What Is Oil Pulling?
Oil pulling is the term given to a technique that involves swirling oil around the mouth, ‘pulling’ the oil between the teeth in order to trap bacteria and then (eventually) spitting out the oil-bacteria mixture (Asokan) .
Oil pulling comes from the Indian healing system of Ayurveda and is mentioned in ancient Ayurvedic texts such as Charak Samhita and Sushruta Samhita (Shanbhag).
More recently, the popularity of oil pulling seems to be largely due to the advocacy of one Dr F Karach (Asokan). Oil pulling pops up almost every time I am on Facebook (and drives me mad). Oil pulling has its very own website and over 35,000 posts on Instagram including #oilpullingchallenges (not a good idea as we will discuss!) And yes it has been commericialized. You can buy over 300 ‘oil pulling’ products on Amazon. Quite an impact, Dr Karach!
There are two main approaches to oil pulling that people are trying:
- Kavala Gandoosha which involves completely filling the mouth with oil (sounds awful).
- Kavala Graha which involves lesser amounts of oil. (the more common among today's “pullers”... that just sounds so wrong).
The “recommended” dose is one tablespoon of oil for adults and one teaspoon of oil for children over the age of five.
Because – as you'll see below – the practice is based mainly on folklore, there is considerable variability in the guidelines on the frequency and duration required for effective oil pulling. Generally, oil pulling is done before meals and can last anywhere from 5 to 30 minutes per session. Different sources recommend oil pulling one to three times per day. Yes, do the math: That would be 90 minutes of oil pulling in a day, which has to cause jaw ache if not extreme boredom.
Oil pulling has been tried with a wide range of oils (Shanbhag). Sesame, coconut, almond, sunflower and olive oil have all been used. Milk, mango and gooseberry extracts have also been used for oil pulling. Sesame oil is generally considered the oil of choice. However personal preference for the tastes of the different oils and/or a history of allergy to specific oils can also influence the choice of oil. Cold pressed oils are also generally preferred over the cheaper commercially produced oils.
But let's pause for a minute to ask the most important question...
Should anyone even be oil pulling at all?
Depending on your perspective in life, there are two possible ways to look at oil pulling.
That is, “What research is there to support any of the health claims made about oil pulling?”, and “What possible risks are associated with the practice?”
As you'll see below, research on Oil Pulling mainly focuses on health benefits confined to the mouth.
It is worth noting here that the American Dental Association don’t support oil pulling for dental hygiene.(ADA websites 1 and 2)
We recognize that not everyone values scientific evidence, or, when little research exists on something like Oil Pulling, people want answers anyway. In this scenario, tradition often ascends.
In the Ayurvedic tradition, the tongue is believed to be closely connected to the organs of the body (Singh). So the tongue in Ayurveda is equivalent of the foot in reflexology. The tongue-body connection theory extends the role of oil pulling outside of the mouth to the entire body and general health.
The problem with traditions is that they deny the need for rigorous proof. People take them on and believe them precisely because they have been used before.
On matters of health, scientific evidence must come first. Where evidence doesn't exist “let's wait and see” is the safest, cheapest approach.
Lastly, a Note On Human Microbiota
Where no evidence exists for a claim about Oil Pulling, I've commented on the biological plausibility of it; That is, “Is there any chance that this even could be true, if it were to be studied?”. In these parts of the article, you'll hear me mention Human Microbiota.
Human Microbiota is an hot area of research in medical science right now. This is the name given to the trillions of bugs that live with us each and every day. They live on our skin and in our gut. The human microbiota is composed of bacteria, fungi and viruses.
The human gut contains over 1014 bacteria and these bugs play a key role in our overall health and well-being (Qin). These bugs help us make vitamins, ferment our food, break down hormones, maintain our immune system etc.
Some people call them our closest friends but in reality some of these bugs are not so good for us. Usually the bad bugs are kept in check by having a healthy number of good bugs.
Just like our individual fingerprint, our microbiota is unique to each and every one of us.
Everything in your life contributes to the uniqueness of your individual microbiota. Your microbiota is influenced by everything that happens over the span of your life -things such as breast versus bottle feeding, antibiotic use, diet, how you clean your fruit and vegetables, use of antibacterial soap etc. We all have bacteria in our mouth. The bacteria that we have in our mouth are essentially part of the gut microbiota.
What's Microbiota Got To Do With Oil Pulling?
In theory, Oil pulling would play a role in determining the composition of your microbiota as it removes some of the bacteria that live in your mouth. Since your microbiota is just like any ecological system, if you make a change in any ecological system, then you might expect downstream effects.
So... filed under the heading of “Ceppie being as open minded as she can be” is the comment:
There's some small possibility that Oil Pulling has an effect on the body outside of oral hygiene, due to it's influence on Microbiota.
However, a key and unanswered question is whether that would be a positive or negative effect. After all, we don't know whether oil pulling is removing the good or the bad bugs.
