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Role of Coconut Oil Pulling On Oral Health – An Overview

Authors:
Role of Coconut Oil Pulling On Oral Health - An Overview
ABSTRACT: Oil pulling (extended mouth swishing) is a long-established ancient herbal practice that includes swishing
of oil for a prolonged period in the mouth for maintaining better oral environment and providing systemic healthy effects.
There are number of edible oils which are used in this therapy but the scientific evidence is limited. Recent literature
shows that coconut is one of the most popular pulling oil amongst all. Coconut oil is effective against many oral and
systemic conditions and also in bacterial and fungal infections because of the presence of lauric acid which is a major
fatty acid component. This article reviews the literature regarding the mechanism, composition, benefits and scientific
clinical studies related to coconut oil pulling therapy on oral health.
KEY WORDS: oil pulling, coconut oil, lauric acid, monolaurin
HOW TO CITE: Saher F, Hosein M, Ahmed J. Role of coconut oil pulling on oral health - an overview. J Pak Dent
Assoc 2018;27(3):94-99.
DOI: https://doi.org/10.25301/JPDA.273.94
Received: 17 April 2018, Accepted: 18 May 2018
INTRODUCTION
ral health correlates with systemic health and
maintaining oral health is very important as oral
cavity is considered a reflection of the general well
being of human body.1 Unnecessary use of antibiotics,
increasing microbial resistance and toxicity has forced
scientists to research on natural herbal products.2 Hence, the
search for alternative therapies to replace the toxic effects
of allopathic medicine has been increased nowadays.3
In these current years Complementary and Alternative
Medicine (CAM) has gained recognition over conventional
allopathic medicine on the grounds that the practices and
products used are natural and safe.4 The CAM is highly
recommended due to the advantages of being cost effective,
safe and giving the freedom of self-treatment without having
any harmful effects.5 Ayurveda is an ancient and well known
modality of CAM which is defined as "The system of
traditional medicine native to the Indian subcontinent and
is practiced in other parts of the world as a form of alternative
medicine".6 Ayurveda emphasize mainly on the prevention
of different kind of systemic diseases rather than curing the
pathological problems or symptoms.7
According to World Health Organization around 80%
of the population across the globe still depends upon these
traditional alternative therapies for their health care.8 This
system is around 5000-year-old which uses specific herbs
and minerals for the treatment of various diseases and the
plants and herbs which are used in the Ayurvedic medicine
have been proven to be harmless and efficient since the
ancient times.9
Oil pulling is a well known ancient herbal procedure that
includes prolonged swishing of oil in the oral cavity to
enhance better oral environment. It is a natural remedy that
has been practiced for centuries in sub-continent specially
in India as a holistic Ayurvedic technique which is mentioned
in the text books written by Charaka and Sushrutha.10 Oil
pulling is not a new concept because way back around
3000BC oil pulling has been discussed in Ayurvedic texts
with the names of Kavala or Gandusha and it has been
beneficial for about 30 different illnesses including diabetes,
asthma, headache and migraine.9,11 In Russia the idea of oil
pulling was renewed by Dr. Karach during the 1990's.6
Dr. Med. Karach mentioned about this extraordinary way
of treatment in a conference at the Academy of Sciences of
UDSSR. He spoke about various different pathologies
including cardiovascular diseases, digestive troubles and
many hormonal disorders which can be treated by oil pulling.12
BENEFITS OF OIL PULLING THERAPY
Oil pulling is currently a well renowned CAM remedy
1. Lecturer and M.Phil candidate Department of Oral Biology Ziauddin College of
Dentistry Karachi.
2. Head of Department Department of Oral Biology Ziauddin College of Dentistry
Karachi.
3. Lecturer and M.Phil candidate Department of Pharmacology Ziauddin College of
Medicine Karachi.
