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Oil Pulling Your Leg

Oil pulling is a traditional Ayurveda method of oral care. It involves swishing sesame oil or a similar oil, perhaps mixed with other substances, in the mouth for 10-20 minutes as a means of preventing caries (cavities), reducing bacteria, and promoting healthy gums. In our internet-fueled age of misinformation, oil pulling has seen a surge in popularity as it makes the rounds on Facebook and other popular social media sites.

The proliferation of unscientific medical advice also essentially assured that oil pulling would be updated to incorporate the latest marketing memes in the alternative marketplace. It is therefore not surprising that this technique is being presented as a cure-all, treating all sorts of systemic diseases by allegedly pulling toxins from the mouth. The Wellness Mama (the first hit on Google) proclaims:

Oil pulling is an age-old remedy that uses natural substances to clean and detoxify teeth and gums. It has the added effect of whitening teeth naturally and evidence even shows that it is beneficial in improving gums and removing harmful bacteria!

Food Matters also gushes:

It is believed that these oils help the lymphatic system of the body as harmful bacteria are removed and beneficial microflora are given with [sic] a healthy environment to flourish. Because of this holistic perspective, oil pulling has been used as a preventative health measure for many other conditions.

This is followed by a long list of conditions from migraines to bronchitis.

Oil pulling for dental care

Using oil as a rinse for oral care in the time before modern medicine was perhaps not a bad idea, and does have a modicum of plausibility. Just the mechanical act of swishing any fluid around the mouth is likely to dislodge bits of food and clean the teeth. I wouldn’t recommend it over brushing your teeth, but it is probably better than nothing.

Recently several researchers have done small pilot studies looking at the effects of oil pulling. Some are overtly trying to support traditional Indian treatments, but at least they are clear about their biases. In any case, these small studies show that swishing oil in the mouth daily does have an effect, unsurprisingly, on oral bacteria.

A 2008 study by Asokan et al. found that a standard mouthwash containing chlorhexidine reduced Streptococcus mutans (a significant contributor to tooth decay) in plaque at all four time points measured (24 hours, 48 hours, 1 week and 2 weeks) and in the saliva in the latter three time points. The oil pulling group had reduced S. mutans only in plaque at one and two weeks. So the standard therapy, chlorhexidine, was superior to oil pulling in reducing S. mutans.

A 2011 study also by Asokan published in an Indian journal found that oil pulling was equally effective to chlorhexidine in reducing halitosis and bacteria associated with halitosis.

Asokan also investigated a possible mechanisms of action of oil pulling. He found:

Sesamin and sesamolin isolated from sesame oil did not have any antibacterial effect against oral microorganisms like Streptococcus mutans, Streptococcus mitis and Streptococcus viridans. Emulsification of sesame oil occurs during oil-pulling therapy. Increased consumption of NaOH in titration is a definite indication of a possible saponification process.

And concluded:

The myth that the effect of oil-pulling therapy on oral health was just a placebo effect has been broken and there are clear indications of possible saponification and emulsification process, which enhances its mechanical cleaning action.

It seems that rinsing with oil leaves oil in the oral cavity, and that swishing with oil can have a mechanical cleaning action.

That also seems to be the extent of the peer-reviewed scientific literature on oiling pulling – a few preliminary studies by a single researcher with an apparent cultural bias. Even if researcher bias is put aside, the evidence is hardly overwhelming. If taken at face value it indicates that swishing with oil is helpful to oral health, probably just because of the mechanical cleaning (perhaps enhanced by oil emulsification), but is not as effective as standard modern therapy with mouth wash.

Proponents of oil pulling do provide a few more references in obscure journals, but they do not show up on Pubmed even when searching by exact title and author names (which suggests the journals are not officially recognized as peer-reviewed). The studies show similar results – preliminary evidence that swishing with various oils reduces some bacteria, but not better than chlorhexidine.

I did come across one other published paper on oil pulling – a report of recurrent lipoid pneumonia from oil pulling. Lipoid pneumonia is a chemical lung disease caused by aspirating (breathing in) small amounts of oil. The long duration of mouth swishing with oil recommended by oil pulling advocates may increase the risk of lipoid pneumonia as a complication. This is a good reminder that no matter how “natural” and “ancient” a treatment is, we should not assume it is entirely without risk.

Oil pulling for general health

While oil pulling may be a better-than-nothing alternative if you are stuck without modern dental care, there is no scientific basis in either plausibility or empirical evidence for any claims of benefits to general health. Of course, lack of plausibility and evidence is not a barrier to promotion by the alternative gurus.

The claim here is that oil pulling removes “toxins” and harmful bacteria from the body through the oral cavity. Like all alleged detox treatments, specific toxins are never named or measured, nor is any specific causal link made to the specific diseases that are claimed to be treated.

Proponents often refer to the preliminary studies above showing some effect for oral health, again probably just from the mechanical swishing, and then use that to claim that “oil pulling works,” followed by claims that it treats specific diseases and conditions for which there is no evidence. Dr. Bruce Fife, who wrote about recommending oil pulling, claims you should try it:

If you suffer from asthma, diabetes, arthritis, migraine headaches, or any chronic illness,

and

All disease starts in the mouth!

In the extreme oil pulling has become just another “one cure to cure them all” alternative pseudoscience.

Conclusion

Oil pulling is a suggestive misnomer, implying that something bad is being pulled from the mouth (toxins and bacteria). What little scientific evidence exists shows that it is probably not as effective as standard mouth wash, and what benefit it has is likely entirely due to the mechanical act of swishing to remove particles and bacteria from teeth and gums.

There is no reason either theoretically or based upon any evidence to recommend oil pulling (which should be renamed “oil-swishing”) instead of standard modern health care with flossing, tooth-brushing, and mouth rinse. However, it does appear to be better than nothing, and might have a role in developing countries without access to modern oral care. The one caveat is that extended periods of swishing that are commonly recommended (10-20 minutes) are likely not necessary and further present a risk of lipoid pneumonia from accidentally breathing in small amounts of oil.

Oil pulling for general health or any other indication is pure pseudoscience. Detox claims are based on nothing, as are all detox claims. There is no evidence or plausible rationale to recommend oil pulling for any indication other than as a poor substitute for oral care.

Posted in: Dentistry, Herbs & Supplements

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