Abstract: Oil pulling with sesame oil is said to be a very effective means to remove pathogenic bacteria while allowing healthy oral bacteria to survive. Chemical mouthwashes, such as Chlorhexidine, are shown to indiscriminately kill all oral bacteria and have many side-effects. Oil-pulling with sesame oil has few side-effects and may aid in establishing a healthy oral microbiome, dental health, and overall health. Additional benefits of oil-pulling are derived from the length and nature of the treatment which causes prolonged vagus nerve stimulation. To confirm that a change in the oral microbiome occurs due to the effects of oil-pulling, samples of oral bacteria were analyzed using uBiome's 16s rRNA bacterial sequencing prior to, and after a 20 minute oil-pulling session using sesame oil. These results show an increase in probiotic strains of oral bacteria and a decrease in pathogenic strains.
[Please Note: I have used links to external resources in lieu of a formal reference and citation system. None of the links contained in the article are of a commercial nature, unless specified, to highlight products used in the experiment.]
Background: At age 40 I began developing tooth sensitivities, deep periodontal pockets, halitosis, cracked teeth, tooth erosions, and mouth sores. Despite annual cleanings and daily flossing/brushing, my oral health was in steep decline. A "tipping point" occurred after breaking a large molar (Universal Numbering System 18) and an increase in several periodontal pockets approaching a severe depth of 9mm.
My oral health decline appeared simultaneously with the onset of metabolic syndrome symptoms: high blood pressure, high cholesterol, high triglycerides, pre-diabetes, gout, and hypothyroidism. Oral health is linked to overall health as noted by many health agencies, and especially heart disease. A decline in both general health and oral health should be taken as a serious sign of impending disaster.
Discussion: While searching for natural alternatives to the heavily fluoridated toothpaste and frequent cleanings recommended by my dentist, I stumbled across references to oil pulling on the internet. In 2011, I began a regimen of brushing my teeth upon waking using fluoride-free, xylitol-based toothpaste (Amazon: Xyli-White). After my evening meal, I oil-pull for 20 minutes using sesame oil (Amazon: Dynasty Sesame Oil). The oil is spit into a trash can to prevent fouling of home plumbing. I then floss between my teeth using standard dental floss.
Oil Pulling: Oil pulling is an ancient Ayurvedic technique that dates back thousands of years originating in India. Oil pulling is accomplished with raw oil by placing approximately one tablespoon (TBS) of oil in the mouth. The traditional oil used was sesame oil, however sunflower oil is also mentioned in several texts. In at least one study, coconut oil was used with success. The oil is "swished" back and forth between the teeth and around the gums for 15-20 minutes. The oil forms an emulsion with saliva which creates a saponification (soap) action with the oil that allows it to get into the smallest crevices and gaps in your mouth. The oils have antimicrobial properties which attack pathogenic microbes such as S. mutans. Studies have shown oil pulling to be just as effective as the harshest chemicals sold as antibacterial mouthwash, with few side-effects. Ayurvedic writings say that oil pulling is effective at not only reducing plaque, gingivitis, and halitosis, but also other metabolic diseases such as diabetes and asthma. Many sources described the technique as a scam while others were offering high-priced oils guaranteed to cure all sorts of illnesses. Many websites describe an unsubstantiated effect in which toxins are "pulled" from the body and attach themselves to the oils. Further good effects on health may occur through the stimulation of the vagus nerve, described in detail later.
Results: Teeth that had been sensitive to cold and sweet healed almost immediately. My teeth felt cleaner and bad breath was eliminated. A routine dental cleaning after approximately 5 months of daily oil-pulling showed that deep periodontal pockets had nearly all been reduced in size. The dental hygienist remarked that my teeth were nearly plaque-free and very easy to clean. After one-year, nearly all periodontal pockets were reduced to unremarkable depths of 3mm or less. One pocket remains at 5mm on a back molar, causing no apparent problems and remaining constant at this depth.
Here are dental records showing my periodontal status from 2007-2014:
|2007, 2009, 2011|
Before-and-After Oil-pulling Bacterial Sampling: Using a bacterial analysis kit from uBiome (uBiome Explorer Kit), I extracted a bacterial sample, using the provided swab, upon waking. Then, I performed a 20-minute oil-pulling session using sesame oil (Amazon: Dynasty sesame oil). Upon completion, I spit out the emulsified oil, and rinsed for approximately 15 seconds with water to remove oily residues. After a 20-minute waiting period, I extracted a second sample. The samples were immediately shipped to uBiome's facility for processing with 16s rRNA sequencing to identify the bacteria present in each sample.