Corresponding author: “Dr. Fizza Saher” <drfizzajabbar@gmail.com >
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REVIEW ARTICLE
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JPDA Vol. 27 No. 03 Jul-Sep 2018
Fizza Saher1BDS
Mervyn Hosein2FDS RCS, FDS RCSE, FFDRCSI
Jabbar Ahmed3BDS
for different oral illnesses.13 Oil pulling is claimed to reduce
the chances of dental caries, bleeding gums, xerostomia,
cracked lips and to maintain overall health of the teeth,
gums, and jaws.14 It also helps in removing bad odor from
the mouth and stimulates the taste buds. Oil pulling can be
an alternative cleaning method in those patients where
brushing is difficult as in mouth ulceration, or in those who
have a tendency to gag as in asthmatics and severe cough.15
However, a survey was conducted by an Indian daily
newspaper "Andhra Jyoti" in1996, on the effects of oil
pulling on various diseases in which total 1041 readers were
included, out of which 89% reported healthy beneficial
effects and only 11% did not reported any improvement in
the signs and symptoms of illnesses.16 The procedure is
useful in number of systemic diseases which have been
illustrated in Fig 1.17
OIL PULLING THERAPY PROCEDURE
In oil pulling, a teaspoonful of any kind of oil is swished
around the mouth early in the morning preferably before
having breakfast, for about 15-20 minutes. The oil is 'pulled'
and forced around the oral cavity. If done correctly, oil will
become viscous, milky white and thinner. It is then
expectorated, the mouth is thoroughly washed with warm
saline or normal tap water followed by routine tooth
brushing.2 If the duration is less than 10 minutes it is not
sufficient and if it exceeds more than 20 minutes there are
chances of reabsorption of toxins. It can be performed by
anyone above 5 years of age, also during pregnancy and
menstruation.18
COMMONLY USED OILS
Commonly used oils for oil pulling include:14
. Coconut oil
. Sunflower oil
. Sesame oil
. Corn oil
. Palm oil
. Soya bean oil
. Rice bran oil.
IMPORTANCE OF COCONUT OIL
Coconut oil is derived from the dried kernel of fully
ripe coconuts. Grown in tropical regions, it has been among
the primary sources of dietary fat for decades.19 Coconut oil
is commonly and culturally used throughout the sub continent
especially in India and Pakistan.20 Coconut oil has many
healthy effects on hair, skin, cholesterol levels and weight
loss. It boosts the immune system and has been used
in stress relief.21 With added health and nutritional benefits
it acts as an anti-inflammatory, immune modulator22,
moisturizer and wound healer. It shows a potent anti-
microbial and anti-fungal activity also.23,24
COMPOSITION OF COCONUT OIL
Coconut oil is made up of medium chain fatty acids
whereas other edible oils have long chain fatty acid
structure.20,25 There are 92% saturated fatty acids, 6%
monounsaturated fatty acids and 2% polyunsaturated fatty
acids in the composition. The distribution of its total fatty
acid content is shown in table 1. Lauric acid, myristic acid
and palmitic acid are its saturated fatty acids components
where as oleic acid and linoleic acid are its only
Role of coconut oil pulling on oral healthSaher F/ Hosein M/ Ahmed J
JPDA Vol. 27 No. 03 Jul-Sep 2018
Table 1
Fatty acid composition of coconut oil
Diabetes
Eczema
Thrombosis
Systemic
benefits of oil
pulling
Chronic skin
disease
Inhibits
metastasis
Body
detoxification
Asthma
Bronchitis
Figure 1
Systemic effects of oil pulling
95
monounsaturated and polyunsaturated fatty acids respectively
whereas, α-tocopherol, β-tocopherol with α-, β and γ-
tocotrienol are the anti-oxidants present in the coconut oil.23
The lauric and capric acids hydrolyzes to become
monoglycerides named as monolaurin and monocaprin,
which are approved by the US Food and Drug Administration
(FDA) as non-toxic compounds and used as generally
recognized as safe(GRAS) food additive.19
MECHANISM OF ACTION
The actual mechanisms behind oil-pulling therapy are
not identified yet. It has been assumed that the plaque
aggregation and bacterial adhesion on the tooth surface can
be inhibited by the high viscosity of coconut oil.26 Moreover,
the monolauric and monocapric acids present in the oil has
the tendency to penetrate cell membranes and eventually
kills the harmful pathogens by inhibiting the enzymes utilized
in energy production and nutrient transfer 25 Another probable
mechanism might be due to the alkali hydrolysis of oil by
the presence of bicarbonates in saliva known as the
