Should You Try Oil Pulling?

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Oil pulling is currently in vogue to improve oral health and your overall health. Why not try it?

Oil pulling -- swishing or gargling with oil for a few minutes with sesame, sunflower or coconut oil -- is an age-old process from the traditional Indian Ayurveda[i] medical practice that has gained modern popularity in promoting oral and overall health. It is believed to support more than 30 systemic diseases when practiced regularly.

Due to side effects from modern medicines and oral hygiene products, people are increasingly interested in complementary natural and traditional practices like Ayurveda, which rely heavily on herbs, plants, oils and spices for healing and wellness.[ii]

How does it work? Oil pulling generates antioxidants that damage the cell wall of microorganisms and kill them.[iii] After five minutes of oil pulling with about a tablespoon of oil (for children ages 5 to 15 use only a teaspoon), the oil gets emulsified -- white, foamy consistency -- and the surface area of the oil increases. This oil will coat the teeth and gingiva -- gums -- inhibiting bacteria and plaque formation.[iv]

Plaque and Plaque-Induced Gingivitis

Oil pulling with sesame oil and sunflower oil was found to reduce plaque and plaque-related gingivitis -- inflammation of the gums. While you can get the same bacteria-fighting benefits with sesame or sunflower oil, coconut oil has the added benefit of being a medium-chain fatty acid with 45% or more lauric acid -- well-known for its antimicrobial and anti-inflammatory properties -- making it more effective in preventing plaque formation and even tooth decay.[v]

Recent literature shows that coconut oil is effective for many systemic diseases since laurin fights bacterial, viral and fungal infections.[vi] For 30 days, 60 age-matched adolescent boys and girls from 16 to 18 years old who had plaque-induced gingivitis added coconut oil pulling to their oral hygiene routine. Plaque and gingival indices significantly decreased with coconut oil pulling.[vii]

A total of 20 age-matched adolescent boys with plaque-induced gingivitis were evenly divided into an oil pulling with sesame oil group and a chlorhexidine (CHX) mouthwash control group, done each day for 10 days before brushing. Both groups significantly reduced plaque, gingival index scores and the total colony count of aerobic microorganisms in the mouth.[viii]

In a trial of 10 subjects who used sunflower oil pulling along with their other oral hygiene measures for 45 days, all had significant reductions in dental plaque and gingival scores.[ix]

In a clinical observer cross-over study, 24 participants with gingivitis who first had prophylaxis -- a deep teeth cleaning at the dentist -- used coconut oil pulling for four days with a washout period of 14 days followed by sesame oil pulling for another four days. Coconut and sesame oil performed similarly to inhibit plaque regrowth, tooth staining, gingival index and gum bleeding in exam.[x]

After 29 gingivitis subjects received professional prophylaxis, they rinsed with either coconut oil or 0.2% CHX for four days followed by a washout period of 14 days and then the other rinse for four days in a cross-over design model. Oil pulling therapy presented similar inhibitory activity on plaque regrowth, gingivitis score and bleeding index compared with CHX, but the coconut oil demonstrated less staining.[xi]

A sample of 20 gingivitis patients aged 18 to 35 years old was divided into a group who used coconut oil pulling as a mouthwash and a control group that did not add mouthwash to their usual dental hygiene for 30 days. Gingivitis-plaque index and bleeding index decreased in both groups, with a more relevant and significant drop in the coconut oil pulling group.[xii]

Bad Breath and Oral Bacteria

Nearly 60% of the world's population experience oral malodor -- offensive odors in the oral cavity -- from the overgrowth of proteolytic, anaerobic bacteria, which particularly gather on the tongue surface -- clinically known as coated tongue.[xiii],[xiv]

Oral malodor is also called halitosis, or bad breath.[xv] A well-documented association exists between halitosis and anaerobic bacteria that produce volatile sulfur compounds (VSCs), such as methyl mercaptan and hydrogen sulfide, which can be measured in the tongue microbiota.[xvi],[xvii]

In 85% of those with halitosis, causes are intraoral such as smoking, mouth breathing due to sinus conditions, regular pungent food consumption or suboptimal oral hygiene leading to plaque and gingivitis.[xviii] Halitosis has also been linked to systemic health issues such as diabetes, kidney failure, liver cirrhosis, gastric acid reflux, cancers and syphilis.[xix],[xx]

Successful treatments include tongue brushing, toothbrushing and mouth rinsing with zinc, natural oils like coconut or sesame or cetylpyridum chloride, which reduce the organoleptic -- taste, sight, smell and touch -- scores of individuals with moderate oral malodor.[xxi]

