How dental professionals can respond to "oil pulling" patients

Chicago dentist offers tips for addressing an increasingly popular home care therapy

Note: Although the literature on oil pulling has increased substantially in western countries in recent years, there is still much confusion among dental professionals about the proper response to a patient who has adopted this alternative therapy. In this article, Chicago cosmetic dentist Dr. Jessica T. Emery, founder and owner of Sugar Fix Dental Loft, shares her expertise on the topic of oil pulling and offers guidance for peers who are confronted by a patient who declares oil pulling as part of a home regimen. Read on to hear her response to this issue from a doctor’s point of view and advice on how to approach patients if they ask about it.

By Jessica T. Emery, DMD

For the record, a regular oil-pulling routine should not replace routine dental visits and traditional at-home oral care. Oil pulling does not reverse the effects of tooth decay, and it’s important that patients are made fully aware of that. That being said, I do believe that it is a great supplemental therapy. The phrase “oil pulling” comes from the process of the oil being “worked” in the mouth by pulling, pushing, and sucking it through the teeth. This type of oral therapy isn’t new at all; it has its origins in Ayurvedic medicine dating back 3,000 years.

The procedure involves rinsing (swishing) approximately one tablespoon of oil around in your mouth. As the oil hits your teeth and gums, microbes are picked up as though they are being drawn to a powerful magnet. Bacteria hiding under crevices in the gums and in pores and tubules within the teeth are sucked out of their hiding places and held firmly in the solution.

---------------------------------------------------------

Related article

Nancy Burkhart, RDH magazine columnist, also offers tips for responding to oil-pulling patients

Related video

RDH hosts panel discussion about oil pulling

---------------------------------------------------------

The longer you push and pull the oil through your mouth, the more microbes are pulled free. The oil needs to be swished around long enough for it to turn a milky white, which indicates that the bacteria has been "pulled" off. After roughly 20 minutes the solution is filled with bacteria, viruses and other organisms; at this point, the person spits out the oil and rinses thoroughly with water.

People that “oil pull” state that it has helped whiten their teeth, alleviate halitosis, and even reduce gingivitis. In many cases, people also claim that it helps “prevent” cavities, as well as relieve gum and tooth sensitivity.

It all makes sense from a mechanical perspective. We know the primary cause of tooth decay is bacteria. While I certainly can’t support every claim that is out there, I do believe that this simple oral health technique will likely improve dental health, and, as I’ll discuss later, it may even benefit overall health and wellness.

The oils used

Most microorganisms inhabiting the mouth consist of a single cell. Cells are covered with a lipid (fatty) membrane, which is the cell’s skin. When these cells come into contact with oil, “a fat,” they naturally adhere to each other.

People use different types of oil such as sesame and sunflower oil, but these oils both have omega 6 fats that are pro-inflammatory, and most of us have too much of these in our diet as it is. Coconut oil is preferred because 50% of the fat in coconut oil is comprised of the bacteria whooping ingredient lauric acid. Lauric acid is very well known for its antimicrobial actions; it inhibits Strep mutans that are the primary bacteria that cause tooth decay. With that in mind, it should be no surprise that recent studies have shown the benefit of coconut oil in the prevention of tooth decay.

There is no question that oil pulling lessens the bacterial load in the mouth. As we all know, the mouth is the gateway to the body. When you consider the fact that a clean mouth may have between 1,000 and 100,000 bacteria on each tooth, and those that do not have a clean mouth may have between 100 million and a billion bacteria on each tooth, surely oil pulling can’t hurt? I know the immune system would appreciate a little coconut oil as part of a regular routine. We all want to do what we can to function at the optimal level of health. So, why not oil pull as part of your daily routine? Other than taking a little extra time, what’s the downside? It’s certainly food for thought, pardon the pun!