Anyhow, let's take this from the top...
Is Oil Pulling Good For Teeth?
Well the answer to that question depends on who you listen to. Here we have the traditional east-west divide.
Dr Karach and Ayurvedic practitioners and followers (aka the East) will say yes.
The American Dental Association (aka the West) does not recommend oil pulling (ADA websites 1 and 2). They say that there is not enough evidence to support oil pulling. To quote them exactly -’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.’
Oil pulling is classified by the Association as ‘unconventional dentistry’. The American Dental Association (ADA) prefers Listerine which has small amounts of four essential oils (thymol, eucalyptol, methyl salicylate and menthol) in an aqueous solution over oil pulling. The policy statement on oil pulling even reminds consumers that ‘Several Listerine antiseptic mouth rinses carry the ADA Seal of Acceptance because they have been shown, through laboratory and clinical studies, to help reduce plaque and gingivitis’.
As an aside, Listerine is currently enjoying extreme fame since a study just published showed that it can help eliminate gonorrhea from the back of the throat (Chow). Listerine wins again it seems!
But now back to the east-west divide.
Researchers from the Centre for Evidenced Based Medicine, Oxford University carried out a comprehensive literature review of all randomised control trials examining the effectiveness of oil pulling on oral hygiene (Gbinigie). They interrogated numerous databases including AMED (Allied and Complementary Medical Databases) and Google Scholar and found 26 relevant studies. Only five of these 26 studies were considered to be well conducted and suitable for inclusion in a systematic overview. The study with the longest duration was just 45 days.
The Oxford researchers concluded that there was ‘limited evidence of moderate quality showing some possible benefits of oil pulling as compared to chlorhexidine mouthwash or placebo’.
Specifically oil pulling was as effective as chlorhexidine in terms of the plaque index, gingival index and reduction of key salivary bacteria known as Strep mutans.
So overall, oil pulling was as effective as chlorhexidine for dental hygiene. However the Oxford researchers explain that it is uncertain if there are real life downstream clinical benefits from the dental hygiene effects of oil pulling.
Since this 2016 review, a new paper from India (again) has been published (Nagilla). This was a randomized, control trial in 40 dental students. The study looked at the effects of oil pulling on plaque. Dental plaque is made up of microorganisms and their products which are all embedded in a complex biological matrix. Dental students were randomized to either a coconut oil arm or a control group with 20 students in each group.The coconut oil group rinsed with coconut oil for 10 minutes per day for 7 days. Would they have been better off studying for those 70 minutes? Apparently not. Statistically significant decreases in plaque scores were noted within just 3 days and lasted for the full 7 days of the study. On the downside, this was a very short study and was non randomized. On the plus side, dental students are likely to have followed the instructions and would have been good judges of plaque scores.
Bottom Line: There is no evidence based reason to use oil pulling instead of regular mouthwash for oral hygiene. Not only is it no more effective at best, it takes longer too.
Does Oil Pulling Help Bad Breath (Halitosis)?
Researchers on oil pulling all make the distinction between bad breath that comes form the mouth (oral malodor) versus bad breath (halitosis). It seems to be a really big deal in this line of work. Just to make things worse, they also call it ‘Organoleptic Breath Assessment’. They then sub-divide it into subjective and objective ‘Organoleptic Breath assessments’. (Maybe they need to get out a bit more?)
The same researchers from Oxford looked at subjective and objective ‘Organoleptic Breath Assessments’ (Gbinigie).
Bottom line: The evidence was inconsistent across the five studies they looked at and no conclusions could be drawn as to whether Oil Pulling improved bad breath.
Does Oil Pulling Help Acne, Psoriasis, or Eczema?
There are no clinical studies to support the role of oil pulling to help acne, psoriasis on eczema.
Based on our current level of understanding, it is not possible to comment on a tongue-body connection or the microbiota theory as plausible mechanisms for possible oil pulling in skin disorders. Only time will tell.
Bottom Line: There is no evidence to support the efficacy of oil pulling in dermatological conditions.
Does Oil Pulling Help Headaches?
There is nothing in the medical literature to directly support the role of oil pulling for the relief of headaches.
There are a number of unsubstantiated reports on blogs and websites about individuals who feel that their headaches improved with the regular use of oil pulling.
Let me be as open minded as I possibly can again.
Some bugs in the mouth break down nitrates and nitrites. This is considered beneficial for heart disease but can trigger migraine headaches. A new study has just been published in the medical literature which shows that migraineurs (yes, thats what they call them) have higher levels of the bugs that break down nitrates (Gonzalez). So now at least we have a tenuous link.
There is some possible biological plausibility for oil pulling helping headaches. However this only works if oil pulling is decreasing the bugs that degrade nitrates. We have to throw out the whole theory if we find that oil pulling actually increases those types of bugs.
But pullers shouldn't run away with this comment just yet...
