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 Table of Contents  
REVIEW ARTICLE
Year : 2017  |  Volume : 8  |  Issue : 3  |  Page : 57-60

Oil pulling: A traditional method on the edge of evidence


Department of Public Health Dentistry, Sri Siddhartha Dental College, Tumkur, Karnataka, India

Date of Web Publication8-Aug-2017

Correspondence Address:
H Mythri
Department of Public Health Dentistry, Sri Siddhartha Dental College, Tumkur, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/denthyp.denthyp_64_16

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  Abstract 

Introduction: Oil pulling is an ancient, traditional folk remedy that has been practiced for centuries in India and southern Asia as a holistic Ayurvedic technique. The practice of oil pulling involves placing a tablespoon of an edible oil (e.g. sesame, olive, sunflower, coconut) inside the mouth, and swishing or “pulling” the oil through the teeth and oral cavity for anywhere from 1–5 minutes to up to 20 minutes or longer. Materials and Methods: Articles related to oil pulling were collected by using oil pulling as Keyword in Google and Medline. Out of the 21 related articles published till 2016, 6 articles with the proper study designs were used for analysis. Results: The studies were unreliable for many reasons, including the misinterpretation of results due to small sample size and improper study design. Conclusion: Though the promoters claim it as one of the best method to be as adjuvant to mechanical control methods, scientific evidences are lacking.

Keywords: Ayurveda, oil pulling, oral hygiene, traditional method


How to cite this article:
Mythri H. Oil pulling: A traditional method on the edge of evidence. Dent Hypotheses 2017;8:57-60

How to cite this URL:
Mythri H. Oil pulling: A traditional method on the edge of evidence. Dent Hypotheses [serial online] 2017 [cited 2017 Oct 20];8:57-60. Available from: http://www.dentalhypotheses.com/text.asp?2017/8/3/57/212436




  Introduction Top


Oral health is of prime importance to all individuals. Oral hygiene habits are instilled in childhood irrespective of the nationality or geographic location of an individual. The most reliable and worldwide accepted methods of oral hygiene maintenance are mechanical methods of tooth cleaning but adjuvant for decreasing plaque formation and maintaining oral hygiene have been sought. At present, chemotherapeutic agents are used as adjuvant agents to reduce plaque formation, however, they have their own disadvantages.[1]

In the text books of Ayurveda written by Charaka and Sushrutha (Charaka Samhita and Sushrutha’s Samhitha), there is a mentioning of a procedure in which an individual takes a comfortable amount of oil/medicated oil and holds it or swishes it in the mouth. When the oil turns thin and milky white it is spit out without swallowing. This procedure in Ayurveda is called as Kavala graha or Gandoosha.[2]

Dr. F. Karach popularized this procedure as oil pulling.[3] He claimed that oil pulling can cure several illnesses including oral diseases, however, his claims were not supported by evidence.

Hence, oil pulling or oil swishing is a folk remedy where oil is “swished” or “held” in the mouth.[4] Practitioners of oil pulling claim that it is capable of improving oral and systemic health, including a benefit in conditions such as headaches, migraines, diabetes mellitus, asthma, and acne, as well as whitening the teeth. Its promoters claim it works by “pulling out” toxins, which are known as ama in Ayurvedic medicine, and thereby reducing inflammation.[5]

Oil pulling has received little study and there is little evidence to support claims made by the technique’s advocates. The health claims of oil pulling have failed scientific verification or have not been investigated. The National Center for Health Research states that “it’s still unclear whether or how the practice actually works to get rid of bad bacteria in our mouths. It’s also unknown what the long term effects on oral and overall health may be.”[4]

Hence, the present review is done to collect and highlight the lacunas in this area so that it paves the way for future researchers to bring out the traditional technique benefits on scientific grounds.

History

In traditional Ayurveda, gargling treatments are used to treat imbalances of various doshas (problems) and it is believed that the dominant dosha in both the individual and nature determines health care, including dental health.[6]

Background

Oral cavity has billions of bacteria, viruses, fungi, and parasites living in our mouth. There are over 600 species of bacteria alone that make our mouths their home. Many of these bacteria produce toxins as by products, which damage the teeth and irritate the gums, causing inflammation and bleeding. An overgrowth of these bacteria leads to tooth decay and gum disease, and eventually tooth loss.[7]

Discolored teeth, plaque, tartar, cavities, bleeding gums, sensitive teeth, and chronic bad breath are all signs of an overgrowth.