Scientists divided 60 subjects into three groups. The first group rinsed with 10 milliliters (ml) of coconut oil for 10 minutes, the second group rinsed with 5 ml CHX mouthwash for one minute and the third group rinsed with 5 ml of distilled water for one minute in the morning before brushing. Coconut oil pulling and the CHX rinse significantly reduced S. mutans bacteria in the saliva with the coconut oil being the safest option with no side effects.[xxii]

Coconut oil pulling also exhibited strong antimicrobial activity against S. mutans and C. albicans in a study of oral microorganisms in biofilm experiments.[xxiii] Researchers observed 60 patients with oral malodor in their three-week trial showing that oil pulling with sesame oil was equally efficient when compared with CHX mouthwash in reducing oral malodor and causative microorganisms.

Both treatments reduced the gingival index scores, mean plaque index scores, volatile sulfur compounds and mean anaerobic bacterial count in the oral cavity thus resulting in reduced organoleptic scores.[xxiv] In a controlled pilot trial involving 20 adolescents, oil pulling with sesame oil was found to be as effective as CHX to reduce halitosis and microorganisms associated with it.

The oil pulling occurred once daily for 10 to 15 minutes before tooth brushing for 14 days. Gum index score, plaque index score, organoleptic breath assessment score, breath score from self-assessment and tongue coating sample scores were equally reduced in both the CHX and oil pulling groups.[xxv]

Dental Caries (Cavities)

Cavities occur when dental plaque builds up and eats at tooth enamel and causes a hole. Plaque is a sticky substance that covers teeth and occurs when bacteria in the mouth combines with food, acid and saliva.[xxvi]

In a study of tooth swabs from 20 children aged 3 to 6, coconut oil was found to have a strong antifungal effect against Candida bacteria, particularly reducing the C. Albicans variety in the mouth in a statistically comparable way to treatment with CHX or Ketoconazole -- a prescription antifungal drug -- but without the negative side effects.[xxvii]

In a study of 40 subjects with mild to moderate plaque and gingivitis, 20 of them performed oil pulling with sesame oil for 45 days and the other 20 continued with their normal oral hygiene routine. Oil pulling showed a statistically significant decrease in plaque, gingival scores and mouth bacteria.[xxviii] Oil pulling helps prevent dental caries, gingivitis, oral candidiasis and periodontitis from occurring.[xxix],[xxx]

The Link Between Oral Health and Overall Health

As your oral health encompasses everyday functions of eating, breathing and speaking, and may impact your self-confidence, well-being and the ability to socialize and work without pain, discomfort and embarrassment, it can detrimentally affect your functionality and quality of life.

Oral diseases -- the most common noncommunicable diseases worldwide that affect an estimated 3.5 billion people -- encompass a range of diseases and conditions that include dental caries, periodontal (gum) disease, tooth loss, oral and laryngeal cancers, oro-dental trauma and birth defects such as cleft lip and palate.[xxxi]

Most oral diseases and conditions share modifiable risk factors like tobacco use, alcohol consumption and unhealthy diets high in sugars, with the leading noncommunicable diseases -- diabetes, cardiovascular diseases, cancer, chronic respiratory diseases and mental disorders.

For example, diabetes is linked with the development and progression of periodontitis. Moreover, there is a causal link between high consumption of sugars and diabetes, obesity and dental caries.[xxxii]

In addition, a strong relationship has been established between various oral and systemic diseases. In fact, the prevention and treatment of dental caries and periodontal disease have been shown to reduce the risk of diabetes and heart disease significantly. The use of oil pulling is supported by recent studies for its efficacy and long-term use for maintaining and improving oral health.[xxxiii]

Medical conditions may affect oral health and vice versa. For example, in about 10% of halitosis patients, systemic health issues from gastrointestinal diseases, tuberculosis, stomatitis, urinary system problems, respiratory illnesses, poor diet and use of certain drugs are thought to cause bad breath.[xxxiv]

In addition, the metabolic processes of Type 2 diabetes can explain the increased destruction of tissue seen in diabetic periodontitis. In turn, like other infections, periodontal disease has been shown to exacerbate glycemic control in diabetic patients, and lower overall medical costs have been seen among diabetic patients who receive proper periodontal care.

