Oil Pulling for Better Oral Health-Myth or Reality?

and for which various natural oils like Abstract In this era of holistic approach traditional methods of treatment are gaining importance. Traditional medicine lays emphasis on natural product usage and has few side effects. Oil pulling or oil swishing, in alternative medicine, has been used to prevent decay, oral malodor, bleeding gums, and dryness of throat, and cracked lips and for strengthening teeth, gums, and jaws. It is a simple rejuvenating treatment which when done routinely, enhances the senses, maintains clarity, brings a feeling of freshness and invigorates the mind. Various natural oils like refined sunflower oil, sesame oil, olive oil, coconut oil and liquids like milk and water, gooseberry and mango extracts have been used for oil pulling.


Introduction
In this era of holistic approach traditional methods of treatment are gaining importance. Traditional medicine lays emphasis on natural product usage and has few side effects [1]. Oil pulling or oil swishing, in alternative medicine, has been used to prevent decay, oral malodor, bleeding gums, and dryness of throat, and cracked lips and for strengthening teeth, gums, and jaws [2][3][4][5]. There are two types Gandusha and Kavalagraha. Gandusha involves filling the oral cavity completely with liquid medicine held for about three to five minutes and then released. In Kavalagraha, a comfortable amount of fluid is retained within the mouth for about three minutes and then gargled. It is a simple rejuvenating treatment which when done routinely, enhances the senses, maintains clarity, brings a feeling of freshness and invigorates the mind. Various natural oils like refined sunflower oil, sesame oil, olive oil, coconut oil and liquids like milk and water, gooseberry and mango extracts have been used for oil pulling [6].

Procedure of oil pulling
It is better to perform it during early morning hours, on an empty stomach slowly in sitting position with chin up. A tablespoon of oil is taken in the mouth, sipped, sucked and pulled between the teeth for ten to fifteen minutes. The viscous oil turns thin and milky white. It is claimed that the swishing activates enzymes and draws toxins out of the blood. The oil should not be swallowed as it contains bacteria and toxins. Oil pulling therapy should be followed by tooth brushing and rinsing of the mouth with warm water or salt water. The procedure can be done for a maximum of three times in a day in case of acute diseases. It is contraindicated for children below the age of five years due to danger of aspiration and swallowing. It can be practiced even during pregnancy and menstruation. Unlike chlorhexidine no time gap is advised after oil pulling and rinsing [7,8].

Mechanism of Action
The exact mechanism of oil pulling still remains unclear. It is assumed that swishing the oil in the mouth activates enzymes and pulls the toxins out of the blood [1,9]. Another proposed mechanism states that the viscosity of the oil may prevent bacterial adhesion and coaggregation. Moreover, recently an invitro study proposed that the effects of oil-pulling therapy showed clear indications of possible saponification and emulsification process which enhances its mechanical cleansing action [6]. Sesame oil is a vegetable fat which when reacted with salivary alkalis like bicarbonates causes saponification by acting as an emulsifying agent. This emulsification increases the surface area of oil and promotes better cleansing action [6].

Effects
Oil pulling, a biological healing method was found to cure a variety of symptoms without side effects. The simplicity of

Journal of Complementary Medicine & Alternative Healthcare
this healing system is that oil has a stimulating effect on body's alimentary system. It was found to possibly heal individual cells, cell conglomerates such as lymph nodes and more complex tissues like internal organs simultaneously. This occurs because beneficial microflora throughout the body is provided with a healthy continuum that enables the usual pattern of human health to lean towards wellness than illness [10,11].

Discussion
Ayurveda, a part of alternative medicine is gaining back its importance in various aspects of health, as it uses all natural products. Oil pulling is one such age old process which has innumerable systemic and dental health benefits. It has become a mystic cure for many systemic diseases like diabetes, migraine etc.
Several studies done on the efficacy of oil pulling in improving oral health including anti-caries effect, anti-halitosis effect using various oils like sesame oil, sunflower oil and coconut oil have shown that oil pulling is equally effective to chlorhexidine mouth rinses (Table 1). Hence the evidence suggests that oil pulling can be used as a useful adjunct in improving and maintaining oral health Table 1: Showing studies conducted on the efficacy of oil pulling.

Sl. No Oil used Authors Objectives of the Study Results Conclusion
1 Sesame oil Asokan S, et al. [12] Effect of oil pulling with sesame oil on the count of Streptococcus mutans in plaque and saliva of children, using the Dentocult SM Strip mutans test, and to compare its efficacy with that of chlorhexidine mouthwash

Significant reduction in the count of Streptococcus mutans in plaque
Effective & preventive adjunct in oral health maintenance.
2 Sesame oil Asokan S, et al. [12] Evaluate the effect of oil pulling with sesame oil on halitosis and the microorganisms that could be responsible for it and to compare its efficacy with chlorhexidine mouthwash.
Equally effective like chlorhexidine on halitosis and organisms, associated with halitosis.
Useful adjunct in oral health maintenance.
3 Sesame oil T Durai Anand, et al. [13] Effect of oil-pulling on the reduction of total count of bacteria. The in-vitro antibacterial activity of sesame oil against dental caries causing bacteria was determined.
Reduction in the total count of bacteria. Streptococcus mutans and Lactobacillus acidophilus were moderately sensitive.
The process of oilpulling had reduced the susceptibility of a host to dental caries 4 Sunflower oil Amith, et al. [14] Assessed the effect of sunflower oil pulling on Plaque and Gingivitis and monitored its safety on oral soft and hard tissues.
No adverse reactions to any hard and soft tissues of the oral cavity.
Low levels of plaque and gingivitis at 45 days 5 Coconut oil Intahphuak S, et al. [15] The anti-inflammatory, analgesic, and antipyretic effects of Virgin coconut oil (VCO) were assessed.
In acute inflammatory models, VCO showed moderate anti-inflammatory effects. Inhibitory effect on chronic inflammation. Moderate analgesic effect and antipyretic effect in yeast-induced hyperthermia Possess antiinflammatory, analgesic, and antipyretic properties

Conclusion
Few short term studies have demonstrated the beneficial effects of oil pulling on plaque, gingivitis and dental caries prevalence suggesting that it be used as an oral hygiene maintenance aid. Further research with long term studies is in need to explore the other effects of oil pulling therapy on overall health. Scientific validations of the ayurvedic dental health practices could justify their incorporation into modern dental practice. Overall, as is true for many folk remedies, oil pulling therapy has insufficient peer-reviewed scientific studies to support its use for oral conditions.