saponification process. These soaps might be efficient in
removing microbes or plaque materials.25,27 Coconut oil has
a high saponification index (254.82 mg KOH/100 g oil)
when compared with other edible oils like soybean and
sunflower oil.28 It forms a soap like substance called sodium
laurate, when lauric acid of the oil gives a chemical reaction
with sodium hydroxide and bicarbonates present in saliva,
resulting in decreased plaque adhesion and accumulation
which enhances cleansing action.27,29 Furthermore, the third
theory hypothesizes that the antioxidants present in the oil
cause detoxification by preventing lipid peroxidation, resulting
in an antibiotic-like effect thus helping in the destruction of
microorganisms.30
DISCUSSION
The main advantage of oil pulling therapy is its simplicity
and a method which is economical for the fact it uses only
oil for the swishing for the improvement and maintenance
of good oral health with no strict precautions required to
follow the regimen. Compared to other detoxification
methods, it is effortless and simple.17 However researches
has been done on the side effects produced by the oil pulling
Kuroyama et al reported two cases of exogenous lipoid
pneumonia in patients who routinely performed oil pulling
with sesame oil. The manifestations of exogenous lipoid
pneumonia are fever, weight reduction, cough, dyspnea,
chest discomfort, and hemoptysis. Oil might be accidentally
suctioned amid oil pulling and it was assumed that if the
suctioned oil is microorganism rich, at that point it might
bring about appearance of lipoid pneumonia.31 Upset stomach
has additionally been encountered whereas more scientific
data is required to give proof of conceivable side effects.32
STUDIES RELATED TO THE EFFECTS OF
COCONUT OIL ON SYSTEMIC HEALTH
Literature suggests the use of coconut oil because of its
high saponification value.28 In 2017, Mythri assumed the
formation of sodium laurate( the main component of soap)
which is formed by the interaction of lauric acid found in
coconut oil and sodium hydroxide from the saliva during oil
pulling causes the cleansing effect and decreased plaque
formation in oral cavity.10 Furthermore the presence of lauric
acid in coconut oil can inhibit the growth of Staphylococcus
aureus, Bacillus cereus, Salmonella typhimurium and
Escherichia coli at a concentration of 5% when compared
with Ciprofloxacin.33 In 2006, Ósk Thorgeirsdóttir et al.
investigated the effects of monocaprin acid as a denture
disinfecting agent and he reported an increased antimicrobial
activity against Candida when it is topically applied.34
Likewise, a study done in Nigeria, evaluated 100%
concentration of coconut oil which showed an inhibitory
effect on some species of Candida when compared to
fluconazole.35 Besides this, Verallo-Rowell et al. in 2008
conducted a clinical trial on the antibacterial effects of virgin
coconut oil (VCO) against Staphylococcus aureus collected
from human atopic dermatitis skins and reported a highly
significant decrease in the bacterial count.36
According to an animal study done by S. Intahphuak et
al. VCO was useful in the reduction of ear and paw edema.
The results showed significant anti inflammatory effects
when VCO was given in high doses.37 Furthermore, in a
study by Swee Keong Yeap et al in 2015, mice which were
treated with VCO showed increased levels of brain
antioxidants and reduction of 5-hydroxy tryptamine with
the lowered levels of serum cholesterol, triglyceride, glucose
and corticosterone. He proposed that VCO can be used as
an anti- stress functional oil.38 Horas et al in 2017 conducted
a study to evaluate the beneficial effect of VCO on
palatoplasty, palatal surgical wound healing. The topical
application of virgin coconut oil accelerated wound healing
showing an increased number of fibroblast cells appearing
in the wound, as well as with fewer pain complaints.39
STUDIES RELATED TO EFFECTS OF COCONUT
OIL PULLING ON ORAL HEALTH
Online literature searches in PubMed and Google scholar
provided eight scientific articles on oil pulling therapy related
to coconut oil which are discussed below:
Role of coconut oil pulling on oral healthSaher F/ Hosein M/ Ahmed J
JPDA Vol. 27 No. 03 Jul-Sep 201896
Chalke et al in 2017 conducted a trial with 75 subjects
having plaque-induced gingivitis on the effects of coconut
oil pulling. The clinical parameters such as plaque and
gingival index scores were assessed at day 0, 15 and 30.
