Effect of Oil pulling on Oral Health- A Microbiological Study

 

Smitha Sammith Shetty¹*, Darrien Ray Quays², Justina John², Ng See Yee², Daneshwary a/p Appu², Lim Meng Tze², Tee Shin Chuen², Ahaliaa a/p Sachchithanantham², Sacha Miriam Augustus²

¹Associate Professor, Department of Oral Pathology, Faculty of Dentistry, Melaka Manipal Medical College, Manipal, Karnataka, India

²III Year BDS, Faculty of Dentistry, Melaka Manipal Medical College, Melaka Campus, Malaysia.

 

ABSTRACT:

Introduction: Oil pulling is an Ayurveda practice involving swishing of various types of oils in the mouth for oral and systemic health benefits. The effects of oil pulling has been studied with various oils such as sesame oil, coconut oil and sunflower oil. There are limited reports on assessment on the oral microbial status following oil pulling. Hence we aimed to evaluate the effect of oil pulling with coconut oil and compare its efficacy with chlorhexidine mouthwash. Materials and Method: A study was performed on 20 students between the age group of 19-23 years. They were randomly divided into the test or oil pulling group (Group 1, n=10) and positive control or chlorhexidine group (Group 2, n=10). Recording of the plaque index and microbial analysis of the baseline plaque samples was performed, before and after the oil pulling and use of chlorhexidine in study test and control group respectively. Results: Oil pulling therapy and use of chlorhexidine showed reduction in plaque formation and number of colony forming units. But there was no statistically significant difference in the values of plaque score and colony forming units. Conclusion: The chlorhexidine mouthwash and oil pulling with coconut oil produces near similar effects in terms of plaque formation and reduction of oral bacteria, hence oil pulling can be considered as an alternative in patients with allergy to chlorhexidine.

 

 

 

INTRODUCTION:

Oil pulling is an Ayurveda practice involving swishing of various types of oils in the mouth for oral and systemic health benefits.¹ It is an ancient practice described as “CharakaSamhita” as “Kavalagraha” or “KavalaGandoosha.” which involves detoxifying the body through the salivary glands. Oil pulling has been used extensively as home remedy to prevent tooth decay, strengthening the gums, halitosis, bleeding of the gums, dry throat and cracked lips.²  The pure oils used in oil pulling have antiseptic and antibacterial effects thereby inhibits pathogenic bacteria, fungus and other organisms of the mouth.³

 

 

Oil pulling therapy can be performed using edible oils such as coconut oil, sunflower or sesame oil.⁴ It is a well-known ancient detoxifying Ayurvedic technique practiced in India and has gained popularity in recent times as an alternative medicinal remedy for various systemic ailments.³

 

Researchers at the Athlone Institute of Technology's in Ireland carried out research to evaluate the antibacterial function of natural coconut oil and one treatment with enzymes which brings about digestion. It was tested against the strains of Streptococcus bacteria, which are normal flora in the mouth. It was seen that the enzyme-modified coconut oil effectively inhibited the growth of most strains of Streptococcus bacteria, including Streptococcus mutans, which are the main cause for dental caries.⁵

 

Chlorhexidine is the gold standard antiplaque agent and the most effective antiseptic mouth wash. It decreases the pellicle formation and hence inhibits the formation of plaque.⁶ Although chlorhexidine mouthwash has its own beneficial effects, it also has some adverse effects that may not be pleasant to a user. Chlorhexidine mouthwash can produce an unpleasant taste, burning sensation, staining of teeth and restorative materials. It also have high potential to cause mucosal irritation due to its content and allergy in some individuals.⁷

 

The effects of oil pulling has been studied with various oils such as sesame oil, coconut oil and sunflower^1,8,9. The literature provides very limited data on the effectiveness of oil pulling in bringing about plaque control. Hence our study aimed to explore the effect of oil pulling using coconut oil by both clinical and microbial assessment of the plaque following therapy.

