IS OIL PULLING THE SILVER BULLET IT IS TOUTED TO BE?

The concept of oil pulling - washing the mouth with an oil - is gaining attention globally. It is endorsed by several celebrities on the internet, and many swear by its health benefits. It is an ancient practice that has gained renewed interest among people looking for an alternative to reduce the adverse effects of modern medicine.  

In this article, we discuss the concept of oil pulling in detail and its benefits for oral health. 

What is oil pulling?

Oil pulling (or oil washing) is a home-based remedy that involves swishing oil in the mouth for 5-20 minutes early in the morning. The concept of oil pulling dates back to 3000 BC and has been extensively discussed in Ayurvedic texts such as Charaka Samhita and Sushrutha’s Arthashastra. This process is known as Kavala Gandoosha or Kavala Graha in Ayurveda. The continuous swishing of oil inside the mouth activates several enzymes (proteins) that remove toxins from the blood, curing several systemic and oral diseases. Research suggests that after practicing oil pulling for 40 days, a 20% reduction in the microbial count was observed in the oral cavity. 

What oils are used for oil pulling? 

Here are some of the oils that can be used for oil pulling:

• Coconut oil: Coconut oil is the most recommended oil for oil pulling. It mainly comprises lauric acid, which offers antimicrobial properties against a wide range of microorganisms in the mouth. In addition, coconut oil boosts the immune system and has anti-inflammatory properties beneficial to oral health. Even the pleasant taste of the oil makes it comfortable to use. Coconut oil has antiseptic properties and is considered safe to use. 
• Sesame oil: Sesame oil is rich in chemicals (e.g., sesamin, sesamolin, also sesaminol) containing Vitamin E and good fats (polyunsaturated fatty acids). The presence of vitamin E in sesame oil infuses antioxidant properties which lessen damage or injury to the oral tissues. Research suggests sesame oil aids in the removal of the bacterial film (plaque) present on teeth and gums. 
• Olive oil: Olive oil contains 70% of healthy fats (monosaturated fatty acids) and is rich in vitamin A, E, and K. These constituents impart antimicrobial and antioxidative effects, which aid in maintaining oral health. It is claimed that oil pulling using olive oil prevents bad breath. 
• Refined sunflower oil: Refined sunflower oil is rich in antioxidants and has antimicrobial properties. Just like sesame oil, it helps remove the bacterial film from the surfaces of teeth and gums. 

Liquid extracts of gooseberries and mangoes can also be used for oil pulling. 

How is oil pulling performed?

Oil pulling should be ideally performed in the morning on an empty stomach. Here are some of the steps involved in performing oil pulling:

• Take one tablespoon (~10ml) of oil into the mouth.
• Swish the oil gently for 5-20 minutes between the teeth. If the jaw starts aching, then slow down the procedure. Swishing oil changes the consistency of oil and makes it thin and milky.
• Spit the oil on tissue paper or directly into the trash instead of the sink or toilet to avoid clogging of pipes over time. 
• Use water to rinse your mouth thoroughly, followed by brushing and flossing.

What is the mechanism of action of oil pulling?

The exact mechanism of oil pulling is still not clear. However, some of the proposed theories are as follow:

• Oils used in oil pulling are rich in antioxidants. These antioxidants damage the bacterial cell wall and remove infection-causing microorganisms aiding in oral health maintenance.  
• During oil pulling, oil gets emulsified (oil combined with water present in the saliva), and its surface area increases. This allows oil to coat different surfaces of teeth and gums in the mouth. Since oils used for oil pulling contain fats, it attracts the fat-rich layer (lipid layer) of bacterial cell membranes causing them to stick to the oil. When people spit the oil after swishing, they spit out the toxins too. This process claims to inhibit the formation of the bacterial film (plaque) responsible for tooth decay, gum infections, and bad odor. 

What are the benefits of oil pulling?

