REVIEW ARTICLE

Role of Coconut Oil Pulling On Oral Health - An Overview

Fizza Saher1 BDS
Mervyn Hosein2 FDS RCS, FDS RCSE, FFDRCSI
Jabbar Ahmed3 BDS

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 According to World Health Organization around 80%

of the population across the globe still depends upon these

O
ral health correlates with systemic health and traditional alternative therapies for their health care.8 This
maintaining oral health is very important as oral system is around 5000-year-old which uses specific herbs
cavity is considered a reflection of the general well and minerals for the treatment of various diseases and the
being of human body.1 Unnecessary use of antibiotics, plants and herbs which are used in the Ayurvedic medicine
increasing microbial resistance and toxicity has forced have been proven to be harmless and efficient since the
scientists to research on natural herbal products.2 Hence, the ancient times.9
search for alternative therapies to replace the toxic effects Oil pulling is a well known ancient herbal procedure that
of allopathic medicine has been increased nowadays.3 includes prolonged swishing of oil in the oral cavity to
In these current years Complementary and Alternative enhance better oral environment. It is a natural remedy that
Medicine (CAM) has gained recognition over conventional has been practiced for centuries in sub-continent specially
allopathic medicine on the grounds that the practices and in India as a holistic Ayurvedic technique which is mentioned
products used are natural and safe.4 The CAM is highly in the text books written by Charaka and Sushrutha.10 Oil
recommended due to the advantages of being cost effective, pulling is not a new concept because way back around
safe and giving the freedom of self-treatment without having 3000BC oil pulling has been discussed in Ayurvedic texts
any harmful effects.5 Ayurveda is an ancient and well known with the names of Kavala or Gandusha and it has been
modality of CAM which is defined as "The system of beneficial for about 30 different illnesses including diabetes,
traditional medicine native to the Indian subcontinent and asthma, headache and migraine.9,11 In Russia the idea of oil
is practiced in other parts of the world as a form of alternative pulling was renewed by Dr. Karach during the 1990's.6
medicine".6 Ayurveda emphasize mainly on the prevention Dr. Med. Karach mentioned about this extraordinary way
of different kind of systemic diseases rather than curing the of treatment in a conference at the Academy of Sciences of
pathological problems or symptoms.7 UDSSR. He spoke about various different pathologies
including cardiovascular diseases, digestive troubles and
1. Lecturer and M.Phil candidate Department of Oral Biology Ziauddin College of
Dentistry Karachi.
many hormonal disorders which can be treated by oil pulling.12
2. Head of Department Department of Oral Biology Ziauddin College of Dentistry
Karachi. BENEFITS OF OIL PULLING THERAPY
3. Lecturer and M.Phil candidate Department of Pharmacology Ziauddin College of
Medicine Karachi.
Corresponding author: “Dr. Fizza Saher” <drfizzajabbar@gmail.com > Oil pulling is currently a well renowned CAM remedy

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 Saher F/ Hosein M/ Ahmed J Role of coconut oil pulling on oral health

for different oral illnesses.13 Oil pulling is claimed to reduce menstruation.18

the chances of dental caries, bleeding gums, xerostomia, COMMONLY USED OILS
cracked lips and to maintain overall health of the teeth,
gums, and jaws.14 It also helps in removing bad odor from Commonly used oils for oil pulling include:14
the mouth and stimulates the taste buds. Oil pulling can be . Coconut oil
an alternative cleaning method in those patients where . Sunflower oil
brushing is difficult as in mouth ulceration, or in those who . Sesame oil
have a tendency to gag as in asthmatics and severe cough.15 . Corn oil
However, a survey was conducted by an Indian daily . Palm oil
newspaper "Andhra Jyoti" in1996, on the effects of oil . Soya bean oil
pulling on various diseases in which total 1041 readers were . Rice bran oil.
included, out of which 89% reported healthy beneficial
effects and only 11% did not reported any improvement in IMPORTANCE OF COCONUT OIL
the signs and symptoms of illnesses.16 The procedure is
useful in number of systemic diseases which have been Coconut oil is derived from the dried kernel of fully
illustrated in Fig 1.17 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
Diabetes especially in India and Pakistan.20 Coconut oil has many
healthy effects on hair, skin, cholesterol levels and weight
Bronchitis Eczema 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 modulator 22 ,
moisturizer and wound healer. It shows a potent anti-
Chronic skin
Systemic microbial and anti-fungal activity also.23,24
benefits of oil Thrombosis
disease pulling
COMPOSITION OF COCONUT OIL

