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Review Article

Oil Pulling: A Traditional Method on the Edge of Evidence

H. Mythri
Department of Public Health Dentistry, Sri Siddhartha Dental College, Tumkur, Karnataka, India

Abstract
Introduction: Oil pulling is an ancient, traditional folk remedy that has been practiced for centuries in India and southern Asia as a holistic
Ayurvedic technique. The practice of oil pulling involves placing a tablespoon of an edible oil (e.g. sesame, olive, sunflower, coconut) inside
the mouth, and swishing or “pulling” the oil through the teeth and oral cavity for anywhere from 1–5 minutes to up to 20 minutes or longer.
Materials and Methods: Articles related to oil pulling were collected by using oil pulling as Keyword in Google and Medline. Out of the 21
related articles published till 2016, 6 articles with the proper study designs were used for analysis. Results: The studies were unreliable for
many reasons, including the misinterpretation of results due to small sample size and improper study design. Conclusion: Though the
promoters claim it as one of the best method to be as adjuvant to mechanical control methods, scientific evidences are lacking.

Key words: Ayurveda, oil pulling, oral hygiene, traditional method

INTRODUCTION claim that it is capable of improving oral and systemic health,

Oral health is of prime importance to all individuals. Oral
hygiene habits are instilled in childhood irrespective of the
nationality or geographic location of an individual. The most
reliable and worldwide accepted methods of oral hygiene
maintenance are mechanical methods of tooth cleaning but
adjuvant for decreasing plaque formation and maintaining
oral hygiene have been sought. At present, chemotherapeutic
agents are used as adjuvant agents to reduce plaque
formation, however, they have their own disadvantages.[1]
In the text books of Ayurveda written by Charaka and
Sushrutha (Charaka Samhita and Sushrutha’s Samhitha),
there is a mentioning of a procedure in which an
individual takes a comfortable amount of oil/medicated oil
and holds it or swishes it in the mouth. When the oil turns thin
and milky white it is spit out without swallowing. This
procedure in Ayurveda is called as Kavala graha or
Gandoosha.[2]
Dr. F. Karach popularized this procedure as oil pulling.[3] He
claimed that oil pulling can cure several illnesses including
oral diseases, however, his claims were not supported by
evidence.
including a benefit in conditions such as headaches, migraines,
diabetes mellitus, asthma, and acne, as well as whitening the
teeth. Its promoters claim it works by “pulling out” toxins,
which are known as ama in Ayurvedic medicine, and thereby
reducing inflammation.[5]
Oil pulling has received little study and there is little evidence
to support claims made by the technique’s advocates. The
health claims of oil pulling have failed scientific verification
or have not been investigated. 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.”[4]
Hence, the present review is done to collect and highlight the
lacunas in this area so that it paves the way for future
researchers to bring out the traditional technique benefits
on scientific grounds.
History
In traditional Ayurveda, gargling treatments are used to treat
imbalances of various doshas (problems) and it is believed

Hence, oil pulling or oil swishing is a folk remedy where oil is

“swished” or “held” in the mouth.[4] Practitioners of oil pulling Address for correspondence: Dr. H. Mythri, Department of Public Health
Dentistry, Sri Siddhartha Dental College, Tumkur, Karnataka, India.
E-mail: drmythripcd@gmail.com
Access this article online
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DOI:
10.4103/denthyp.denthyp_64_16 How to cite this article: Mythri H. Oil pulling: A traditional method on
the edge of evidence. Dent Hypotheses 2017;8:57-60.

© 2017 Dental Hypotheses | Published by Wolters Kluwer - Medknow 57

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Mythri: A review on oil pulling

that the dominant dosha in both the individual and nature
determines health care, including dental health.[6]
Background
Oral cavity has billions of bacteria, viruses, fungi, and
parasites living in our mouth. There are over 600 species
of bacteria alone that make our mouths their home. Many of
these bacteria produce toxins as by products, which damage
the teeth and irritate the gums, causing inflammation and
bleeding. An overgrowth of these bacteria leads to tooth
decay and gum disease, and eventually tooth loss.[7]
Discolored teeth, plaque, tartar, cavities, bleeding gums,
sensitive teeth, and chronic bad breath are all signs of an
overgrowth.
Mechanism of action
The general view about oil is that it acts like a cleanser, and
when it is put in the mouth and worked around the teeth and
gums, it pulls out bacteria and other debris much
like the motor oil of a car engine. The motor oil pulls
picks up dirt and grime and when it is drained it pulls the
dirt along with it leaving the engine relatively clean.
Consequently, it was believed that the harmful substances
are expelled from the oral cavity when oil is swished.[7]
There are various hypotheses regarding the mechanisms
by which oil pulling may act in decreasing the
plaque and gingivitis. In oil pulling, as the oil is
swished in the mouth the mechanical shear forces are
exerted
on the oil leading to its emulsification and the surface area
of the oil will be greatly increased. The oil film formed on
the surface of the teeth and the gingiva can reduce plaque
adhesion and bacterial co aggregation.[8]
It has also been proposed that the alkalis in the saliva react
with the oil leading to saponification and formation of a soap-
like substance, which in turn reduces the adhesion of
plaque.[8,9] Oil pulling uses the salivary glands in the
mouth as detoxifying organs; the saliva can trap the toxin
within the oil particles.[4]
MATERIALS AND METHODS
Articles related to oil pulling were collected by using oil
pulling as Keyword in Google and Medline. Out of the 21
related articles published till 2016, 6 articles which
checked the effectiveness of oil pulling were used for
comparison [Table 1].
The review showed that mechanism of action of
oil pulling therapy is still not clear.[10] The articles
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.[4] Oil pulling is best done first thing in the
morning before eating breakfast. After eating, brush the

