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Official Publication
INDIAN ASSOCIATION OF PUBLIC HEALTH DENTISTRY
ISSN 2319-5932
Volume 15 | Issue 3 | July-September 2017
Journal of
Indian Association of
Public Health Dentistry
Journal of
Indian Association of
Public Health Dentistry
Journal of Indian Association Of Public Health Dentistry • Volume 15 • Issue 3 • July-September 2017 • Pages 197-???
Spine
4.5 mm
© 2017 Journal of Indian Association of Public Health Dentistry | Published by Wolters Kluwer ‑ Medknow
200
Abstract
Original Article
IntroductIon
The concept of oil pulling has been described in the ancient
Ayurvedic text “CharakaSamhita” as “Kavalagraha”
or “KavalaGandoosha.” It involves use of pure oils as
antibacterial agents for inhibiting harmful bacteria, fungus,
and other organisms of the mouth, teeth, gums, and throat.[1]
Ukranian physician Fedor Karach popularized the concept of
oil pulling in 1992 in Russia.
Oil pulling therapy can be done using edible vegetable oils such
as sesame oil, sunower oil, coconut oil, olive oil, and almond
oil. Oil pulling is a powerful detoxifying traditional Indian folk
technique that has recently become popular as a complementary
and alternative remedy to prevent decay, oral malodor, bleeding
gums, and for strengthening teeth, gums, and jaws.[2,3]
Coconut (Cocos nucifera L.) is one of the major commercial
crops in southern India, which gives many useful products to
the inhabitants.[4] Pure coconut oil is produced by crushing
copra, the dried kernel, which contains about 60%–65% of the
oil. The lauric acid (one of the fatty acids) in coconut oil is a
proven antimicrobial as it can kill bacteria, viruses, and fungi
that make it especially well‑suited for oral health.[5] The taste
of coconut oil is also fairly pleasant compared to other oils.[6]
Over, 400 microbial species can be found in the human mouth,
and in general, this ecosystem is maintained at homeostasis,
with each microbe inhabiting in its own ecological niche.[7]
Changes in the oral cavity caused by an increase in glucose
Introduction: Oil pulling as described in ancient Ayurveda involves the use of edible vegetable oils as oral antibacterial agents. It is a practice
of swishing oil in the mouth for oral and systemic health benets. Pure coconut oil has antimicrobial properties and is commonly available in all
Indian households. Aim: This study aims to assess the effect of oil pulling therapy with pure coconut oil on Streptococcus mutans count and to
compare its efcacy against sesame oil and saline. Materials and Methods: A randomized controlled concurrent parallel‑ triple blinded clinical
trial was conducted. Thirty participants in age range of 20–23 years were randomly allocated into Group A (coconut oil), Group B (sesame
oil), and Group C (saline), with 10 in each group. The participants were instructed to swish and pull 10 ml of oil on empty stomach, early
morning for 10–15 min. Unstimulated saliva collected before and after oil pulling procedure was analyzed for colony forming units (CFU) per
ml saliva of S. mutans. The data were analyzed using paired t‑test, ANOVA, and post hoc analysis using Tukey’s honest signicant difference.
Statistical signicance was set at P < 0.05. Results: A statistically signicant reduction in S. mutans CFU count after oil pulling with pure
coconut oil (P = 0.001) was found. There was no statistically signicant difference between sesame oil and coconut oil (P = 0.97) and between
sesame oil and saline (P = 0.061). When efcacy of coconut oil against saline was evaluated, a statistical signicant difference (P = 0.039) was
found. Conclusion: Oil pulling is an effective method for oral hygiene maintenance as it signicantly reduces S. mutans count in the saliva.
Keywords: Coconut oil, dental caries, sesame oil, Streptococcus mutans
Address for correspondence: Dr. Varsha Komath Pavithran,
“KOMATH”, 4th Cross, Ayappa Nagar, S.M. Road, Jalahalli West,
Bengaluru - 560 015, Karnataka, India.