 

MATERIALS AND METHODS:

The study was performed on 20 students between the age group of 19-23 years. The students were randomly divided into the test or oil pulling group (Group 1, n=10) and positive control or chlorhexidine group (Group 2, n=10).  Informed consent was obtained from the students prior to the participation in the study. Subjects with a history of antibiotic usage, previous users of mouthwash, those who have undergone scaling within a month, smokers (past and current), and those having an allergy to the oil used in the study were set as the exclusion criteria. Group 1 was asked to do the oil pulling, while group 2 was asked to use chlorhexidine mouth wash for 15 days. The plaque index (Silness J. and Loe H. in 1964)¹⁰ was recorded and microbial analysis of the baseline plaque samples was performed before and after therapy for both the groups on day 0 (a day before starting the therapy) and day 16 (next day of stopping the therapy).

 

Oil pulling: The students were instructed to do oil pulling by rinsing or swishing the mouth with 10 ml of coconut oil on an empty stomach in the morning before brushing. Oil pulling was to be done with the mouth closed and chin up and the oil to be sipped, sucked, and pulled through the teeth for 10 minutes. The subjects were asked not to gargle in the throat. The oil had to be spit out as the mouth gets full. The mouth and teeth to be washed thoroughly with water after oil pulling. The subjects were instructed to do oil pulling for 15 consecutive days. The same procedure to be followed for use of chlorhexidine mouthwash.

 

Plaque Index:  For recording of plaque index, the assessment of plaque was done on six index teeth 16,12, 24,36,32, and 44. Surfaces of the tooth that were examined includes the four gingival areas; disto-facial, facial, mesio-facial, and lingual surface. The plaque index scores for each individual was recorded.

 

Microbial analysis of Plaque: For microbial analysis of the plaque, the plaque sample was collected using a sterile periodontal probe approximately 1 to 2 hours after eating and brushing. The samples were diluted in saline and then inoculated in blood agar, MacConkey agar using sterile loops, and then incubated at 37°C for 24 hours. The total colony count of the aerobic microorganisms present in the plaque sample were assessed by colony counter. The total number of colonies were counted and multiplied by the dilution factor.

 

The data obtained was subjected to statistical analysis using students paired ‘t’ test, with p< 0.05 considered to be statistically significant.

 

RESULTS:

The study showed no statistical significant difference on comparison of mean pre- plaque scores and colony forming units (CFU) on Blood agar and Mc Conkey’s medium (Table 1) in both the groups indicating that the baseline values of both the groups were same. The comparison of post therapy values for plaque scores (Graph 1) and colony counts showed no statistical significance difference either (Table 2). There was considerable reduction in the pre and post values for plaque scores and colony units for blood agar (Graph 2) in oil pulling therapy. Plaque index scores showed a value of 0.235 and colony forming units of blood agar and MacConkey’s agar showed a value of 0.928 and 0.999 respectively, but these were not statistically significant for the test group. The positive control which was the chlorhexidine group did reduce the colony count in MacConkey’s medium (Graph 3) with a value of 0.31. The values of plaque scores and colony forming units in blood agar however showed values of 0.28 and 0.59 respectively but even these differences were not statistically significant (Table 3).

 

Table 1: Comparison of Mean Pre- plaque scores and CFU on Blood agar and McConkey’s medium

	Group	Mean, SD	df	t	.sig.
Pre Plaque Scores	Test	0.6 ± 0.34	18	0.26	0.794
	Positive Control	0.65 ± 0.48
Pre CFU (Blood Agar)	Test	3.29 ± 3.01	18	0.166	0.869
	Positive Control	3.09 ± 2.1
Pre CFU (MaConkey's)	Test	2.37 ± 1.15	18	1.14	0.262
	Positive Control	3.24 ± 2.09

Level of significance p < 0.05

 

Graph 1: Mean pre and post plaque score for oil pulling and Chlorhexidine group

 

Graph 2: Mean Pre and Post Colony forming units (CFU) on Blood Agar

Table 2: Comparison of Mean Post-Plaque scores and Blood agar and McConkey’s medium

	Group	Mean, SD	df	t	.sig.
Post Plaque Scores	Test	0.47 ± 0.36	18	0.09	0.927
	Positive Control	0.49 ± 0.58			NS
Post CFU (Blood Agar)	Test	3.14 ± 2.54	18	0.471	0.643
	Positive Control	3.65 ± 2.28			NS
Post CFU (MaConkey's)	Test	2.37 ± 2.45	18	0.221	0.827
	Positive Control	2.15 ± 1.9			NS