Coconut oil is made up of medium chain fatty acids

Inhibits
whereas other edible oils have long chain fatty acid
Asthma
metastasis structure.20,25 There are 92% saturated fatty acids, 6%
Body monounsaturated fatty acids and 2% polyunsaturated fatty
detoxification
acids in the composition. The distribution of its total fatty
acid content is shown in table 1. Lauric acid, myristic acid

Figure 1
Systemic effects of oil pulling

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 Table 1
Fatty acid composition of coconut oil
sufficient and if it exceeds more than 20 minutes there are
chances of reabsorption of toxins. It can be performed by and palmitic acid are its saturated fatty acids components
anyone above 5 years of age, also during pregnancy and where as oleic acid and linoleic acid are its only

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 Saher F/ Hosein M/ Ahmed J Role of coconut oil pulling on oral health

monounsaturated and polyunsaturated fatty acids respectively bring about appearance of lipoid pneumonia.31 Upset stomach
whereas, α-tocopherol, β-tocopherol with α-, β and γ- has additionally been encountered whereas more scientific
tocotrienol are the anti-oxidants present in the coconut oil.23 data is required to give proof of conceivable side effects.32
The lauric and capric acids hydrolyzes to become
monoglycerides named as monolaurin and monocaprin, STUDIES RELATED TO THE EFFECTS OF
which are approved by the US Food and Drug Administration COCONUT OIL ON SYSTEMIC HEALTH
(FDA) as non-toxic compounds and used as generally
recognized as safe(GRAS) food additive.19 Literature suggests the use of coconut oil because of its
high saponification value.28 In 2017, Mythri assumed the
MECHANISM OF ACTION formation of sodium laurate( the main component of soap)
which is formed by the interaction of lauric acid found in
The actual mechanisms behind oil-pulling therapy are coconut oil and sodium hydroxide from the saliva during oil
not identified yet. It has been assumed that the plaque pulling causes the cleansing effect and decreased plaque
aggregation and bacterial adhesion on the tooth surface can formation in oral cavity.10 Furthermore the presence of lauric
be inhibited by the high viscosity of coconut oil.26 Moreover, acid in coconut oil can inhibit the growth of Staphylococcus
the monolauric and monocapric acids present in the oil has aureus, Bacillus cereus, Salmonella typhimurium and
the tendency to penetrate cell membranes and eventually Escherichia coli at a concentration of 5% when compared
kills the harmful pathogens by inhibiting the enzymes utilized with Ciprofloxacin.33 In 2006, Ósk Thorgeirsdóttir et al.
in energy production and nutrient transfer 25 Another probable investigated the effects of monocaprin acid as a denture
mechanism might be due to the alkali hydrolysis of oil by disinfecting agent and he reported an increased antimicrobial
the presence of bicarbonates in saliva known as the activity against Candida when it is topically applied.34
saponification process. These soaps might be efficient in Likewise, a study done in Nigeria, evaluated 100%
removing microbes or plaque materials.25,27 Coconut oil has concentration of coconut oil which showed an inhibitory
a high saponification index (254.82 mg KOH/100 g oil) effect on some species of Candida when compared to
when compared with other edible oils like soybean and fluconazole.35 Besides this, Verallo-Rowell et al. in 2008
sunflower oil.28 It forms a soap like substance called sodium conducted a clinical trial on the antibacterial effects of virgin
laurate, when lauric acid of the oil gives a chemical reaction coconut oil (VCO) against Staphylococcus aureus collected
with sodium hydroxide and bicarbonates present in saliva, from human atopic dermatitis skins and reported a highly
resulting in decreased plaque adhesion and accumulation significant decrease in the bacterial count.36
which enhances cleansing action.27,29 Furthermore, the third According to an animal study done by S. Intahphuak et
theory hypothesizes that the antioxidants present in the oil al. VCO was useful in the reduction of ear and paw edema.
cause detoxification by preventing lipid peroxidation, resulting The results showed significant anti inflammatory effects
in an antibiotic-like effect thus helping in the destruction of when VCO was given in high doses.37 Furthermore, in a
microorganisms.30 study by Swee Keong Yeap et al in 2015, mice which were
treated with VCO showed increased levels of brain
DISCUSSION antioxidants and reduction of 5-hydroxy tryptamine with
the lowered levels of serum cholesterol, triglyceride, glucose
The main advantage of oil pulling therapy is its simplicity and corticosterone. He proposed that VCO can be used as
and a method which is economical for the fact it uses only an anti- stress functional oil.38 Horas et al in 2017 conducted
oil for the swishing for the improvement and maintenance a study to evaluate the beneficial effect of VCO on
of good oral health with no strict precautions required to palatoplasty, palatal surgical wound healing. The topical
follow the regimen. Compared to other detoxification application of virgin coconut oil accelerated wound healing
methods, it is effortless and simple.17 However researches showing an increased number of fibroblast cells appearing
has been done on the side effects produced by the oil pulling in the wound, as well as with fewer pain complaints.39
Kuroyama et al reported two cases of exogenous lipoid
pneumonia in patients who routinely performed oil pulling STUDIES RELATED TO EFFECTS OF COCONUT
with sesame oil. The manifestations of exogenous lipoid OIL PULLING ON ORAL HEALTH
pneumonia are fever, weight reduction, cough, dyspnea,
chest discomfort, and hemoptysis. Oil might be accidentally Online literature searches in PubMed and Google scholar
suctioned amid oil pulling and it was assumed that if the provided eight scientific articles on oil pulling therapy related
suctioned oil is microorganism rich, at that point it might to coconut oil which are discussed below:

