Omega-3 and low-dose aspirin show promise in periodontitis

Iveta Ramonaite, Dental Tribune International

Fri. 9. October 2026

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SÃO PAULO, Brazil: Concerns about antimicrobial resistance and the limitations of adjunctive antibiotics have prompted research into other approaches to periodontal treatment. A year-long randomised clinical trial has explored the combined use of omega-3 and aspirin in patients with severe periodontitis to improve periodontal outcomes. The findings suggest that modulating the inflammatory response this way could eventually offer an alternative for selected patients for whom systemic antibiotics are unsuitable.

Omega-3 combined with low-dose aspirin may help control periodontitis by promoting the resolution of inflammation, according to Dr Nídia Cristina Castro dos Santos, who led a recent clinical trial evaluating this adjunctive approach. (Image: Dr Nídia Cristina Castro dos Santos)

Lead author Dr Nídia Cristina Castro dos Santos, a researcher at the Faculdade Israelita de Ciências da Saúde Albert Einstein in São Paulo, explained the rationale for combining the agents to Dental Tribune International: “Omega-3s work differently from conventional anti-inflammatory drugs: rather than blocking inflammation, they help the body produce molecules that actively resolve it and support tissue repair, and low-dose aspirin boosts the formation of these mediators.”

The researchers therefore investigated whether high-dose omega-3 and low-dose aspirin could improve control of the persistent inflammatory response associated with periodontitis when used as an adjunct to non-surgical periodontal treatment. They conducted a multicentre trial involving 109 patients with Stage III or IV periodontitis. Metronidazole and amoxicillin, the antibiotic combination with the strongest evidence of clinical benefit as an adjunct, were included for comparison. All participants underwent subgingival instrumentation and were randomly assigned to receive placebo treatment, the antibiotic regimen, omega-3 and aspirin, or both adjunctive regimens.

Outcomes comparable to antibiotics

At the one-year follow-up, over half of the patients receiving any of the three adjunctive regimens met the study’s treatment target of no more than four remaining sites with a probing depth of at least 5 mm, compared with fewer than a quarter of those treated with subgingival instrumentation alone. Although the observed outcomes were similar across the three adjunctive regimens, the study was too small to draw firm conclusions about their relative effectiveness

Based on the findings of a randomised clinical trial she co-authored, Prof. Magda Feres believes that omega-3 combined with low-dose aspirin could eventually offer an alternative for selected patients who cannot take systemic antibiotics. (Image: Prof. Magda Feres)

“The combination of omega-3 and low-dose aspirin achieved clinical benefits comparable to those of the metronidazole and amoxicillin protocol, opening up a real alternative for those who can’t take antibiotics, especially patients with allergies or intolerance to these medications,” senior author Prof. Magda Feres, chair of the Department of Oral Medicine, Infection, and Immunity at Harvard School of Dental Medicine in Boston in the US, said in a press release.

Dr Castro dos Santos also highlighted two further noteworthy findings: “First, combining antibiotics with omega-3 and aspirin did not add any further benefit. Second, the improvements in the supplement group persisted six months after patients stopped taking them, which suggests that reprogramming the inflammatory response may have long-lasting effects.”

The findings are particularly relevant in the context of antimicrobial resistance, as host modulation strategies could potentially help preserve systemic antibiotics for patients in whom they are clinically necessary. However, the study comprised only systemically healthy non-smokers and excluded patients with gastric ulcers or blood disorders, an important consideration given the contra-indications of aspirin. Larger studies involving more diverse patient populations, including people with systemic conditions such as diabetes, will therefore be needed to determine which patients are most likely to benefit from this approach.

“Our message is one of cautious optimism. This is an important step, but not the end of the story,” Dr Castro dos Santos said. “We are currently analysing the microbiological data from this trial, and preliminary results suggest that these therapies reduce disease-associated bacteria and favour species associated with periodontal health.”

The study, titled “Immunomodulators, associated or not with systemic antibiotics, to treat periodontitis: A 1-year multicenter, placebo-controlled, double-blind, randomized clinical trial”, was published in the July 2026 issue of the Journal of Periodontology.

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Antibiotics Antimicrobial resistance Aspirin Dental research Nonsteroidal anti-inflammatory drugs Omega-3 Periodontitis

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