Level of Significance P <0.05; NS – Not significant

 

 

Graph 3: Mean Pre and post Colony forming units (CFU) on McConkey’s Agar

 

Table 3: Comparison of Pre and Post values of Plaque scores and total CFUs on Blood Agar (BA) and McConkey Agar (MA) for both the groups

Oil Pulling                                      Mean  and Standard Deviation
	Plaque Scores	CFU (BA)	CFU (MA)
Pre- Scores Post- Scores	0.6 ± 0.34 0.47 ± 0.36	3.29 ± 3.01 3.14 ± 2.54	2.37 ± 1.15 2.37 ± 2.45
t	1.27	0.093	0.001
.sig	0.235 (NS)	0.928 (NS)	0.999 (NS)
Chlorhexidine
Pre- Scores Post-scores	0.65 ± 0.48 0.49 ± 0.58	3.09 ± 2.1 3.65 ± 2.28	3.24 ± 2.09 2.15 ± 1.9
t	1.14	0.55	1.05
.sig	0.28 (NS)	0.59 (NS)	0.31 (NS)

NS – Not significant; level of significance at 0.05,

 

 

 

DISCUSSION:

Oral cavity contains wide range of bacteria which includes the normal microflora as well as few other species which is believed to cause oral disease such as dental caries, gingivitis and periodontitis.⁴ Various underlying mechanisms are postulated to be the cause for these oral diseases, and maintaining good oral hygiene can reduce its prevalence.¹¹ Chlorhexidine is considered to be an effective anti-plaque agent to date but some shortcomings such as allergy and discomfort can be confronted in some patients.⁶ The alternate method of oil pulling has been proved to be effective in reducing dental caries, gingivitis and other periodontal disease related to plaque but scientific data to prove its effectiveness is limited.⁴

 

Our study included both clinical and microbiological assessment following the oil pulling therapy and use of chlorhexidine mouth wash. When the mean pre and post plaque scores in oil pulling and chlorhexidine group were compared there was declined in the plaque index score in both the groups (Table 3), indicating both having similar and potential role in decreasing plaque adherence. Asokan et al., reported the oil pulling with sesame oil to be as effective as chlorhexidine in bringing about reduction in decreasing plaque induced gingivitis.¹ Faizal et al., found oil pulling with coconut oil brings about decrease in plaque index score from day 7 of therapy and which further deceases on continued usage.¹²

 

The effectiveness of the therapy can be monitored by microbial analysis of the plaque through the total number of colony forming units. In our study there was decrease in CFUs in blood agar from pre to post therapy of oil pulling where as a surprising increase in CFUs in blood agar from pre to post therapy with chlorhexidine but the results were not statistically significant (Table 3). However this could be due to fact the even normal flora was counted and mean values were considered for total CFUs. Pavithran et al., conducted study on oil pulling using coconut and sesame oil and reported significant reduction in CFUs in saliva following oil pulling with coconut as well as sesame oil.⁹  Similar results were seen in study conducted by Asokan et al., were there was reduction in CFUs post therapy with sesame oil.¹³

 

Analysis of the colonies in the MacConkey’s agar provides significant information about the gram negative bacteria as it resists the growth of gram positive bacteria in the media. Our study showed reduction in CFUs on comparison between pre and post therapy with chlorhexidine. While there was no change in the mean value of CFUs pre and post therapy of oil pulling (Table 3). Asokan et al., also reported similar results with reduction in CFUs but the results were not statistically significant.¹⁴ Hence identification of specific type of bacteria would be of future important in ruling out the definite role of oil pulling in reduction of the bacteria.

 

The effects of using chlorhexidine mouthwash and oil pulling with coconut oil produces near similar effects in terms of prevention of plaque formation and reduction in pathogenic oral bacteria. Chlorhexidine has been known to produce discomfort, discoloration and allergic reactions in some individuals. The disadvantages of chlorhexidine mouthwash can be overcome with oil pulling which may be an effective aid in maintaining oral hygiene.

 

CONFLICT OF INTEREST:

Nil

 

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Accepted on 28.07.2018        © RJPT All right reserved

Research J. Pharm. and Tech 2019; 12(1): 01-04.