Several studies have also shown an association between periodontal disease and adverse outcomes in pregnancy complications such as premature deliveries, fetal growth restriction and pre-eclampsia.[xxxv]

The connection between oral health and overall health can also be seen in oral and pharyngeal cancers. Over 54,000 cases of oral and pharyngeal cancers are diagnosed annually and an estimated 11,580 deaths will occur in the U.S. in 2023 due to these types of cancers.[xxxvi]

African American males, in particular, have a relatively high incidence of oral cancers and as a group are typically diagnosed at later stages of the disease and have a significantly lower five-year survival rate.[xxxvii]

Recent studies have shown associations between poor oral health and coronary heart disease (CHD). A U.S. national sample of 44,119 male health professionals from 40 to 75 years of age with no diagnosed CHD, cancer or diabetes at baseline were studied. In a six-year follow up, researchers found 757 incidents of CHD, including fatal and non-fatal myocardial infarction and sudden death. Among men who reported pre-existing periodontal disease, those with 10 or fewer teeth were at increased risk of CHD compared with men with 25 or more teeth.[xxxviii]

In both a British cohort study of 2,147 subjects aged 71 to 92 years with nine-year follow up and a U.S. cohort of 3,075 people from 71 to 80 years old with 15-year follow up, oral health was measured by tooth loss, periodontal disease, dry mouth and self-rated oral health.

In the British study, tooth loss was associated with all-cause mortality while in the U.S. study, tooth loss, dry mouth and having three or more oral problems were associated with all-cause mortality. Periodontal disease was also associated with increased cardiovascular mortality while tooth loss and accumulation of oral problems were associated with high respiratory mortality.[xxxix]

In a study of 5,212 British male adults from ages 70 to 92, participants were assessed after an eight-year follow-up for oral health markers -- denture use, tooth count, periodontal disease, self-rated oral health, dry mouth and perceived difficulty eating -- and on their physical frailty and severe frailty. Oral health problems, particularly tooth loss and dry mouth, were associated with progression to frailty and severe frailty in aging populations.[xl]

In a longitudinal study of 2,024 community-dwelling adults who had no cognitive decline issues at the start of the study, 19% of those who took a later follow-up survey showed new-onset mild cognitive impairment (MCI)--a precursor for dementia. Researchers defined oral frailty as poor performance on three or more measures -- number of teeth, masticatory status, tongue pressure, oral motor skills and difficulties in eating and swallowing.

The oral frailty group had a significantly higher risk ratio for MCI than the other members in the survey, particularly those with teeth loss, low tongue pressure and difficulty eating tough foods.[xli]

Poor oral health in older age, particularly three or more oral health issues such as periodontal disease, dry mouth and tooth loss, was consistently associated with inflammatory, hemostatic and cardiac biomarkers in a study of 5,222 U.S. and British adults aged 71 to 92.[xlii] 

Oil Pulling Impacts Oral Health and Overall Health

Oil pulling, typically with coconut or sesame oil, can be used to improve your oral health along with teeth brushing and flossing. Research shows strong links between keeping your teeth, gums and oral cavity in good shape and preventing oral diseases, which are tied to developing many systemic diseases. Great oral health can help you to achieve better overall health outcomes and increase your longevity. To read additional articles, see GreenMedInfo.com's oil pulling research database.


References

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[xxi] Loesche WJ, Kazor C. Microbiology and treatment of halitosis. Periodontol 2000. 2002;28:256-79. doi: 10.1034/j.1600-0757.2002.280111.x. PMID: 12013345

[xxii] Mamta Kaushik, Pallavi Reddy, Roshni Sharma, Pooja Udameshi, Neha Mehra, Aditya Marwaha. The Effect of Coconut Oil pulling on Streptococcus mutans Count in Saliva in Comparison with Chlorhexidine Mouthwash. J Contemp Dent Pract. 2016 ;17(1):38-41. Epub 2016 Jan 1. PMID: 27084861

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[xxiv] Sood P, Devi M A, Narang R, V S, Makkar DK. Comparative efficacy of oil pulling and chlorhexidine on oral malodor: a randomized controlled trial. J Clin Diagn Res. 2014 Nov;8(11):ZC18-21. doi: 10.7860/JCDR/2014/9393.5112. Epub 2014 Nov 20. PMID: 25584309; PMCID: PMC4290321.

[xxv] Asokan S, Kumar RS, Emmadi P, Raghuraman R, Sivakumar N. Effect of oil pulling on halitosis and microorganisms causing halitosis: a randomized controlled pilot trial. J Indian Soc Pedod Prev Dent. 2011 Apr-Jun;29(2):90-4. doi: 10.4103/0970-4388.84678. PMID: 21911944.

[xxvi] Higuera, Valencia. Cavities in Kids. Healthline. October 22, 2020. Accessed on May 30, 2023 from https://www.healthline.com/health/childrens-health/cavities-in-kids.

