Introduction
Oil pulling originated in India as a holistic, Ayurvedic medicinal practice dating as far back as 3000-5000 years. It was believed that oils derived from either sunflower, palm, sesame, or coconut had the ability to extract harmful toxins from the bloodstream and reduce systemic inflammation.1,2 Traditional Ayurvedic remedies involve the use of herbs and spices to address the condition and understand the root cause of any problem.3 Presently, many patients are seeking holistic options for treatment recommendations and are electing natural ingredients in their oral health care products. Although a holistic approach to care is one that many dental professionals practice when considering oral systemic wellness, evidence behind the true benefits of oil pulling is limited. The microbial environment, caries incidence, and the host inflammatory response when evaluating for periodontal disease, are all clinical parameters that dental professionals consider when providing care to their patients. Despite limited statistically significant evidence on the oral health benefits of oil pulling, various studies have been conducted outlining the potential effects of oil pulling and how it could be pivotal in areas where oral hygiene resources are minimal. This article aims to objectively review the most current research on this practice.
What is Oil Pulling?
Oil pulling involves vigorous swishing of one tablespoon of oil between the teeth ideally for 15-20 minutes, starting in the morning and completing 3 times per day.2 Typical oils used are sesame, coconut, palm, or sunflower. Therapeutic benefits of oil pulling have been believed to include reduction in systemic inflammation, relieving dry mouth, soothing chapped lips, whitening teeth, reducing halitosis, plaque reduction, and improvements in oral hygiene.3 Coconut oil and palm oil are composed mainly of triglycerides. Through lipolysis, which is the process of breaking down lipids into energy, triglycerides in these oils are broken down into free fatty acids and monoglycerides.1 The main fatty acid composition of virgin coconut oil is lauric acid, which studies have shown may have antimicrobial properties.1 Another byproduct of lipolysis of oil includes monolaurin and other monoglycerides. These byproducts may play a role in altering bacterial cell walls, disrupting membranes, and inhibiting enzymes required for energy production and nutrient transfer, leading to bacterial cell death.1 However, how much lipolysis activity occurs in the mouth and how much lipase is available in the saliva can vary between patients, thus potentially altering the therapeutic benefits of coconut oil.1 Sesame oil is another product used for pulling because it does not stain and has no aftertaste, but isn’t necessarily cost effective in comparison to over-the-counter mouth rinses.4 This oil in particular possesses antioxidative properties that support the action of Vitamin E.2 Studies have looked to sesame oil and the possible therapeutic benefits it could provide, however no statistically or clinically significant evidence has been definitively made.
Therapeutic Benefits
The true mechanism of action and oral health benefits of oil pulling is unclear, however several studies have pointed to a few different theories.2,3 It has been postulated that oil pulling may improve the water repelling abilities of the lipid enriched pellicle that forms on the tooth surface. This increase in hydrophobicity may prevent bacteria from collecting and subsequently biofilm, from adhering to the tooth surface.1,2 Oil is also very viscous and when swished for a period of time, it takes on the consistency of soap. This saponification, or “soap making” process involves combining fat into bicarbonate ions that are normally found in the saliva and which play a crucial role in the pH buffering capabilities of saliva.3,4 When soap mixes with oil, the surface area is increased which expands the oil’s cleansing ability.3 Oils also possess antioxidant properties that cause detoxification by preventing lipid peroxidation, which is a process that can lead to membrane rupture and cell death. This process acts as an antibiotic by enhancing the abilities of Vitamin E in the mouth.2,3 Other studies have looked to coconut oil as an antifungal and its abilities to kill yeast and eliminate candida pathogens in the oral cavity, however there have been no statistically significant evidence supporting this hypothesis.2,4
Variations between study parameters and participants, such as length of time one is required to swish with oil, how frequent oil pulling is to be completed, restrictions on oral hygiene care, types of oil used, and study duration all contribute to conflicting study results.5 A recent Meta-Analysis performed a systematic quantitative analysis on published randomized controlled trials to determine the effects oil pulling has on oral health.3 Clinical markers that were evaluated in this study included reduction in S. mutans count, reduction in salivary bacterial colony count, and improvements in both gingival and plaque indices. Of the studies evaluated, no statistically significant difference was found in S. mutans reduction when comparing the control group with oil pulling.3 Despite these results, some studies have shown that oil pulling can reduce caries risk from marked to mild or moderate. On the contrary, there was a statistically significant reduction in salivary bacterial count with oil pulling versus the control group.3 When analyzing the effect of oil pulling on gingival and plaque indices, the studies evaluated did not yield any statically significant difference when comparing oil pulling to the control group.3 Many studies produce results that could propose benefits around reduction in microbial load and caries incidence, however further studies must be conducted to establish objectively significant differences.5
Practice Guidelines
When it comes to practice guidelines and what recommendations to provide patients with regarding oil pulling practices, there are some things to consider in addition to the aforementioned research. It is clear that until more research evolves, there is a lack of clinical parameters around this practice and patients need to be made aware of this information.2 Oil pulling is a sought after practice because there are no strict precautions to follow the regimen, other than children under the age of 5 should not use due to risks for swallowing.2 Elderly adults, or those at risk for aspiration, should also be cautious around using oil pulling as a few cases of exogenous lipid pneumonia have pointed to fatty substances being introduced into the airway when swallowed or aspirated, leading to an inflammatory reaction.5 Oil pulling does have possible benefits in inflammation and plaque reduction, so in public health cases where access to oral hygiene aids may be limited, or if patients are purely looking for a holistic anti-inflammatory option, oil pulling could be a practice to consider.5
Conclusion
The process of oil pulling has existed for several years and studies present with conflicting information regarding the benefits due to variations in study parameters. Sesame oil and coconut oil are two products that study results are showing possible therapeutic benefits, however many studies present with high bias and lack of statistical significance. In holistic medicine, oil pulling has demonstrated systemic health benefits, and this is not to say that with more rigorous research and consistent study parameters, that the oral health benefits of oil pulling will become well understood and accepted in oral health care.5 Presently, oil pulling does not have any side effects and is easy to use, so it can certainly be utilized as an adjunctive to a patient’s oral hygiene routine if they choose. However, patients should understand the limited research supporting this practice and oral health care professionals should remain optimistic that conducting further studies will only help develop and guide this practice further.
References
1. Siripaiboonpong N, Matangkasombut O, Pengcharoen H, et al. Microbiological effects of virgin coconut oil pulling in comparison with palm oil pulling as an adjunctive oral hygiene care for patients with gingival inflammation: A randomized controlled trial. J Indian Soc Periodontol. 2022;26(1): 58-63.
2. Naseem M, Khiyani MF, Nauma H, et al. Oil pulling and importance of traditional medicine in oral health maintenance. Int J Health Sci. 2017;11(4): 65-70.
3. Peng TR, Cheng HY, Wu TW, et al. Effectiveness of oil pulling for improving oral health: A Meta Analysis. Healthcare. 2022;10: 1-9.
4. Raja BK, Devi K. Oral health effects of oil pulling: A Systematic Review of Randomized Controlled Trials. J Indian Assoc Public Health Dent. 2021;19: 170-179.
5. Jong FJX, Ooi DJ, Teoh SL. The effect of oil pulling in comparison with chlorhexidine and other mouthwash interventions in promoting oral health: A systematic review and meta analysis. Int J Dent Hygiene. 2024;22: 78-94.