Mechanism of action

The general view about oil is that it acts like a cleanser, and when it is put in the mouth and worked around the teeth and gums, it pulls out bacteria and other debris much like the motor oil of a car engine. The motor oil pulls picks up dirt and grime and when it is drained it pulls the dirt along with it leaving the engine relatively clean. Consequently, it was believed that the harmful substances are expelled from the oral cavity when oil is swished.[7]

There are various hypotheses regarding the mechanisms by which oil pulling may act in decreasing the plaque and gingivitis. In oil pulling, as the oil is swished in the mouth the mechanical shear forces are exerted on the oil leading to its emulsification and the surface area of the oil will be greatly increased. The oil film formed on the surface of the teeth and the gingiva can reduce plaque adhesion and bacterial co aggregation.[8]

It has also been proposed that the alkalis in the saliva react with the oil leading to saponification and formation of a soap-like substance, which in turn reduces the adhesion of plaque.[8],[9] Oil pulling uses the salivary glands in the mouth as detoxifying organs; the saliva can trap the toxin within the oil particles.[4]


  Materials and Methods Top


Articles related to oil pulling were collected by using oil pulling as Keyword in Google and Medline. Out of the 21 related articles published till 2016, 6 articles which checked the effectiveness of oil pulling were used for comparison [Table 1].
Table 1: Studies which checked the effectiveness of oil pulling

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The review showed that mechanism of action of oil pulling therapy is still not clear.[10] The articles suggested that the prolonged and forceful mechanical action could play a part in dislodging bacteria and undigested particles from the deep crevices within the mouth.[4] Oil pulling is best done first thing in the morning before eating breakfast. After eating, brush the teeth normally. It can be done one to three times a day, on an empty stomach.[4]

Oils which can be used for the therapy

As per Ayurvedic literature, sesame oil is one among many medicinal fluids recommended for daily preventive use and/or seasonal use to reduce dryness of the mouth and reduce inflammation and burning sensation in the mouth.[2],[4],[11]

In case of specific issues, Ayurvedic practitioners suggest coconut oil and sunflower oil or other herbalized oils after proper diagnosis of the specific ailment.[4]

Literature suggested the use of coconut oil because of its high saponification value (hence it is the oil most commonly used in making soaps).[12],[13] The soaps produced with coconut oil can lather well and have an increased cleansing action.[12] The lauric acid in the coconut oil can easily react with sodium hydroxide in saliva during oil pulling to form sodium laureate, the main constituent of soap,[13] which might be responsible for the cleansing action and decreased plaque accumulation.


  Results Top


Evidence-based studies

Dentists remain sceptical of the claimed benefits behind oil pulling [Table 1].[4] In-vitro lab studies have shown antibacterial activity of edible oils such as coconut oil, sesame oil, and sunflower oil.[4],[14]

A study conducted at Ireland in 2012 indicates that coconut oil which has been partially digested (or enzyme modified) by saliva is more effective as an antifungal and antibacterial, than natural coconut oil. Among the pathogens tested were Candida albicans and Streptococcus mutans which are most often related to oral health issues.[4] However, reliable scientific evidence of the benefits and risks is scarce and the American Dental Association (ADA) states that insufficient research has been done on oil pulling.[4] Hence, rather than oil pulling alone, the ADA recommends brushing the teeth twice a day, flossing, and the use of an antiseptic mouthwash.[4]

The Canadian Dental Association, responding to published research, has stated that “We sense oil pulling won’t do any harm, we’re not convinced there are any particular benefits to it.”[4]


  Discussion Top


Recent articles in the media recommending oil pulling procedures generally have not described potential adverse health effects, however, case reports of lipoid pneumonia associated with oil pulling or mineral oil aspiration have appeared in the literature. In addition, cases of diarrhoea or upset stomach have been reported.[19],[20]

Reports on the health benefits of oil pulling had clear limitations.[8],[15],[16],[17],[18] The existing studies were unreliable for many reasons, including the misinterpretation of results due to small sample size, confounders, absence of negative controls, lack of demographic information, and lack of blinding. To date, scientific studies have not provided the necessary clinical evidence to demonstrate that oil pulling reduces the incidence of dental caries, whitens teeth or improves oral health and well-being.[8],[15],[16],[17],[18],[21]

As emphasized in the ADA policy statement on unconventional dentistry, the provision of dental care should be based on sound scientific principles and demonstrate clinical safety and effectiveness.


  Conclusion Top


Based on the lack of evidence, oil pulling cannot be recommended as a replacement for standard, time-tested oral health behaviours and modalities but can be an effective supplemental aid in a daily oral hygiene regimen.

Overall, as is true for many folk remedies, oil pulling therapy has insufficient peer-reviewed scientific studies to support its use for oral conditions. Only, rigorous scientific analysis can assure its effectiveness and safety.

Financial support and sponsorship

Nil.

Conflicts of Interest

There are no conflicts of interest.