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Chalke et al in 2017 conducted a trial with 75 subjects Chlorhexidine group.44

having plaque-induced gingivitis on the effects of coconut Moreover, an in-vitro study was conducted by Shino et
oil pulling. The clinical parameters such as plaque and al with the isolation of Candida species in children with
gingival index scores were assessed at day 0, 15 and 30. Early Childhood Caries. The antifungal activity of coconut
Results showed a significant decrease in pre- and post- oil, 0.2% chlorhexidine and probiotics on Candida albicans
treatment scores of plaque and gingival index and they using Disc Diffusion method, when compared with routinely
concluded that coconut oil pulling can be used as an adjunctive prescribed ketoconazole. Results showed that coconut oil
oral hygiene aid in reducing the plaque formation and was more effective than probiotics having the mean zone of
subsequent plaque-induced gingivitis.40 inhibition= 16.8 mm. The study reported that Chlorhexidine
In 2017 a randomized controlled triple blinded clinical and coconut oil have comparable antifungal effects with
trial was conducted by Varsha et al. to evaluate the effect of ketoconazole.45
oil pulling therapy with pure coconut oil on Streptococcus Another study by Peedikayil was done in 2015 to assess
mutans count. Total thirty patients were included between the effect of coconut oil pulling on plaque formation and
the ages of 20-23 years and randomly divided into coconut plaque induced gingivitis. The trial included sixty age matched
oil, sesame oil and saline groups. The collection of adolescent teenagers comprising of the age-group between
unstimulated saliva before and after oil pulling therapy was 16-18 years with plaque induced gingivitis who were advised
done and analyzed for the colony forming units (CFU) pe oil pulling for 30 days. Patients were evaluated at baseline,
rml saliva for S. mutans. There was a statistically significant days 1,7,15 and 30 for periodontal scores. Results showed
decrease in the CFU of S. mutans after oil pulling with pure statistically significant reduction in the plaque and gingival
coconut oil showing P value = 0.001 and also against saline indexes from the 7th day. Peedikayil concluded that coconut
with P value = 0.039. The results showed that the oil pulling oil pulling could be used as an efficient supportive therapy
with pure coconut oil can be effective for maintaining the in plaque induced gingivitis.29
oral hygiene as it reduces the S. mutans count in saliva.41 An in-vitro study in 2011 was done by Thaweboon S.
Another trial was carried out in 2017 by Jithender Nagilla on oil-pulling using coconut oil, corn oil, sesame oil,
et al., among 40 dental students. The students were randomly sunflower oil, palm oil, soya bean oil and rice bran oil. The
assigned to a study group having coconut oil and the control biofilm models of Streptococcus mutans, Lactobacillus casei
group having a placebo. Plaque levels were assessed on and Candida albicans were evaluated on salivary-coated
