Oil pulling

Oil pulling or oil swishing is a folk remedy where oil is "swished" (kavala graha) or "held" (snigda gandoosha) in the mouth.^[1]

Practitioners of oil pulling claim 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 teeth. Its promoters claim it works by "pulling out" toxins, which are known as ama in Ayurvedic medicine, and thereby reducing inflammation.^[2][3][4][5]

Oil pulling has received little study and there is little evidence to support claims made by the technique's advocates.^[6] In one small study, sesame oil was found to be effective at reducing plaque and oral bacterial load, but was less effective than chlorhexidine (an antiseptic mouthwash); the health claims of oil pulling have otherwise failed scientific verification or have not been investigated.^[7][8] 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."^[9]

Traditional usage

In traditional Ayurveda, gargling treatments like kavala graha and gandusha are used to treat imbalances of various doshas.^[10][11] Ayurveda does not recommend general treatments blindly for everyone,^[12] but, rather, health is held to be very individualistic, and the dominant dosha in both the individual and nature determines health care, including dental health.^{[13][14][15][16]} As per Ayurvedic literature, sesame oil is one among many medicinal fluids recommended for daily preventive use and/or seasonal use to reduce dryness (vata dosha) of the mouth and reduce inflammation and burning sensation in the mouth.^[1][11] In case of specific issues, Ayurvedic practitioners might also suggest other treatments such as coconut oil and sunflower oil or other herbalized oils after proper diagnosis of the specific ailment or dosha.^[17]

Current origin

The phrase "oil pulling" and usage in its current form was popularized in the early 1990s by one of the early adopters, Tummala Koteswara Rao in Bangalore, South India. Rao actively evangelized oil pulling as an ancient Ayurvedic practice.^[18]

Rao claims to have been introduced to oil pulling by a paper presented by Fedor Karach to the All Ukrainian Association of the Academy of Science of the USSR in which he advocated a method of oil pulling.^{[19][20][21][22][23][24]} The paper is claimed to have been widely circulated in the German Magazines Natur & Heilen (Nature & Healing - author: Günther W. Frank) and, Natur und Medizin (Nature and Medicine - author: Veronica Carstens).^[25] It is further claimed, in the same paper, that Siberian shamans practised oil pulling with sunflower oil for more than a century.^[26]

The extensive promotion as an Ayurvedic practice, the increased commercial interest in vegetable oil, and the claimed anecdotal benefits helped firmly establish oil pulling as a popular alternative medicine home remedy.^[26][27]

Traditionally, sesame oil was used for oil pulling, but recent endorsements by celebrities has resulted in increasing popularity of coconut oil based oil pulling in the Western world.^[28]

Purported mechanism of action

Even after several (limited) studies, the exact mechanism of action of oil pulling therapy is still not clear.^[29]

The suggestion is that oil provides a surface layer that prevents plaque or bacteria adhering to teeth.^[30][31][32]

It is also suggested that by increasing the secretion of saliva, oil pulling uses the salivary glands in the mouth as a detoxifying organ: the saliva can trap the toxin within the oil particles.^[33]

It is also 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.^[34][35]

Oil pulling with sesame seed oil moisturizes gums, which can provide a measure of relief to those suffering from dry mouth. Dry mouth is known to increase bacteria growth.^[32][36]

Research

Dentists remain skeptical of the claimed benefits behind oil pulling.^[17][37] Reliable scientific evidence of the benefits and risks is scarce and American Dental Association states that insufficient research has been done on oil pulling.^{[8][14][15][16][38][39]} Rather than oil pulling, the ADA recommends brushing the teeth twice a day, flossing, and the use of an antiseptic mouthwash.^[40] 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."^[41]

A 2013, in vitro, study found that oil pulling with olive oil, safflower oil, or linseed oil had no effect on microbial colonization of the enamel. The authors concluded that it could not be recommended for biofilm reduction.^[42]

In vitro, lab studies have indicated the antibacterial activity of edible oils such as coconut oil, sesame oil and sunflower oil.^{[43][44][45][46][47][48]} Also, multiple studies have indicated the effectiveness of essential oils such as tea tree oil against gingivitis and dental plaque formation when used in combination with regular oral hygiene.^[49][50][51]

• A 2012 - AIT, Ireland - study indicates that coconut oil which has been partially digested (or enzyme modified) by saliva is more effective than natural coconut oil.^[52][53][54]

• It was reported in Mar–Apr 2014 that Dr. Leslie Laing, from the University of Toronto's Faculty of Dentistry, conducted an as yet unpublished pilot study on the use of coconut oil for treatment of dry mouth in a dozen patients suffering from Sjögren's syndrome, with promising results.^[32][41][55]

Against the background of current scientific and empirical knowledge, edible oils might be used as oral hygiene supplements but a decisive benefit for the oral health status is questionable.^[56] The drawbacks highlighted by medical professionals and experts are:^[57][58]

• Oil pulling cannot replace care from a qualified dentist, and any delays in going to the dentist might make it difficult to treat mouth problems.
• It consumes more time than conventional alcohol-free, antiseptic mouthwash
• There is a report of lipid pneumonia caused by accidental inhalation of the oil during oil pulling.^[35][59][60]
• Coconut oil, in rare cases, can act as an antigenic agent that causes contact dermatitis.^[61][62][63]
• The oil has to be spit into the garbage can, not the sink. Coconut oil if it solidifies can clog the pipes.^[64][65]
• Ayurvedic experts warn of negative side effects - if improper technique is used - such as dry mouth, excessive thirst, muscular stiffness, exhaustion and loss of sensation or taste in the mouth.^[15][16]

See also

• List of topics characterized as pseudoscience

References