Oil pulling: Can we recommend it yet?

December 7, 2015

Despite the purveyance of articles online and on social media, I find some hygienists are still unaware of oil pulling.

Despite the purveyance of articles online and on social media, I find some hygienists are still unaware of oil pulling.

Have you had a patient ask you about oil pulling yet? If you haven’t, I imagine you will. Articles I see claim oil pulling helps and/or cures allergies, chronic fatigue, diabetes, PMS, chronic skin problems, migraines, asthma, back and joint pain and mood swings to name just a few. I’ve even read oil pulling has the ability to cure chronic ailments medical science has yet to and to allows a person to live up to 145-150 years of age.

Oil pulling is an ancient Ayurvedic remedy for oral health and detoxification. It involves the use of pure vegetable oils as agents for supposedly pulling harmful bacteria, fungus and other organisms out of the mouth, teeth, gingiva and throat. This is done by swishing or “pulling” oil in the mouth for about 20 minutes at least once but up to three times per day. This swishing of oil is said to activate enzymes, which draw toxins out of the blood, according to several websites I found. As a hygienist, I’d like to focus on the oral health benefit claims as some of those claims include stabilizing mobile teeth, curing gum disease and decay, whitening teeth and halting and even “fixing” recession.

First, we need to look at dental plaque. For review: Dental plaque is a bacterial biofilm that forms a physical barrier, a polysaccharide matrix, that protects bacteria from the effects of antibiotics, antiseptics (rinses) and your immune system. This is why taking an antibiotic for gum disease isn’t the most effective as the antibiotic cannot break through the biofilm’s protective layer. The claim that oil can break through this barrier has not been proven. The most effective and proven method to disrupt biofilm is through mechanical/physical means-in other words, by brushing and flossing (or cleaning interdentally in the best way to fit your needs).

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Next, I’d like to comment on the claims of oil pulling “healing” gum disease. Simply rinsing with mouthwash, oil or any other liquid only reaches 1-2 mm into a gingival sulcus. Most people have deeper pockets than this, especially when they have gingivitis or periodontitis. This is why rinsing alone is not the delivery of choice. Like mechanical removal of biofilm, this has been proven in scientific studies. So why would oil be able to miraculously get deeper into the pocket? Until I see a valid, reproducible and large sample-sized scientific study, I must hold true to what has been proven thus far.

When you read these articles online, I hope you notice who writes them. Are they written by a medical/dental professional or researcher or, for instance, a non-medically trained stay-at-home mom who has a natural living blog? When studies are referenced validating the claims of oil pulling, are you able to easily find these studies and fact check? I’ve noticed the study results referenced in many articles were written in a way to make oil pulling look effective, but the full results of the research were actually left out.

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For instance, one article said oil pulling was effective after one and two weeks regarding plaque reduction, but left out that the control group using chlorhexidine was effective at 24 and 48 hours and at one and two weeks. Further, couldn’t just swishing with water or any liquid for 20 minutes be just as “effective”? The studies do not delve into if it was the actual oil or the act of swishing that made it effective. Also, what about probing depths, bleeding indices, using a control group of just water or salt water, etc.? So many questions are unanswered!

Additionally, brushing for two minutes twice per day, along with flossing for a few minutes once per day, simply takes less time. I have a hard time motivating patients to brush for two minutes let alone swish with oil for 20 minutes. Patients also need to know that oil pulling has been associated with upset stomach, vomiting, diarrhea and even lipoid pneumonia, which is pneumonia from inhaling tiny droplets of oil. Also, if the oil is spit in the sink, toilet, etc. it can clog drains.

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The ADA states, “Based on the lack of currently available evidence, oil pulling is not recommended as a supplementary oral hygiene practice and certainly not as a replacement for standard, time-tested oral health behaviors and modalities. The ADA recommends patients follow a standard oral hygiene regimen that includes twice-daily tooth brushing with fluoride toothpaste and cleaning between teeth once a day with floss or another interdental cleaner.

“Current reports on the potential health benefits of oil pulling have clear limitations. Existing studies are unreliable for a number of 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.”

Research has shown that a healthy mouth leads to a healthy body. However, there’s just not enough evidence to prove oil pulling is the answer. Time will tell as more research emerges. Who knows-in a few years, I may change my tune. I realize coconut oil has an antimicrobial effect, but until I see scientific research that shows oil can reach the bottom of a gingival pocket and break through the barrier of biofilm, among other points of interest, I must stick with what is proven scientifically.

References:

http://wellnessmama.com/7866/oil-pulling-for-oral-health/

http://www.oilpulling.com/

http://www.coconutresearchcenter.org/article%20oil%20pulling.htm

http://www.ada.org/en/science-research/science-in-the-news/the-practice-of-oil-pulling

http://www.ncbi.nlm.nih.gov/pubmed/18408265

http://www.ncbi.nlm.nih.gov/pubmed/25584309

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