By Lory Laughter, RDH, BS
A few years ago, I wrote an article on oil pulling. Patients were coming to me with questions and trying the home-care process. In the last couple of months, I have received four emails asking me to address the subject again or telling me I was wrong in my original conclusion -- this time, the requests came from dental professionals. As luck would have it, when I started researching the subject again, Facebook was flooded with links and testimonials touting the wonderful benefits of oil pulling.
For those not familiar with the procedure, a person holds and swishes oil in their mouth for 10 to 20 minutes. The type of oil varies and the time factor can be adjusted but the process is fairly uniform. What is not uniform are the health benefits claimed by authors -- everything from a lower S. mutans count to the curing of leukemia. The fact remains that very little of the information has been verified by reliable scientific research.
Other articles by Laughter
One web link appearing more than once in social media and even referenced in an email sent to me contains very little information.1 The web page is a blog, one paragraph in length and references the Athlone Institute of Technology in Ireland. Just below the blogger's paragraph (and the cute picture of the child brushing with coconut oil) is a "paid endorsement disclosure" statement where the blogger "may receive monetary compensation … for my endorsement." I appreciate the author's honesty, and the disclosure was not hidden in any print. But it still does not make the endorsement science based.
Another site sent to me more than once did have sources referenced and was written in more academic formatting than the others.2 Yet, the body of the article contains claims not substantiated by any source listed. "The Health Benefits of Oil Pulling" article suggests that benefits from the procedure may include supporting normal kidney function, improved sleep patterns, and even a reduction in hangover symptoms after alcohol consumption.
None of these claims is studied in the cited resources. The first source listed3 is a fairly well-done study comparing chlorhexidine rinse to oil pulling with sesame oil. This study was one of the few to admit oil pulling cannot remove toxins from the blood as claimed; the oral mucosa does not act as a semi-permeable membrane to allow toxins to pass through. While the outcome was a greater reduction in S. mutans in the chlorhexidine group, the researchers focused on the fact oil pulling was tolerated better by some because it does not stain like chlorhexidine. The study lacked a control group that used neither substance being evaluated, but it is a viable source when read in its entirety.
The second source cited in the article was also a well-done study.4 Published in the Journal of Oral Health and Community Dentistry in 2007, the authors recommend further studies with larger sample sizes. I do have a few concerns about this reference. There was no control group and no control for Hawthorne effect in which participants may change behavior or increase efforts to improve during the study. There was only one examiner who randomly chose five teeth at each evaluation rather than selecting the same sites for evaluation in each subject. Also, due to the lack of a control group, the examiner had no way to be blinded. The article does note some plaque scores increased. Overall, though, there was a reduction in mean plaque scores. In this study, the oil was swished and pulled between the teeth for eight to 10 minutes, a more realistic situation than the 15 to 20 minutes that many articles suggest.
The last source cited on this web page is from the African Journal of Microbiology Research.5 Sesame oil was also used in this study, and the subjects selected had dental caries. The study reports a 20% reduction in total oral bacteria after 40 days, which they translate to a 50% reduction in caries susceptibility. In this study, there was no control group, and I could find no mention of how many subjects were included. The article had my attention with tables showing the effects of oil pulling on specific bacteria and details on how the samples were selected until this statement is made with no supporting evidence: "Toxins and bacteria from the body might be expelled through the tongue and trapped in the oil and removed from the body." This claim was not part of the research study.
I am aware of at least one university in the United States that is conducting oil pulling research. A PubMed search, however, fails to list any published articles from dental or dental hygiene schools. When I challenged dental hygiene colleagues to provide me with a reputable source for oil pulling research, the only response was for a site selling oil used in oil pulling.6 This website also cites the African Journal of Microbiology Research piece and quotes F. Karach, MD. Surprisingly, a Google and Yahoo search failed to locate any credentials on Dr. Karach, but he is listed as the first to introduce modern oil pulling in 1992.
This web page recommends oil pulling before breakfast as it works better on an empty stomach and notes such dental benefits as fastening of loose teeth, healing of sores, elimination of bleeding gums, and visible whitening of teeth. The promises don't stop there, though, as the page also claims illnesses such as migraines, arthritis, bronchitis, and meningitis will show remarkable improvement.
There are many anecdotal reports of patients with improved gingival appearance after oil pulling. While not discounting these incidences, they do not constitute research or prove any cause and effect. There is no suggestion oil pulling is harmful, and I do not fear for those practicing the technique. But our recommendations should be based on credible research and not merely observation. In my clinical practice, I have seen both positive and negative outcomes from oil pulling with much of the success or failure dependent on the method followed. One cannot, in good conscience, make a broad, sweeping recommendation for oral hygiene based on vague visual assessments and limited double-blind, randomized clinical studies -- not to mention no meta-analysis or systematic review of the literature.
My quest for real answers in the oil pulling debate is not over. I will continue to search for the credentials of Dr. Karach and read more about his presentations. My plan is to continue the ongoing search for university-based research published in the last 10 years. There are many more opinions and testimonials not touched on in this article that warrant mention. This will not be the last time oil pulling appears in this column. In the meantime, let us base our patient education on viable research and not the miracle of the moment.
Websites mentioned in this column
LORY LAUGHTER, RDH, BS, practices clinically in Napa, Calif. She is owner of Dental IQ, a business responsible for the Annual Napa Dental Experience. Lory combines her love for travel with speaking nationally on a variety of topics. She can be contacted at firstname.lastname@example.org.
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