[xxvii] Shino B, Peedikayil FC, Jaiprakash SR, Ahmed Bijapur G, Kottayi S, Jose D. Comparison of Antimicrobial Activity of Chlorhexidine, Coconut Oil, Probiotics, and Ketoconazole on Candida albicans Isolated in Children with Early Childhood Caries: An In Vitro Study. Scientifica (Cairo). 2016;2016:7061587. doi: 10.1155/2016/7061587. Epub 2016 Mar 14. PMID: 27051559; PMCID: PMC4808662.

[xxviii] Saravanan D, Ramkumar S, Vineetha K. Effect of Oil Pulling with Sesame Oil on Plaque-induced Gingivitis: A Microbiological Study. J Orofac Res 2013;3(3): 175-180.

[xxix] Ballal V. Oil therapy. Br Dent J. 2009 Sep 12;207(5):193. doi: 10.1038/sj.bdj.2009.772. PMID: 19749698.

[xxx] Lakshmi T., Rajendran R., Krishnan V. Perspectives of oil pulling therapy in dental practiceDent Hypotheses. 2013;4:131-134. 

[xxxi] Who International. Team. Non Communicable Diseases. Global Status Report on Oral Health 2022. https://www.who.int/team/noncommunicable-diseases/global-status-report-on-oral-health-2022/

[xxxii] Who International. Health Topics. Oral Health. https://www.who.int/health-topics/oral-health#tab=tab_1

[xxxiii] 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.

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[xxxv] Nannan M, Xiaoping L, Ying J. Periodontal disease in pregnancy and adverse pregnancy outcomes: Progress in related mechanisms and management strategies. Front Med (Lausanne). 2022 Oct 25;9:963956. doi: 10.3389/fmed.2022.963956. PMID: 36388896; PMCID: PMC9640773.

[xxxvi] Cancer.net. Cancer Types. Oral and Oropharyggeal Cancer. Statistics. https://www.cancer.net/cancer-types/oral-and-oropharyngeal-cancer/statistics

[xxxvii] Institute of Medicine (US) Board on Health Care Services. The U.S. Oral Health Workforce in the Coming Decade: Workshop Summary. Washington (DC): National Academies Press (US); 2009. 2, The Connection Between Oral Health and Overall Health and Well-Being. Available from: https://www.ncbi.nlm.nih.gov/books/NBK219661/

[xxxviii] Joshipura KJ, Rimm EB, Douglass CW, Trichopoulos D, Ascherio A, Willett WC. Poor Oral Health and Coronary Heart Disease. Journal of Dental Research. 1996;75(9):1631-1636. doi:10.1177/00220345960750090301

[xxxix] Kotronia E, Brown H, Papacosta AO, Lennon LT, Weyant RJ, Whincup PH, Wannamethee SG, Ramsay SE. Oral health and all-cause, cardiovascular disease, and respiratory mortality in older people in the UK and USA. Sci Rep. 2021 Aug 12;11(1):16452. doi: 10.1038/s41598-021-95865-z. PMID: 34385519; PMCID: PMC8361186.

[xl] Kimble R, Papacosta AO, Lennon LT, Whincup PH, Weyant RJ, Mathers JC, Wannamethee SG, Ramsay SE. The Relationship of Oral Health with Progression of Physical Frailty among Older Adults: A Longitudinal Study Composed of Two Cohorts of Older Adults from the United Kingdom and United States. J Am Med Dir Assoc. 2023 Apr;24(4):468-474.e3. doi: 10.1016/j.jamda.2022.11.022. Epub 2022 Dec 28. PMID: 36584971.

[xli] Nagatani M, Tanaka T, Son BK, Kawamura J, Tagomori J, Hirano H, Shirobe M, Iijima K. Oral frailty as a risk factor for mild cognitive impairment in community-dwelling older adults: Kashiwa study. Exp Gerontol. 2023 Feb;172:112075. doi: 10.1016/j.exger.2022.112075. Epub 2022 Dec 26. PMID: 36581224.

[xlii] Kotronia E, Wannamethee SG, Papacosta AO, Whincup PH, Lennon LT, Visser M, Kapila YL, Weyant RJ, Ramsay SE. Poor Oral Health and Inflammatory, Hemostatic, and Cardiac Biomarkers in Older Age: Results From Two Studies in the UK and USA. J Gerontol A Biol Sci Med Sci. 2021 Jan 18;76(2):346-351. doi: 10.1093/gerona/glaa096. PMID: 32306041; PMCID: PMC7812424.

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