Analysis: uBiome's "dashboard" of visual analysis tools and raw data reveals several interesting findings. As expected, the predominate genus of bacteria was Streptococcus. This genus of bacteria is almost always the largest colonizer of the oral microbiome, and consists of about 33 species. Streptococcus gordonii (S. gordonii) is the most common of the streptococcus bacteria to inhabit the mouth, known as an "initial colonizer." S. gordonii is generally non-pathogenic, but creates biofilms and initiates dental plaque. Streptococcus thermophilus (S. thermophilus), however, is a true "probiotic" species of oral bacteria. In fact, S. thermophilus is found in commercial oral probiotics designed for dental care (Amazon: Oral Probiotics) and also found naturally in fermented dairy products.
The Streptococcus genus shows a reduction in overall abundance after oil pulling, but a look at the species makeup tells us more:
Oil-pulling appears to have removed almost all of the plaque-forming S.gordonii while sparing S. thermophilus. The small amount of S. mutans present was also halved. Streptococcus mutans is the main cause of dental decay.
Further examination of bacterial genera which displayed changes of statistical importance show that a large change occurred in the genera Leptotrichia, Haemophilus, and Fusobacterium. In regards to Haemophilus, the species present in my sample was H. parainfluenzae. This normal human species can become extremely pathogenic, and is implicated in endocarditis, meningitis, and bacteremia.The overall numbers of H. parainfluenza decreased from 5% of total bacterial count to under 1%. Fusobacterium experienced a two-fold increase, specifically seen in the added abundance of F. periodonticum, a non-pathogenic fermenter of glucose.
The theme of the changes is one of increases in non-harmful commensals ("probiotics") and decreases in bacteria known to be pathogens. Some of these differences can be explained by the makeup of the bacteria, ie. Gram positive or Gram negative, but other changes within genera seem to defy explanation. However, this species-selective killing of pathogens has been described in other ancient remedies such as medicinal healing clays.
In a study of Chlorhexidine, a chemical used in commercial mouthwash preparations (Crest: Mouthwash), a near-linear killing effect of all oral bacteria was seen.
Similar results are seen in studies of commercial mouthwash preparations (Amazon: Listerine and Plax). The goal of consumer and medical grade mouthwash and oral rinses is broad-spectrum killing and overall reduction of colony forming bacteria of all types. The problem with this approach is that the initial colonizers after treatment are often capable of forming biofilms which keep probiotic species at a disadvantage.
In terms of diversity, charts provided by uBiome show genus-level percentages of the samples. It appears that there were less genera represented after oil-pulling than before, but a hand-count in the raw data shows that prior to oil-pulling, there were 45 genera represented and 54 after (for your reference, the full raw data is available via my DropBox in Excel: Before After). Many of these genera represent only a fraction of a percent, so it is hard to show them on a pie-chart, but the overall diversity seems to have increased after oil-pulling. Perhaps my analysis is incorrect, but from looking at the pie-charts, it's obvious to even the casual observer that large changes occurred, indicating that oil-pulling has, at least, had some effect on the bacteria in my mouth.
Discussion: No other microbial niche is as understated as those in the mouth. Our oral health correlates extremely well with the health of our entire body, yet our lack of attention to treating our mouth correctly is appalling. The conventionally recommended methods of keeping a clean mouth are to brush and floss daily, use toothpaste containing fluoride, and an over-the-counter oral rinse. However, I believe a modern approach may not always be the best when dealing with mouth microbes. The toothbrush as we know it has been around for over 1000 years. In 1820 Napoleon Bonaparte was never without his horse hair toothbrush. Hog hair toothbrushes were used in the Tang Dynasty in China around 700AD. The first nylon toothbrush was commercially sold in the 1930’s. Prior to the use of toothbrushes, “chew sticks” (Amazon: Miswak Stick) were commonly used as long ago as 3500BC. These were just like they sound, twigs that were chewed on to clean the teeth. Also, oil-pulling was commonly used in ancient Indian medicine to remove pathogens from the mouth. Both of these techniques may actually be more effective than modern inventions. My personal experience is that practicing conventional methods of oral hygiene did not produce the desired results and changing to a reliance on fluoride free toothpaste and oil-pulling have proven satisfactory.