baseline, day 3 and day 7. The results showed significant microtiter plates in comparison with the negative and positive
decrease in the mean plaque scores and they concluded that controls i.e. 0.2% chlorhexidine gluconate solution and saline
oil pulling is effective in controlling plaque levels.42 respectively. The author concluded that the coconut oil has
Earlier in 2016, Peedikayil conducted a study on a total a significant antimicrobial activity against S. mutans and C.
of fifty female children aged between 8-12 years for the albicans only.25
evaluation of the antibacterial efficacy of coconut oil in To date, there are insufficient numbers of scientific
comparison with chlorhexidine mouthwash. The treatment studies done on coconut oil pulling itself which can provide
regimen (swishing) continued for 30 days with coconut oil the necessary clinical evidence to demonstrate that it reduces
or with chlorhexidine. Using the Dentocult SM StripMutans the incidence of tooth decay, shows effective teeth whitening
test, the microbial count for S. mutans were recorded on day or improves overall oral health and well-being.17 However,
1, 15, and 30. There was a significant decrease in the S. literature suggests that the use of coconut oil in oil pulling
mutans count in the coconut oil as well as in chlorhexidine therapy may decrease the chances of oral and systemic
group. He concluded that the coconut oil has same harmful effects.
antimicrobial effects when compared with chlorhexidine
mouthwash for the reduction of S. mutans. count. 43 CONCLUSION
Another randomized controlled study was done by
Kaushik et al in 2016 with a sample size of 60. The subjects In reviewing the literature we feel that adequate research
were divided into three groups, Group A: Oil pulling, Group has not been done to assess the benefits of specifically
B: Chlorhexidine, and Group C: Distilled water. Saliva coconut oil pulling in oral cavity, even though there are
samples were collected and cultured on 1st day and after 2 many studies showing the beneficial effects of coconut oil
weeks from all subjects. Colonies were counted to compare on general health and oral environment. Available data have
the efficacy of coconut oil and Chlorhexidine with distilled shown that coconut oil pulling can significantly reduce
water and statistically significant reduction in S. mutans plaque and gingivitis and can be used as an effective
count was seen in both the coconut oil pulling and antibacterial and antifungal agent. Whereas, there is a dire

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need of additional clinical trials which can investigate the 12. Fife B. Oil Pulling Therapy: Detoxifying and Healing the Body
effects of monolaurin on oral microorganisms present in Through Oral Cleansing: Piccadilly Books, Ltd; 2017.
dental plaque.
13. Singh A, Purohit B. Tooth brushing, oil pulling and tissue
regeneration: A review of holistic approaches to oral health. J Ayurveda
CONFLICT OF INTEREST Integr Med. 2011;2(2):64-8.
https://doi.org/10.4103/0975-9476.82525
None declared.
14. Poonam Tomar, Sudheer Hongal, Manish Jain, Kuldeep Rana,
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