 
  References Top

1.
Mandel ID. Chemotherapeutic agents for controlling plaque and gingivitis. J Clin Periodontol 1998;15:488-98.  Back to cited text no. 1
    
2.
Sooryavanshi S, Mardikar BR. Prevention and treatment of diseases of mouth by gandoosha and kavala. Anc Sci Life 1994;13:266-70.  Back to cited text no. 2
    
3.
Bruce Fife MD. Health Colorado Springs: Wise publications Co. 1st ed. 2000. The healing miracle of coconut oil. Piccadilly Books Ltd; pp. 1-46.  Back to cited text no. 3
    
4.
Oil pulling. Available from: https://en.wikipedia.org/wiki/Oil_pulling. Accessed on 24th January 2016.  Back to cited text no. 4
    
5.
Amruthesh S. Dentistry and Ayurveda − IV: Classification and management of common oral diseases. Indian J Dent Res2008;19:52-61.  Back to cited text no. 5
[PUBMED]  [Full text]  
6.
Singh A, Purohit B. Tooth brushing, oil pulling and tissue regeneration: A review of holistic approaches to oral health. J Ayurveda Integr Med 2011;2:64-8.  Back to cited text no. 6
  [Full text]  
7.
Bruce Fife CN. Dental health with oils swishing; Evidence that oil pulling eradicates Harmful Bacteria. Well being J 2008;6:39-42.  Back to cited text no. 7
    
8.
Asokan S, Emmadi P, Chamundeswari R. Effect of oil pulling on plaque induced gingivitis: A randomized, controlled, triple-blind study. Indian J Dent Res 2009;20:47-51.  Back to cited text no. 8
[PUBMED]  [Full text]  
9.
Ambika S. Kartik Offsets Printers. 7th edition. Fundamentals of biochemistry for medical students; 2001. pp. 50-4.  Back to cited text no. 9
    
10.
Lakshmi T, Rajendran R, Krishnan V. Perspectives of oil pulling therapy in dental practice. Dent Hypotheses 2013;4:131-4.  Back to cited text no. 10
  [Full text]  
11.
Saini R, Saini S, Sharma S. Ayurveda and herbs in dental health. AYU 2011;32:285-6.  Back to cited text no. 11
[PUBMED]  [Full text]  
12.
Alsberg CL, Taylor AE. The Fats and Oils − A General Overview (Fats and Oils Studies No.1) Stanford University Press; 1928. pp. 86.  Back to cited text no. 12
    
13.
Pavia DL, Lampman GM, Kriz GS, Engel RG. Brooks/Cole Laboratotory series for organic chemistry. 2nd edition. Introduction to Organic Laboratory Techniques: A Small Scale Approach; 2004. pp. 252-65.  Back to cited text no. 13
    
14.
Thaweboon S, Nakaparksin J, Thaweboon B. Effect of Oil-Pulling on Oral Microorganisms in Biofilm Models. Asia J Pub Health 2011;2:62-6.  Back to cited text no. 14
    
15.
Amith HV, Ankola AV, Nagesh L. Effect of oil pulling on plaque and gingivitis. J Oral Health Community Dent 2007;1:12-8.  Back to cited text no. 15
    
16.
Asokan S, Rathan J, Muthu MS et al. Effect of oil pulling on Streptococcus mutans count in plaque and saliva using Dentocult SM Strep mutans test: A randomized, controlled, triple-blind study. J Indian Soc Pedod Prev Dent 2008;26:12-7.  Back to cited text no. 16
[PUBMED]  [Full text]  
17.
Hannig C, Kirsch J, Al-Ahmad A, Kensche A, Hannig M, Kümmerer K. Do edible oils reduce bacterial colonization of enamel in situ. Clin Oral Investig 2012;17:649-58.  Back to cited text no. 17
    
18.
Peedikayil FC, Sreenivasan P, Narayanan A. Effect of coconut oil in plaque related gingivitis — A preliminary report. Niger Med J 2015;56:143-7.  Back to cited text no. 18
[PUBMED]  [Full text]  
19.
Kim JY, Jung JW, Choi JC, Shin JW, Park IW, Choi BW. Recurrent lipoid pneumonia associated with oil pulling. Int J Tuberc Lung Dis 2014;18:251-2  Back to cited text no. 19
    
20.
Bandla HP, Davis SH, Hopkins NE. Lipoid pneumonia: A silent complication of mineral oil aspiration. Pediatrics 1999;103:E1.  Back to cited text no. 20
    
21.
Science in the news. The practice of oil pulling. American Dental association report. Available from: www.ada.org. Accessed on 24th January 2016.  Back to cited text no. 21
    



 
 
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