E-mail: varsha.k.pavi@gmail.com
This is an open access arcle distributed under the terms of the Creave Commons
Aribuon‑NonCommercial‑ShareAlike 3.0 License, which allows others to remix, tweak,
and build upon the work non‑commercially, as long as the author is credited and the
new creaons are licensed under the idencal terms.
For reprints contact: reprints@medknow.com
How to cite this article: Pavithran VK, Krishna M, Kumar VA, Jaiswal A,
Selvan AK, Rawlani S. The effect of oil pulling with pure coconut oil on
Streptococcus mutans: A randomized controlled trial. J Indian Assoc Public
Health Dent 2017;15:200‑4.
The Effect of Oil Pulling with Pure Coconut Oil on Streptococcus
mutans: A Randomized Controlled Trial
Varsha Komath Pavithran, Madhusudhan Krishna1, Vinod A. Kumar2, Ashish Jaiswal3, Arul K. Selvan4, Sudhir Rawlani5
Department of Public Health Dentistry, Rajah Muthiah Dental College and Hospital, Annamalai University, Chidambaram, Tamil Nadu, 1Department of Public Health
Dentistry, Career Postgraduate Institute of Dental Sciences and Hospital, Lucknow, Uttar Pradesh, 2Depar tment of Public Health Dentistry, Royal Dental College and
Hospital, Iron Hills, Palakkad, Kerala, 3Department of Public Health Dentistry, Sharad Pawar Dental College, Wardha, 5Department of Public Health Dentistry, VSPM
Dental College and Research Center, Nagpur, Maharashtra, 4Department of Microbiology, Krishandevaraya College of Dental Sciences, Bengaluru, Karnataka, India
Access this article online
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Website:
www.jiaphd.org
DOI:
10.4103/jiaphd.jiaphd_29_17
Pavithran, et al.: Oil pulling therapy using coconut oil
Journal of Indian Association of Public Health Dentistry ¦ Volume 15 ¦ Issue 3 ¦ July‑September 2017 201
consumption can shift the homeostasis of this ecosystem to
particularly acidophilic bacteria known to be damaging to the
teeth, resulting in dental caries.[8] The most virulent of these
species is Streptococcus mutans, which is considered crucial
for the initiation and progression of dental caries as they have
more acidogenic and acidophilic properties than those of other
oral bacteria.[9‑12]
Oral infectious diseases are painful conditions which are
expensive to treat specially in a country like India where
oral health care is still beyond the reach of rural population.
Therefore, some economical methods are required to reduce the
cost of dental treatment which can be attained by the practice
of oil pulling therapy.[13] Oil pulling using coconut oil has
shown to reduce plaque‑induced gingivitis and oral malodour
but scientic research related to the effect of coconut oil on
bacteria (S. mutans) responsible for the initiation and causation
of dental caries is scarce. Hence, this present study was aimed
to assess the effect of oil pulling therapy with pure coconut oil
on S. mutans count in saliva and to compare the effect of oil
pulling therapy with sesame oil and saline.
MaterIals and Methods
The trial followed a randomized controlled concurrent parallel
triple blind clinical trial design. This study is in accordance
with the ethical standards on human experiments and with
the Helsinki Declaration of 1975, as revised in 2000. Ethical
clearance was obtained from the Institutional Review Board
of the Dental College. Detailed explanation of the nature,
purpose, and material risks of the proposed procedures
was given to the study participants in a language that they
understand. Informed consent was obtained from the subjects
who were willing to participate before starting the study. The
anonymity of the participants was maintained throughout the
study.
In this study, 54 participants were assessed for eligibility,
and 24 were excluded for various reasons during enrollment
procedure. The allocation ratio for the present study was
taken as 1:1. A total of thirty subjects were included in the
study based on a previous study.[14] There were three study
groups ‑ Group A (Coconut oil), Group B (Sesame oil), and
Group C (Saline). Thirty subjects aged 20–23 years were
selected based on inclusion and exclusion criteria and were
assigned randomly into Group A (10 – experimental group),
Group B (10 – positive control), and Group C (10 – negative
control). The subjects of all the three groups were instructed
to perform oil pulling for a day which was monitored. The
study participants were the students of a Dental College, and
the study was conducted in the Department of Public Health
Dentistry of the same college [Figure 1].