Systemic effects

On a more serious note, we pre-medicate patients that are immunocompromised before dental visits to prevent illness. If bad bacteria enter the body through the bloodstream and get lodged in the wrong place, such as scar tissue on the heart, a person can become very sick. Bacterial infection is the most common cause of endocarditis, which begins when different germs enter the bloodstream and then travel to the heart. We are well aware that bacteria enter the bloodstream during dental treatment. Patients with MVP (mitral valve prolapse), artificial joints or major surgery need to be pre-medicated. The more inflamed the tissues (gingivitis), the more blood and bad bacteria from inside the mouth can travel into the body.

Pregnant women readily develop gingivitis due to hormones. Bacteria from the mouth can get into the body and lead to premature delivery. Dental/medical practitioners, as well as obstetricians and gynecologists, recommend that expectant mothers schedule regular dental visits throughout pregnancy to avoid giving birth to babies with low birth weights. With this knowledge in mind, it seems that this type of oral health regime may not only benefit oral health but it would also benefit our systemic health.

I attended hygiene school at the Forsyth Institute in Boston before attending dental school; I was surprised to read that a 2005 study at my alma mater discovered much higher levels of oral bacteria such as C. gingivitis and P. melaninogenica, and S. mitis, present in oral cancer patients.

Several other studies also strongly suggest a link between the bacteria in your mouth and serious diseases. Streptococcus mutans is known to cause diseases such as pneumonia, meningitis and sinusitis to name a few. So, when there is clear evidence that many diseases and conditions are influenced by the mouth’s ecology and bacteria, why hasn’t oil pulling been encouraged by dental professionals as a supplemental therapy for patients? It’s a valid question; after all we are in the business of “preventing” oral health problems, right? Not just fixing them? While it will likely draw some skepticism from some of my peers, I think it’s a subject that merits further discussion among dental professionals.

Patient education

If patients embrace oil pulling as part of their daily teeth cleaning regimen, they should adhere to few guidelines:

• Swish gently. If your jaw starts aching after five minutes, slow down. You’re working too hard!
• Do not swallow the oil while swishing. if you find it hard not to, you likely have too much oil in your mouth. Spit it out and try again with a smaller amount.
• Once you have finished pulling, spit the solution into the trash. Do not discard the oil in the sink or down the toilet because over time the oil may build up and clog the pipes.
• Do not drink anything before rinsing your mouth. Rinse with water first before consuming a beverage.

I truly believe that there isn’t a more natural preventative rinse than oil pulling with refined coconut oil. When you consider the harsh chemicals in most mouthwashes, it makes the practice particularly appealing to me.

I believe actions speak louder than words. So my father and I have adopted oil pulling as part of our morning routine. It took a while to get used to it (I started at 10 minutes, three times week and now do 20 minutes three times week). I do love how my mouth feels after swishing and that feeling lasts for much of the day. My father oil pulls every morning, and he feels more energetic. He also told me that his tooth sensitivity has diminished substantially. This makes sense to me because we use vitamin E oil to soothe the gums and clove oil to soothe toothaches.

If patients prefer holistic approaches, I recommend letting them give oil pulling a try. I’m letting my patients know that it could be used adjunctively with their regular home care routine. The state of their oral health may not improve after one session of oil pulling, but if they can manage to keep it up, they might find themselves reaping the practice’s long-term benefits.

Maybe more research and larger scale studies are needed to legitimize oil pulling. My research indicates that there have only been a handful of published clinical trials to date. In conclusion, I believe we should recognize the link between bacteria in the mouth and systemic health not just oral health. I’m certain that oil pulling can’t hurt you. When used in conjunction with regular brushing and flossing, I’m convinced it will actually help you.

Dr. Jessica T. Emery is the founder and owner of Sugar Fix Dental Loft located in Chicago, Ill. Her goal is to provide a fun, relaxing atmosphere so patients can enjoy each and every visit. Sugar Fix Dental Loft offers a wide array of services, including general, cosmetic and restorative dentistry treatments, using the latest in dental technology. Additionally, Sugar Fix offers sedation dentistry for patients who may normally be anxious about seeing the dentist.