Table 1: Studies which checked the effectiveness of oil pulling

S. no Studies by Year Objective Methodology Conclusion
1 Amith 2007 To assess the effectiveness of oil Sample size:10 Duration: 45 days Oil pulling with sunflower oil was
et al.[15] pulling compared to other forms of Used: Sunflower oil. found to significantly reduce plaque
oral hygiene. index and gingival index after 45
days.
2 Asokan 2008 To assess the effect of oil pulling on Sample size: 20 Duration: 10 days Chlorhexidine was much more
et al.[16] Streptococcus mutans count in Used: Not mentioned which oil but effective in reducing S. mutans levels
plaque and saliva using Dentocult it is randomized controlled trial with in plaque and saliva
SM Strip mutans test. Chlorhexidine as control group.
3 Asokan 2009 To evaluate the effect of oil pulling Sample size: 20 Duration: 14 days Oil pulling therapy with sesame oil
et al.[8] with sesame oil on plaque-induced Used: Seasame oil Vs was as equally effective as
gingivitis, and to compare its Chlorhexidine. Chlorhexidine in decreasing plaque
efficacy with chlorhexidine induced gingivitis.
mouthwash.
4 Thaweboon 2011 To investigate the effect of oil Sample size: Not mentioned. Used: Coconut oil exhibited antimicrobial
et al.[14] pulling against oral microorganisms coconut oil, corn oil, rice bran oil, activity against S. mutans and C.
in biofilm models. palm oil, sesame oil, sunflower oil albicans. Sesame oil had
and soy bean oil. antimicrobial activity against S.
mutans whereas sunflower oil had
antifungal activity against C.
albicans. L. casei remained resistant
to all tested oils.
5 Hannig 2013 To check if edible oils reduce Sample size: Not mentioned. Used: Oil pulling with olive oil, safflower
et al.[17] bacterial colonization of enamel in Olive oil, safflower oil, or linseed oil oil, or linseed oil had no effect on
situ microbial colonization of the enamel.
6 Faizal 2015 To evaluate the effect of coconut oil Sample size: 60 Duration: 30 days Coconut oil effectively reduced
et al.[18] pulling/oil swishing on plaque Used: Coconut oil plaque formation and gingivitis.
formation and plaque induced
gingivitis.

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Mythri: A review on oil pulling
teeth normally. It can be done one to three times a day, on
an empty stomach.[4]
Oils which can be used for the therapy
As per Ayurvedic literature, sesame oil is one among
many medicinal fluids recommended for daily preventive
use and/or seasonal use to reduce dryness of the mouth
and reduce inflammation and burning sensation in the
mouth.[2,4,11]
In case of specific issues, Ayurvedic practitioners suggest
coconut oil and sunflower oil or other herbalized oils after
proper diagnosis of the specific ailment.[4]
Literature suggested the use of coconut oil because of its high
saponification value (hence it is the oil most commonly used
in making soaps).[12,13] The soaps produced with coconut oil
can lather well and have an increased cleansing action.[12] The
lauric acid in the coconut oil can easily react with sodium
hydroxide in saliva during oil pulling to form sodium
laureate, the main constituent of soap,[13] which might be
responsible for the cleansing action and decreased plaque
accumulation.
RESULTS
Evidence-based studies
Dentists remain sceptical of the claimed benefits behind oil
pulling [Table 1].[4] In-vitro lab studies have shown
antibacterial activity of edible oils such as coconut oil,
sesame oil, and sunflower oil.[4,14]
A study conducted at Ireland in 2012 indicates that coconut
oil which has been partially digested (or enzyme modified)
by saliva is more effective as an antifungal and antibacterial,
than natural coconut oil. Among the pathogens tested were
Candida albicans and Streptococcus mutans which are most
often related to oral health issues.[4] However, reliable
scientific evidence of the benefits and risks is scarce and
the American Dental Association (ADA) states that
insufficient research has been done on oil pulling.[4]
Hence, rather than oil pulling alone, the ADA
recommends brushing the teeth twice a day, flossing, and
the use of an antiseptic mouthwash.[4]
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.”[4]
DISCUSSION
Recent articles in the media recommending oil
pulling procedures generally have not described
potential adverse health effects, however, case reports
of lipoid pneumonia associated with oil pulling or
mineral oil aspiration have appeared in the literature. In
addition, cases of diarrhoea or upset stomach have been
reported.[19,20]
Dental Hypotheses ¦ Volume 8 ¦ Issue 3 ¦ July-September 2017
Reports on the health benefits of oil pulling had clear
limitations.[8,15-18] The existing studies were unreliable for
many reasons, including the misinterpretation of results due
to small sample size, confounders, absence of negative
controls, lack of demographic information, and lack of
blinding. To date, scientific studies have not provided the
necessary clinical evidence to demonstrate that oil pulling
reduces the incidence of dental caries, whitens teeth or
improves oral health and well-being.[8,15-18,21]
As emphasized in the ADA policy statement on
unconventional dentistry, the provision of dental care
should be based on sound scientific principles and
demonstrate clinical safety and effectiveness.
CONCLUSION
Based on the lack of evidence, oil pulling cannot be
recommended as a replacement for standard, time-tested
oral health behaviours and modalities but can be an
effective supplemental aid in a daily oral hygiene regimen.
Overall, as is true for many folk remedies, oil pulling therapy
has insufficient peer-reviewed scientific studies to support its
use for oral conditions. Only, rigorous scientific analysis can
assure its effectiveness and safety.
Financial support and sponsorship
Nil.
Conflicts of Interest
There are no conflicts of interest.
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