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Open Sesame!

You will be forgiven for never having heard of oil pulling. I only recently stumbled upon it, when I found my father swishing sesame seed oil in his mouth for ten minutes, first thing in the morning, before spitting it out. He told me that he’d been taught to do this by my grandfather in Nigeria, and it had become part of his daily oral hygiene routine. After my initial surprise, and a quick internet search, I found that it wasn’t so unusual after all: oil pulling originates from ancient Ayurvedic medicine and is probably commonly practiced in parts of South Asia.

Advocates of oil pulling believe that it improves oral health, and may confer additional systemic benefits, such as reduced risk of heart disease. Anecdotally, my father and grandfather reported improved oro-dental health, as well as enhanced exercise tolerance after just a few months of oil pulling.

Spit it out!

How does oil pulling work? Nobody knows for sure.  Some feel that sesame seed oil reacts with alkali in saliva, triggering saponification (soap formation), with a resulting cleansing effect. Sesame seed oil contains lignans (plant compounds), which may have anti-oxidant and health-promoting properties.  Another theory hypothesizes that oil acts as a viscous barrier against plaque formation.  

Genie in a bottle?

Fascinated, I decided with colleagues at the CEBM, to systematically review  what the scientific literature reports about this practice. We searched for published peer-reviewed articles reporting on randomised trials that compared oil pulling using typical cooking oils with some form of control, such as rinsing with a mouthwash. We found five trials, all performed in India, with varying risk of bias. All five investigated oil pulling with sesame seed oil compared with chlorhexidine mouthwash or a placebo rinse, mostly in young adults. The trial methodologies and outcomes examined varied, such that it wasn’t possible to statistically pool the results.  

Bit of a mouthful

Four trials investigated the plaque index score, which is a visual inspection of the amount of plaque on teeth. Three showed no significant difference between the oil pulling and control groups, and the fourth didn’t report the results for the comparison between the oil pulling and control groups.

Four trials assessed gingival inflammation through visual inspection of the gums; two reported on the gingival index score, and a further two on the modified gingival index score. There was no evidence of a difference between oil pulling and control groups for three of the studies reporting on these scores. One study, again, didn’t report between group comparisons.

Two studies asked the participants to assess their own breath odour (Subjective organoleptic breath score): one out of these two studies showed a reduction in malodour reported by the participants in the oil pulling group, compared with the control group.

No harms were reported, but none of the studies stated that they were looking out for harms.

And the bottom line? Press on, oil-most there…

At present there isn’t enough information about the benefits and potential harms of oil pulling to help us decide whether or not we should take on daily oil pulling, as a tooth brushing adjunct. Perhaps, some of the features that matter most to people who use oil pulling have yet to be measured. My wish would be for more randomised clinical trials, with low risk of bias and performed in varied populations, examining important outcomes (including any possible harms), to help us better understand this fascinating practice.  

(To find out more about oil pulling, see: Effect of oil pulling in promoting oro dental hygiene: A systematic review of randomized clinical trials. Gbinigie, Oghenekome et al. Complementary Therapies in Medicine, Volume 26 , 47 – 54.

Author: Dr Oghenekome Gbinigie; MB BChir, MA (Cantab), MRCGP, DRCOG, DfSRH

Oghenekome Gbinigie is an academic GP trainee, based at the Department for Primary Care Health Sciences, University of Oxford.

Acknowledgement: Many thanks to Dr Elizabeth Spencer (Epidemiologist, Department for Primary Health Sciences, University of Oxford) for stylistic input and assistance in pun generation.