The study presents information based on CONSORT Statement
2010 checklist [Figure 1].
Subjects willing to participate in the study were included.
Subjects with a history of antibiotic usage for the past 1 week
or who have used any antimicrobial mouthwash for the past
15 days, smokers (past and current), subjects undergoing
orthodontic treatment or having a dental prosthesis and are
allergic to the oil used were excluded.
In the present study, the pure coconut oil used is extracted
from dried coconut kernels, which are also called Copra. It
is crude, unrened, and without any additives. It was mainly
extracted by compression of copra in a mill using expeller.
On the day of the study, thirty subjects aged 20–23 years
assembled in the Department of Public Health Dentistry of
the dental college. Each subject was allocated to a group
by simple random technique using lottery method by
the secondary investigator (RR). Group A (Coconut oil),
Group B (Sesame oil), and Group C (Saline) included 10
subjects each.
The unstimulated saliva was collected by spitting method in
which the subject allows saliva to accumulate in the mouth and
then expectorates into a preweighted plastic sterile container,
usually once every 60 s for 5–15 min.[15] The subjects were
instructed to come to the department without performing any
type of oral hygiene measures. Before the practice of oil pulling
therapy, subjects of all three groups were instructed to collect
samples of 2 ml unstimulated saliva each in a plastic sterile
container labeled “before.”
Procedure to practice oil pulling:[3,4,14,16] One tablespoon (10 ml)
of respective group oil (coded in similar bottles) was measured
and distributed by RR to each subject, and then, the primary
investigator (VK) instructed the participants to pour the oil
into the mouth on an empty stomach in the morning. With the
mouth closed and chin up, without speed or effort, the subjects
were instructed to sip, suck, swish, and pull the oil in the mouth
between the teeth in a relaxed way, and also exercise the jaw
as if chewing action for a period of 10–15 min. They were
instructed not to gargle the oil in the throat.
Initially, the oil was viscous but slowly loses its viscosity
and turns into thin and milky white color. The subjects were
instructed to spit it out and wash the mouth and teeth thoroughly
with water for 30 s. The subjects were instructed to relax for
2 min and then collect 2 ml of unstimulated saliva sample in
the plastic sterile container labeled “after.” The participants,
principle investigatorand the analyser were blinded throughout
the study. They were blinded to the allocated groups and the
interventions provided for the same. In the end of the study,
RR revealed the coded bottles for interpretation of the results.
The “before” and “after” saliva samples were immediately
taken to the Department to Microbiology of the dental
college. Each saliva sample was vortexed in the vortex
mixer (REMI CM 101) for 1 min. Then, 100 μl of this
specimen was transferred to 9.99 ml sterile brain heart agar
broth and vortexed again for 1 min. Later, 100 μl of the
diluted specimen was transferred to a sterile Mitis Salivarius
Bacitracin Agar (HIMEDIA, Mumbai, Maharashtra, India)
and spread uniformly using a sterile L spreader (TARSONS,
Pavithran, et al.: Oil pulling therapy using coconut oil
Journal of Indian Association of Public Health Dentistry ¦ Volume 15 ¦ Issue 3 ¦ July‑September 2017
202
Kolkata, West Bengal, India). The inoculated culture media
were incubated at 37°C in a candle extinction jar for 48 h.
The colonies on the agar plate were observed. Small convex
deep blue colonies were further studied by gram stain and
identication tests.
S. mutans were identified by gram stain morphology of
Gram‑positive cocci occurring in chains. They were conrmed by
a positive mannitol and sorbitol fermentation tests. The colonies
were counted using a Digital Colony Counter (Labtronics, D.
Haridas and Company, Pune, Maharashtra, India) and the colony
forming units (CFU) per ml of saliva was calculated.
