Omega-3 vs antibiotics, a summit in Chicago, and gums on the podium

Could omega-3 and aspirin replace antibiotics for severe gum disease?

This might be one of my favourite periodontal studies I've read this year.

For decades, periodontal treatment has focused heavily on bacteria: remove the plaque, reduce the bacterial load and, in certain severe cases, use antibiotics to target the pathogenic bacteria that remain.

But we're increasingly recognising that periodontitis isn't simply about which bacteria are present. It's also about how our body responds to them.

A fascinating new randomised clinical trial published in the Journal of Periodontology demonstrates exactly why this matters.

Researchers followed 109 patients with Stage III or IV periodontitis for one year. Everyone received standard non-surgical periodontal treatment, but patients were divided into four groups:

• Periodontal treatment alone
• Periodontal treatment + antibiotics
• Periodontal treatment + omega-3 and low-dose aspirin
• Periodontal treatment + antibiotics + omega-3 and aspirin

The antibiotic group received metronidazole and amoxicillin for 14 days, while the omega-3 and aspirin group received 3 g of omega-3 plus 100 mg of aspirin daily for six months.

The results were fascinating.

After one year, 58.6% of patients receiving antibiotics reached the researchers' clinical treatment target.

In the omega-3 and aspirin group?

57.7%.

Almost identical.

By comparison, only 23.1% of patients receiving periodontal treatment alone reached the same endpoint.

Even more interestingly, combining antibiotics with omega-3 and aspirin did not appear to provide additional benefit over either adjunctive approach alone.

Why does this matter?

Because it reinforces something we're beginning to understand much better about gum disease:

Periodontitis isn't simply a bacterial infection.

It is a complex inflammatory disease that develops through the interaction between an imbalanced oral microbiome and the individual's immune response.

Two people can harbour very similar periodontal bacteria yet experience completely different outcomes. One may develop significant inflammation and periodontal destruction, while the other doesn't.

Part of the explanation lies in how the host body responds to those bacteria.

This is also why simply detecting a "bad" bacterium doesn't necessarily tell us whether someone has, or will develop, periodontal disease. Bacteria are an important part of the picture, but they are not the whole picture. Sorry not sorry for the plug, but that is why at THS Labs we are so passionate about taking an approach that looks at not only your bacteria, but also how your bacteria are acting and how your body is responding to that bacteria (host immune response).

This study is particularly interesting because omega-3 fatty acids can act as precursors for specialised pro-resolving mediators, including resolvins. These molecules help the body actively bring an inflammatory response to an end and return tissues towards homeostasis. Imagine them being fire extinguishers putting out the fire that is inflammation. Aspirin can also positively influence these resolution pathways.

In other words, rather than focusing solely on eliminating bacteria, researchers are investigating whether we can also improve periodontal outcomes by changing the way the host responds to bacteria and helping the body resolve inflammation more effectively; and that represents a much bigger shift in how we think about periodontal disease.

The future may not simply be about asking:

"Which bacteria are there, and how do we kill them?"

But more:

"What is happening within this person's oral ecosystem, how is their immune system responding, and how can we restore balance?"

For me, that's the really exciting part of this study and a true testament to how we think at THS Labs.

It is also incredibly relevant in the context of antimicrobial resistance. Antibiotics remain extremely important medicines and absolutely have a place in dentistry, but finding evidence-based alternatives that could reduce unnecessary antibiotic exposure is something we should all be excited about.

Read the study in the Journal of Periodontology →

I went to the ADA Salivary Diagnostics Summit in Chicago… and I think dentistry is about to change.

This one was particularly special for me.

In June, I was invited to the American Dental Association headquarters in Chicago for its Salivary Diagnostics Framework Summit. I had to squeeze it in between a week of conferences and lectures in London, resulting in me being in Chicago literally for 26 hours. I think I really got the most from those 26 hours…

For someone who has spent the last six years talking about saliva, researching saliva and ultimately building an entire company around its potential (I mean Steven Bartlett called me 'The Saliva Queen' for a reason…), walking into the ADA headquarters to spend a day discussing how we bring salivary diagnostics into mainstream clinical practice felt slightly surreal.

For years, I've had people question what I was doing, dismiss the potential of saliva, and sometimes even make fun of the idea. There were plenty of moments when it would have been easier to follow a more conventional path. So to now be sitting in a room with some of the leading voices in dentistry, science and healthcare, discussing not if salivary diagnostics have a role in the future of healthcare, but how we make them part of everyday clinical practice, felt like a very special full-circle moment.

But what made it particularly exciting was the room itself.

It brought together leading clinicians, scientists, academics, industry, regulatory and payer expertise to tackle one central question:

How do we move salivary diagnostics from an interesting test to something that genuinely changes patient care?