Results showed a significant decrease in pre- and post-
treatment scores of plaque and gingival index and they
concluded that coconut oil pulling can be used as an adjunctive
oral hygiene aid in reducing the plaque formation and
subsequent plaque-induced gingivitis.40
In 2017 a randomized controlled triple blinded clinical
trial was conducted by Varsha et al. to evaluate the effect of
oil pulling therapy with pure coconut oil on Streptococcus
mutans count. Total thirty patients were included between
the ages of 20-23 years and randomly divided into coconut
oil, sesame oil and saline groups. The collection of
unstimulated saliva before and after oil pulling therapy was
done and analyzed for the colony forming units (CFU) pe
rml saliva for S. mutans. There was a statistically significant
decrease in the CFU of S. mutans after oil pulling with pure
coconut oil showing P value = 0.001 and also against saline
with P value = 0.039. The results showed that the oil pulling
with pure coconut oil can be effective for maintaining the
oral hygiene as it reduces the S. mutans count in saliva.41
Another trial was carried out in 2017 by Jithender Nagilla
et al., among 40 dental students. The students were randomly
assigned to a study group having coconut oil and the control
group having a placebo. Plaque levels were assessed on
baseline, day 3 and day 7. The results showed significant
decrease in the mean plaque scores and they concluded that
oil pulling is effective in controlling plaque levels.42
Earlier in 2016, Peedikayil conducted a study on a total
of fifty female children aged between 8-12 years for the
evaluation of the antibacterial efficacy of coconut oil in
comparison with chlorhexidine mouthwash. The treatment
regimen (swishing) continued for 30 days with coconut oil
or with chlorhexidine. Using the Dentocult SM StripMutans
test, the microbial count for S. mutans were recorded on day
1, 15, and 30. There was a significant decrease in the S.
mutans count in the coconut oil as well as in chlorhexidine
group. He concluded that the coconut oil has same
antimicrobial effects when compared with chlorhexidine
mouthwash for the reduction of S. mutans. count.43
Another randomized controlled study was done by
Kaushik et al in 2016 with a sample size of 60. The subjects
were divided into three groups, Group A: Oil pulling, Group
B: Chlorhexidine, and Group C: Distilled water. Saliva
samples were collected and cultured on 1st day and after 2
weeks from all subjects. Colonies were counted to compare
the efficacy of coconut oil and Chlorhexidine with distilled
water and statistically significant reduction in S. mutans
count was seen in both the coconut oil pulling and
Chlorhexidine group.44
Moreover, an in-vitro study was conducted by Shino et
al with the isolation of Candida species in children with
Early Childhood Caries. The antifungal activity of coconut
oil, 0.2% chlorhexidine and probiotics on Candida albicans
using Disc Diffusion method, when compared with routinely
prescribed ketoconazole. Results showed that coconut oil
was more effective than probiotics having the mean zone of
inhibition= 16.8 mm. The study reported that Chlorhexidine
and coconut oil have comparable antifungal effects with
ketoconazole.45
Another study by Peedikayil was done in 2015 to assess
the effect of coconut oil pulling on plaque formation and
plaque induced gingivitis. The trial included sixty age matched
adolescent teenagers comprising of the age-group between
16-18 years with plaque induced gingivitis who were advised
oil pulling for 30 days. Patients were evaluated at baseline,
days 1,7,15 and 30 for periodontal scores. Results showed
statistically significant reduction in the plaque and gingival
indexes from the 7th day. Peedikayil concluded that coconut
oil pulling could be used as an efficient supportive therapy
in plaque induced gingivitis.29
An in-vitro study in 2011 was done by Thaweboon S.
on oil-pulling using coconut oil, corn oil, sesame oil,
sunflower oil, palm oil, soya bean oil and rice bran oil. The
biofilm models of Streptococcus mutans, Lactobacillus casei
and Candida albicans were evaluated on salivary-coated
microtiter plates in comparison with the negative and positive
controls i.e. 0.2% chlorhexidine gluconate solution and saline
respectively. The author concluded that the coconut oil has
a significant antimicrobial activity against S. mutans and C.
albicans only.25
To date, there are insufficient numbers of scientific
studies done on coconut oil pulling itself which can provide
the necessary clinical evidence to demonstrate that it reduces
the incidence of tooth decay, shows effective teeth whitening
or improves overall oral health and well-being.17 However,
literature suggests that the use of coconut oil in oil pulling
therapy may decrease the chances of oral and systemic
harmful effects.