Oil pulling is believed to cure ~30 different systemic ailments such as migraine, headache, asthma, diabetes, and cough. Among oral conditions, it is claimed to reduce the formation of the bacterial film (plaque) or the growth of microorganisms that cause decay, gum, and oral infections. This results in a reduction in the incidence of decay, bleeding gums, bad breath, and fungal and gum infections, improving the health of the gums and teeth. Some even claim that oil pulling aids in the whitening of teeth. 

Oil pulling is a simple and cost-effective procedure that doesn’t require any specialized oil. In addition, unlike the chlorhexidine mouthwash (medicated mouthwash prescribed by dentists), it doesn’t stain teeth or alter the taste sensation on prolonged use. 

What precautions are recommended during oil pulling?

• Avoid swallowing oil as it contains toxins and microorganisms which may have adverse effects on general health.
• Brush and floss your teeth after oil pulling.
• Kids below 5 years of age should avoid oil pulling.
• Avoid the intake of beverages immediately after oil pulling. It is recommended only after rinsing the mouth. 

What are the shortcomings of oil pulling?

In rare cases, lipoid pneumonia is reported in people who accidentally swallow the oil rich in toxins while oil pulling. Common symptoms include - fever, weight loss, cough, breathlessness, discomfort in the chest, and blood-filled spits are commonly observed symptoms. Sometimes people also complain of an upset stomach after oil pulling. 

Is oil pulling good for the mouth?

Oil pulling is among the easiest and most inexpensive means to maintain oral hygiene. According to research by University of Oxford scientists, it has no adverse effects and may benefit oral hygiene. However, it does not reverse the effects of tooth decay and gum infections or cure these conditions completely. It can only act as an additional oral hygiene practice that can be used alongside brushing and flossing of teeth.  

In addition, American Dental Association doesn’t recommend this practice as there is inadequate scientific evidence supporting the benefits of oil pulling in improving oral health. Even the existing literature lacks high-quality trials of a longer duration.

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References:

• Hariharan R, Babu N, Masthan K, Rajesh E. Oil Pulling And Its Oral Benefits-A Review. European Journal of Molecular & Clinical Medicine. 2020;7(03):2020.
• Kode S, Kamble P, Karkhanis D, Khan R. Coconut oil pulling–The holistic medicine: Evaluation of efficacy of coconut oil pulling therapy as an adjunct to scaling in diabetic patients with chronic gingivitis–A clinical and microbiological study. Journal of Interdisciplinary Dentistry. 2019 May 1;9(2):59.
• RCSE F. Role of Coconut Oil Pulling on Oral Health-An Overview. JPDA. 2018 Jul;27(03).
• Shanbhag VK. Oil pulling for maintaining oral hygiene - A review. J Tradit Complement Med. 2016 Jun 6;7(1):106-109.
• https://www.mouthhealthy.org/en/az-topics/o/oil-pulling
• Gbinigie O, Onakpoya I, Spencer E, MacBain MM, Heneghan C. Effect of oil pulling in promoting oro dental hygiene: A systematic review of randomized clinical trials. Complementary therapies in medicine. 2016 Jun 1;26:47-54.
• Saher, Fizza & Hosein, Mervyn & Ahmed, Jabbar. (2018). Role of Coconut Oil Pulling On Oral Health – An Overview. Journal of The Pakistan Dental Association. 27. 94-99. 10.25301/JPDA.273.94.
• Naseem M, Khiyani MF, Nauman H, Zafar MS, Shah AH, Khalil HS. Oil pulling and importance of traditional medicine in oral health maintenance. Int J Health Sci (Qassim). 2017 Sep-Oct;11(4):65-70. PMID: 29085271; PMCID: PMC5654187.
• Woolley J, Gibbons T, Patel K, Sacco R. The effect of oil pulling with coconut oil to improve dental hygiene and oral health: A systematic review. Heliyon. 2020 Aug 27;6(8):e04789.
• https://www.dentistryiq.com/dental-hygiene/patient-education/article/16359465/how-dental-professionals-can-respond-to-oil-pulling-patients

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