The data were entered into the computer (MS‑ofce, Excel)
and were subjected to statistical analysis using the statistical
package ‑ SPSS version 20 (IBM). Proportions, means,
standard deviation, and condence interval for each group
before and after oil pulling were calculated. Paired t‑test
was applied to assess the mean CFU/ml before and after oil
pulling procedure in each group separately. ANOVA was
applied to compare mean differences between and within
groups. Post hoc analysis using Tukey’s honest signicant
difference (HSD) was applied to determine the best among
the three groups. Statistical signicance value was set at
P < 0.05 for this study.
Figure 1: Flowchart of the study protocol according to CONSORT 2010
Pavithran, et al.: Oil pulling therapy using coconut oil
Journal of Indian Association of Public Health Dentistry ¦ Volume 15 ¦ Issue 3 ¦ July‑September 2017 203
results
A total of thirty individuals participated in the study with
ten subjects in each group. The mean age of study subjects
in Group A was 21.7 years, in Group B was 22.3 years,
and in Group C was 21.20 years. In Group A, there were
3 (30%) males and 7 (70%) females. In Group B, there
were 4 (40%) males and 6 (60%) females. In Group C, there
were 2 (20%) males and 8 (80%) females.
The difference in the total number of S. mutans colonies formed
before and after swishing of each of the oils was estimated
using the CFU count. The mean baseline CFU in the Group A
and B was found to be reduced after swishing with coconut oil
and sesame oil, respectively. There is a statistically signicant
reduction (P < 0.05) in S. mutans CFU count before and after
oil pulling with pure coconut oil (P = 0.001) and sesame
oil (P = 0.001). The Group A and B show effectiveness in
CFU compared to baseline and after oil pulling therapy with
coconut oil and sesame oil [Table 1].
There was no statistically signicant difference in S. mutans
CFU count at baseline, between, and within the groups
(F = 0.167; P > 0.05). A statistically signicant difference
in S. mutans count was seen in CFU count after oil pulling
between and within the groups (F = 4.158; P = 0.027)
[Table 2].
Tukey’s HSD post hoc secondary analysis was done to
show multiple comparisons between the Groups A, B, and
C for baseline CFU and after CFU. A statistically signicant
reduction in S. mutans CFU was seen with Group A after
oil pulling with coconut oil when compared to saline
group (P = 0.039) whereas no statistically significant
reduction was noticed between Group B (sesame oil) and
Group C (saline) (P = 0.061). Between sesame and coconut
oil groups, there was no statistically signicant reduction in
S. mutans count (P = 0.976).
dIscussIon
The present study was planned to evaluate the effect of oil
pulling therapy in reducing S. mutans. A study showed that
there is a denite indication of a possible saponication and
emulsification process during oil‑pulling therapy, which
enhances the mechanical cleansing action of the oil during
oil‑pulling therapy.[17] Thus concluding that even one time
swish with edible vegetable oils can reduce the microorganisms
in the oral cavity. Hence, this present study was conducted for
1 day duration.
Sesame oil is found to be effective in reducing bacterial
growth and adhesion.[18] It contains high amounts of linoleic
acid and oleic acid (unsaturated fatty acids).[19] Oil pulling
therapy with sesame oil was proved to have an effect in the
reduction of S. mutans count in plaque and saliva.[2,14,16] Hence,
it was used as positive control. Saline solution was used as a
negative control to rule out the noncausal interpretations of
the results obtained.
In the present study, there was a denite reduction in S. mutans
count after oil pulling with coconut oil (P = 0.001) and sesame
oil (P = 0.001). This nding was in accordance with the
in vitro study which showed that coconut oil (P = 0.008)
and sesame oil (P = 0.039) showed signicant reduction in
antibacterial activity against S. mutans on prepared biolm
models.[19]
In a study, sesame oil showed reduction in mean S. mutans
count in saliva in 24 h (1.7 ± 1.3–0.9 ± 1.1; P = 0.07).[14]
Another study showed decline in mean number of colonies
of microorganisms after 45 days of sesame oil pulling
therapy (37.1 × 103–31.0 × 103; P < 0.01).[16]
The viability of S. mutans was not affected by any of the
vegetable oils.[20] At the highest concentration (416 mg/ml),
olive oil inhibited the growth of S. mutans by 30%, followed
by palm oil which inhibited up to 27% of growth. Coconut oil
and sunower seed oil inhibited bacterial growth by 26% and
23%, respectively. A study showed the antibacterial effect of
sesame oil on total bacteria. The reduction of total count of
bacteria ranged from 10% to 33.4%.[18] The average reduction
of total count of bacteria was 20% after 40 days of oil‑pulling.