Let’s assume that oil pulling is good for migraine headaches. This would mean that there is a reduction in the amount of nitric oxide being produced, which is bad for the heart. Good for the migraine and bad for the heart!
Suffice it to say that it is just not simple. It is over-simplistic in the extreme to say that oil pulling traps bacteria which must be good for us. Not all mouth bugs are bad. We live symbiotically with lots of good bugs and we need some of them.
The science behind the human microbiota is growing daily and maybe it sheds additional light on oil pulling in the coming years.
Does Oil Pulling Assist Weight Loss?
Again there are no studies looking at oil pulling and weight loss. There could be a connection with the human microbiota here too. In medicine we now do human-to-human fecal transplants for people with severe antibiotic related diarrhea (Kelly). Yes, you read that right. It sounds weird but it is entirely true.
We can use fresh feces, frozen-and-thawed feces or caspules that we order online! We have noticed that recipients who get feces from obese donors tend to gain weight (Marotz). This makes us think that the human microbiota is an independent factor in determining body weight.
Assuming that there is a link between oil pulling and the human microbiota, then there could be a connection between oil pulling and body weight. Though again, it would be over-simplistic to make assumptions. We have already seen with the microbiota can have opposite effects on headaches and heart disease so who knows what oil pulling does for weight. Who knows which bugs in our microbiota are pro-obesity and which ones are anti-obesity. Pretty interesting though!
Are There Side Effects To Oil Pulling?
Advocates of oil pulling claim that it is ‘entirely safe’. I have never come across anything that is ‘entirely safe’. We were taught in medical school that nothing is safe when you add ‘free range humans’ into any equation.
People who ‘pull’ vigorously can aspirate the oil-bacteria mix into the lungs. This can cause two possible types of pneumonia. Inflammatory pneumonia in response to the irritant effect of the oil or infectious pneumonia from the bacteria.
The risks are highest in young children who find it hard to co-ordinate the ‘pulling’. For this reason, oil pulling is not recommended for children under the age of five.
For the same reason, I also suspect that the ‘#oil pulling challenges’ that I saw on Instagram might not be a great idea. All you need is a highly competitive oil puller and the risks for lipoid pneumonia must increase!
A 2018 paper from Hong Kong describes the clinical history of two patients with tongue cancer who developed lipoid pneumonia from oil pulling (Wong). On the one hand, I totally understand that people with tongue cancer might opt for oil pulling over conventional tooth brushing which could be very painful. On the other hand, people with cancer of the tongue are at a higher risk of aspiration and that risk is further increased by oil pulling.
Outside of personal side effects, I must comment on the side effects to plumbing!
It is not a good idea to spit the oil out into a sink as it can solidify and block the drain (especially if you are doing it three times per day!).
And then there's jaw ache and boredom. Again, I come back to: Why do this rather than mouthwash?
Does Using Coconut Oil Change Anything?
Each time something about oil pulling interrupts my time on Facebook, it seems to talk about coconut oil as opposed to sesame oil. Dr Shanbhag from the Department of Oral Medicine in Karnataka, India has written about the relative merits of coconut oil for oil pulling (Shanbhag).
He lists pleasant taste, anti-microbial and anti-inflammatory properties as the key advantages of coconut oil. He also mentions that another advantage of coconut oil is that it is a multi-purpose product and can be used as a moisturiser too. There is a single preliminary report from Nigeria which supports the use of coconut oil in plaque related gingivitis but not much else (Peedikayil).
Bottom Line: There is no evidence that suggests some additional “benefit” to oil pulling if Coconut Oil is used rather than any other oil.
Conclusion: Does Oil Pulling Really Work?
The scientific literature just does not support the many claims for the health benefits of oil pulling. There are very few studies and it is hard to reach any definite conclusions. A 2019 review of oil pulling concluded that many of the health claims are based on pre-clinical studies (Wallace). A 2018 review said that oil pulling was based on 'bad science' (King). I have seen some researchers refer to oil pulling as 'pulling your leg'.
This issue arises over and over again when we try to look at the evidence base behind any folk or traditional remedies. Invariably we find that there are very few quality studies that we can rely on. Proponents of things like oil pulling then rely on anecdotes and pre-scientific rationale, ridden with bias.
Someone might say “Well, the risks with Oil Pulling are so low, it's cheap, and if it helps my headache, why not?” But if you don't use the standard of evidence, you'll spend the rest of your life trying everything anyone has ever off handedly recommended to cure that headache, rather than just consulting with a medical professional. At the very least you'll waste money and time.
The focus on the human microbiota in western medicine may well just answer some of the questions people have about oil pulling in the years to come. What we do know so far is that it is way too simplistic to think that getting rid of bugs must be good for you. After all we have 1014 bacteria.
In the meantime advocates of oil pulling do need to acknowledge that there are potential side effects as well.
Personally, I'll stick to brushing and flossing because I don’t want to give five minutes three times a day to something that isn't proven. Not to mention the plumbing bill when I accidentally spit into the sink!