prevention and disease management activities including medication taking, appointment keeping, screening, exercise, and dietary changes [According to 2017 World Workshop of EFP, BOP is an important clinical parameter related to assessment of periodontitis treatment outcomes and post-treatment residual disease risk [Our results obtained at 3 months are in accordance with the study of Deore et al., demonstrating that supplementation with omega-3 PUFA during non-surgical periodontal treatment significantly reduced GI, BOP, PD and CAL [In our study, we also analyzed mean scores of clinical parameters separately for moderate (4–5 mm) and deep (≥ 6 mm) pockets. Inter-group comparison for deep pockets after 3 months showed statistically significant differences between groups for PD, REC and their Δ, and percentage of closed pockets, in favor of the test group. Moreover, assessment after 6 months revealed statistically significant differences between the groups for REC and CAL, and in the number of closed pockets also in favor of the test group. However, inter-group comparison for their Δ baseline–6 months did not reveal statistical differences. When comparing our clinical results with the recent systematic review and meta-analysis on subgingival instrumentation in the treatment of periodontitis [In this study, we also addressed an antimicrobial effect of omega-3 PUFAs. Quantitative analysis of crucial periodontal pathogenic bacteria While omega-3 PUFA anti-inflammatory activity is well-described, little is known about their effect on the growth and survival of oral bacteria. Recently, it was demonstrated that omega-3 PUFAs and their ester derivatives exhibited strong in vitro antimicrobial activity against various oral pathogens, such as Animal studies provided more evidence for possible role of omega-3 PUFAs in bacterial clearance in periodontitis. It was demonstrated that topical treatment with RvE1 inhibited tissue and bone damage, and resulted in eradication of Optimal plaque control is crucial factor of long-term effects of periodontal treatment. In this study, we demonstrated a statistical difference in FMPI between groups at 3 and 6 months. This difference may result from better motivation and involvement in the treatment process of the patients from intervention group, because they received fish oil as an adjunct to SRP. Alternatively, fish oil intake may interfere with supragingival dental plaque formation resulting in lower FMPI in the test group. Nevertheless, we cannot fully exclude that better clinical and microbiological outcome in the test group may be partially attributed to lower FMPI in comparison to the control group.In this study, we used fish-derived oil mixture as a source of EPA and DHA. Natural fish oil was chosen to mimic dietary conditions where a range of essential oils are consumed. To address, how fish oil consumption affected serum lipid composition, gas chromatography/mass spectrometry analysis was performed. We found that FO intake resulted in increased proportions of serum n-3 PUFAs and decreased proportions of n-6 PUFAs. This shift leads to increase in the proportion of EPA and DHA in the membranes of inflammatory cells, and thus by competing reduces the level of arachidonic acid [The present study has several limitations. The first one is the initial difference between the test and control groups in terms of age. This was a result of a relatively high dropout rate, mainly due to SARS-CoV-2 pandemic-related lockdown. When the baseline data of all fifty initially enrolled participants were taken into account, no statistical differences between the groups were noted. Even though at baseline the advancement of periodontitis was similar in both groups, the treatment response might be different as periodontal tissue healing ability may deteriorate with age [