Table 1: Comparison of mean number of colonies (colony
forming units/ml × 103) and paired differences before
and after oil pulling therapy among Group A, B, and C
Groups
(CFU/ml ×
103)
Mean±SD 95% CI P
Paired
sample
Paired
differences
Lower
bound
Upper
bound
A (n=10)
Baseline CFU 585.90±60.43 183.30±78.20 127.35 239.24 0.001*
After CFU 402.60±81.79
B (n=10)
Baseline CFU 563.80±85.73 151.40±84.30 91.09 211.70 0.001*
After CFU 412.40±117.46
C (n=10)
Baseline CFU 573.30±105.23 50.50±23.67 33.56 67.43 0.303
After CFU 522.80±107.95
*P<0.05, statistically signicant, CFU – Colony forming units,
SD – Standard deviation, CI – Condence interval
Table 2: Comparison of colony forming units/ml × 103
before and after oil pulling in between and within groups
(original)
Mean±SD F P
Baseline CFU
Group A 585.90±60.43 0.167 0.847
Group B 563.80±85.73
Group C 573.30±105.23
After CFU
Group A 402.60±81.79 4.158 0.027*
Group B 412.40±117.46
Group C 522.80±107.95
*P<0.05, statistically signicant. SD – Standard deviation, CFU – Colony
forming units
Pavithran, et al.: Oil pulling therapy using coconut oil
Journal of Indian Association of Public Health Dentistry ¦ Volume 15 ¦ Issue 3 ¦ July‑September 2017
204
Therefore, the sesame oil is found to be effective in reducing
bacterial growth and adhesion.
Another study showed that there was a net decline in
mean plaque scores from baseline to 45 days amounting
to 0.81 ± 0.41 (P < 0.01). There was also a net decline in
gingivitis which was 0.39 ± 0.17 (P < 0.01).[21] The results of
the comparisons of the pre‑ and post‑therapy values of plaque
index score and modied gingival index score showed a
statistically signicant difference in the study group that used
sesame oil (P < 0.001).[22]
A study found that sesame oil, olive oil, coconut oil along
with chlorhexidine gel showed a signicant reduction in
values of S. mutans and Lactobacillus count.[13] In a recent
study, the effect of coconut oil in plaque‑related gingivitis
was assessed.[23] There was a steady decline in both the plaque
index and the gingival index values from day 7. The average
gingival index score on day 30 was down to 0.401 and the
plaque index score was 0.385 from 0.91 and 1.19 at baseline,
respectively. A study reported no signicant reduction in
S. mutans after 2 weeks of oil pulling twice daily with sesame
oil on 6–12‑year‑old.[24] whereas another study observed that
oil pulling with sesame oil was as efcient as chlorhexidine
mouthwash in reducing oral malodor and microorganisms, but
the procedure took a long duration of time to be performed.[25]
Although the oil pulling therapy with coconut and sesame
oil has shown reduction in the number of CFU/ml of saliva
in day duration, the increase in the duration of the study to at
least 2 weeks would have given reliable results. Hence, in the
future, studies with longer durations are needed to assess the
in vivo effect of oil pulling therapy with coconut oil over time.
conclusIon
Oil pulling with both coconut oil and sesame oil was found
to be more effective when compared to swishing with saline.
Coconut oil was equally effective as sesame oil on S. mutans in
saliva. Oil pulling therapy assures to be an improved preventive
home remedy adjunct to routine oral hygiene practices in
developing countries like India.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conicts of interest.
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