And that distinction is really important.

We already know saliva can measure an extraordinary number of things. The question now isn't simply: "Can we detect it in saliva?"

It's: "Does knowing it actually change what we do for the patient?"

That was probably my biggest takeaway from the entire summit.

A useful diagnostic test shouldn't just produce an interesting number. It should help us decide whether someone needs treatment, whether they need to be referred, whether their recall interval should change, whether an intervention is working, or whether they are at greater risk of developing disease.

One of the strongest themes from the day was risk stratification.

Instead of diagnostics simply telling us, "this patient has disease", the ambition is to combine biomarkers, genetics, clinical findings, medical history and behaviour to tell us something much more useful:

What is this person's probability of progressing, and what can we do about it?

And, unsurprisingly, I LOVE this.

Because this is exactly where I think healthcare needs to go (and exactly what we are doing at THS Labs).

Dentistry has historically been incredibly reactive. Find the cavity. Fill the cavity. Find periodontal disease. Treat periodontal disease.

But imagine if we could identify the patient heading towards disease before irreversible damage occurs.

That is where saliva becomes incredibly powerful.

For years, salivary diagnostics has felt like something sitting slightly on the fringes of dentistry.

Now some of the biggest organisations and minds in our profession are sitting around the same table asking not whether saliva has a role, but how we make it clinically useful, trusted, standardised and accessible.

That is a very different conversation.

And I think it is a huge step forward for dentistry.

On top of potentially witnessing one of the biggest moments in salivary diagnostics to date, I also managed to try my first ever Chicago Deep Dish (wow) and see 'the bean'.

Thank you Chicago and the ADA for a whirlwind 26 hours.

Could looking after your gums actually make you a better athlete?

Apparently I can't write a newsletter anymore without finding another reason to tell everyone that the mouth is connected to the rest of the body.

The European Federation of Periodontology has highlighted a new report produced by Economist Enterprise examining something that receives surprisingly little attention:

The relationship between oral health and athletic performance.

We obsess over marginal gains in elite sport. Nutrition. Sleep. Hydration. Recovery. Supplements. Heart-rate variability. VO2 max.

Athletes have entire teams analysing tiny physiological changes that might improve performance by a fraction of a percent.

And yet one part of the body has historically been almost completely overlooked.

The mouth.

The report explores several ways poor oral health could potentially affect athletic performance.

Periodontal inflammation may contribute to systemic inflammation. Dental pain can interfere with eating, sleep, concentration and quality of life. Oral disease can affect nutrition, and the report also explores potential relationships with neuromuscular function, strength and balance. Did you know that in 2014, Sir Mo Farah had to have an infected tooth removed, and shortly afterwards became so unwell that he collapsed during training and spent four days in hospital. The disruption contributed to the double Olympic champion withdrawing from the Commonwealth Games, proving that even at the very highest level of sport, a dental problem can have a very real impact on performance.

And athletes may actually have some very specific oral-health challenges.

Frequent carbohydrate intake, sports drinks, dehydration, mouth breathing and demanding training schedules can all create an environment where oral health can become difficult to maintain.

Even swimming gets a mention. Repeated exposure to acidic pool environments can contribute to dental erosion in some circumstances.

What I particularly liked was that the report included voices from the sporting world itself, including Brighton & Hove Albion head coach Fabian Hürzeler and British Olympic medallist Kate Shortman.

The broader message is simple: If we're serious about optimising the body, why are we ignoring the mouth? The report argues that sports dentistry should become more integrated into athlete care, with dental professionals involved not simply when an athlete gets toothache, but in prevention, screening and ongoing performance-focused healthcare.

For me, this is another example of dentistry moving beyond the idea that our job begins and ends with teeth.

Maybe oral health is another marginal gain we've been overlooking all along.

And perhaps one day a periodontal assessment will sit alongside nutrition, physiotherapy, sleep and sports medicine as a routine part of optimising elite performance.

I certainly think it should.

Read the EFP summary and Economist Enterprise report →

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My takeaway this month…

Three completely different stories.

1. Aspirin and omega-3 potentially changing how we manage periodontal inflammation.
2. The ADA bringing leaders together to work out how salivary diagnostics move into mainstream clinical care.
3. And elite sport beginning to recognise that oral health might matter for performance.

But to me, they're all telling us the same thing.

Dentistry is getting bigger.

We're moving beyond simply treating teeth and towards understanding inflammation, immunity, microbiology, genetics, systemic health, prevention and personalised risk.

The mouth isn't separate from the body.

And perhaps, finally, healthcare is starting to behave like it isn't.

See you soon!