CONCLUSION
In reviewing the literature we feel that adequate research
has not been done to assess the benefits of specifically
coconut oil pulling in oral cavity, even though there are
many studies showing the beneficial effects of coconut oil
on general health and oral environment. Available data have
shown that coconut oil pulling can significantly reduce
plaque and gingivitis and can be used as an effective
antibacterial and antifungal agent. Whereas, there is a dire
Role of coconut oil pulling on oral healthSaher F/ Hosein M/ Ahmed J
JPDA Vol. 27 No. 03 Jul-Sep 2018 97
need of additional clinical trials which can investigate the
effects of monolaurin on oral microorganisms present in
dental plaque.
CONFLICT OF INTEREST
None declared.
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2016;2016:5.
https://doi.org/10.1155/2016/7061587
Role of coconut oil pulling on oral healthSaher F/ Hosein M/ Ahmed J
JPDA Vol. 27 No. 03 Jul-Sep 2018 99
... In oil pulling, the oil is swished around the oral cavity in morning preferred on empty stomach for about ten to fifteen minutes and concerning must be done to avoid swallowing the oil. The commonly used oils include coconut, sunflower, sesame, corn, palm, soya bean, and rice bran; coconut oil is consisting of 92% saturated acids and lauric acid represent about 50% of these saturated acids (24,25) . In ancient Indian, it was traditionally believed that the harmful constituents are expelled from the oral cavity when oil is swished (26) . ...
... The cleaning action of coconut oil pulling might explain the slight teeth whitening which reported in this study within the Coconut Oil Swish group only after 2 weeks of use. In one week of use, the whitening effectiveness was insignificant which co-accordance with the fact that natural oil pulling therapy needs more time to get an effect (25) . It was interesting to find tooth health care brands that used coconut oil in its products; some whitening toothpaste contains coconut oil within its' composition as e.g., "Crest 3D White toothpaste with Coconut Oil"; mentioning foaming and cleaning benefits of the oil. ...
... This results could be attributed to the nature of the coconut oil; as it is well established that the main advantages of oil pulling as a traditional therapy in the oral and medical field is due to its natural origin, simplicity, pleasant taste, safe, no allergic reactions, low expense, and promote patient compliance (24,25) . Additionally, coconut has antimicrobial, anti-inflammatory characteristics attributed to the existence of lauric acid, and can be used as emollient and moisturizer (27) . ...
... The processing of oils can change the overall content, chemical structure, and eventual effects on the metabolism [10]. Coconut oil is also composed of: lauric acid -49%, myristic acid -20%, palmitic -7%, capric -6%, caprylic -9%, oleic -4%, steric -3%, linoleic -2%, and caproic acid -1% [15], as can be seen in Figure 2. [15] ...
... The processing of oils can change the overall content, chemical structure, and eventual effects on the metabolism [10]. Coconut oil is also composed of: lauric acid -49%, myristic acid -20%, palmitic -7%, capric -6%, caprylic -9%, oleic -4%, steric -3%, linoleic -2%, and caproic acid -1% [15], as can be seen in Figure 2. [15] ...
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... Besides, the viscosity of coconut oil inhibits plaque and adhesion of bacteria (Asokan et al., 2011) and is an alternate mechanism attributed to the antibiotic effect of coconut oil (Asokan et al., 2011;Naseem et al., 2017). Also, monolauric and monocapric acids in coconut oil penetrate cell membranes and kill pathogens (Saher et al., 2018). Due to its antimicrobial property, coconut oil has been found to be effective against a wide range of microorganisms. ...
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