Vagus Nerve Stimulation: Robert Howland, MD (2014) describes vagus nerve stimulation:
The vagus nerve is a major component of the autonomic nervous system, has an important role in the regulation of metabolic homeostasis, and plays a key role in the neuroendocrine-immune axis to maintain homeostasis through its afferent and efferent pathways. Vagus nerve stimulation (VNS) refers to any technique that stimulates the vagus nerve, including manual or electrical stimulation.
Many modern techniques have been developed to stimulate the vagus nerve for medical effect, but it is often overlooked that the sucking and chewing involved during the eating process also effectively stimulates the vagus nerve. Breastfeeding stimulates the vagus of newborns, causing release of hormones related to anxiety, fullness, and growth. Vagus nerve stimulation speeds motility of the gastrointestinal tract, and chewing gum stimulates the vagus. Chewing gum can be used as a proxy for eating, eg. "sham feeding," to help people who have had gastrointestinal surgery. As chewing is a powerful vagus nerve stimulant, the advice to thoroughly chew your food is based on science. More chewing during meals leads to signals of fullness and release of hormones required for food digestion such as leptin, CCK, and others. The vagus nerve provides the conduit for the oft-cited brain-gut axis.
Oil pulling involves intense activity of all of the muscles in the mouth to facilitate the hydraulic action required to push the oil through the gaps between teeth and along the gum line. Done for 20 minutes, this provides more vagus nerve stimulation than most meals provide. Many of the supposed benefits of oil pulling are claimed to be through the mysterious removal of toxins, not supported by science. However, modern science has indeed seen the incredible power of vagus nerve stimulation. There are many patents for vagus nerve stimulation such as "Systems and methods for vagal nerve stimulation US 20130310909 A1," designed to "modulate the release of inhibitory neurotransmitters in the brain, such as GABA, norepinephrine, and/or serotonin." I submit that oil-pulling is a powerful stimulator of the vagus nerve and as effective as many patented medical devices.
Conclusion: My personal health journey from overweight with metabolic syndrome and poor oral health to great health included many non-medical interventions. My diet now focuses on whole foods while avoiding processed oils, sugars, flours, and additives. I exercise regularly and use oil-pulling as part of my oral hygiene strategy. For people on a similar downward trajectory in health, I highly recommend oil-pulling daily for 20 minutes using sesame oil (Amazon: Dynasty Sesame Oil). I base this recommendation mostly on personal observations of my own health, but I have recently confirmed the selective antibacterial properties of oil-pulling with sesame oil. The ancient method calls for 20 minutes per day using sesame oil, this was my starting point and I have continued doing so for over five years, and see no reason I should ever stop. Sesame oil is cheap and easily sourced. I have used several different brands, but ensure each is labeled "100% pure." I cannot personally recommend other oils, ie. sunflower and coconut, but they have been used successfully in a research setting and should equally stimulate the vagus nerve even if not as effective at manipulating the oral microbiome. More research is needed on different types of oils and minimum effect doses, timing, and duration. The toxin-removing effects of oil-pulling seem undoubtedly over-stated, but the effect on overall health and especially oral health appear to have merit.
To my readers: If any of you would like to do such an experiment, let me know. I think we could design a better test. Preferably several more tests would be performed and a pre-oil-pulling baseline would be established. These tests cost $89 each, so I understand the lack of desire.
Do any of you oil-pull? Anyone convinced now to try? Any questions or comments on specific bacteria present in my tests but not mentioned here?
Further Peer-reviewed Reading:
The effect of oil pulling with rice bran oil, sesame oil, and chlorhexidine mouth rinsing on halitosis among pregnant women: A comparative interventional study. (2016)
Effect of oil pulling in promoting oro dental hygiene: A systematic review of randomized clinical trials. (2016)
The Effect of Coconut Oil pulling on Streptococcus mutans Count in Saliva in Comparison with Chlorhexidine Mouthwash (2016)
Exogenous lipoid pneumonia caused by repeated sesame oil pulling: a report of two cases (2016)
Comparative Evaluation of the Effects of Fluoride Mouthrinse, Herbal Mouthrinse and Oil Pulling on the Caries Activity and Streptococcus mutans Count using Oratest and Dentocult SM Strip Mutans Kit (2015)
Effect of coconut oil in plaque related gingivitis - A preliminary report (2015)
Comparative efficacy of oil pulling and chlorhexidine on oral malodor: a randomized controlled trial (2014)
Lipids in preventive dentistry (2013)
Effect of oil pulling on halitosis and microorganisms causing halitosis: A randomized controlled pilot trial (2011)
Effect of Oil - Pulling on Oral Microorganisms in Biofilm Models (2011)
Tooth brushing, oil pulling and tissue regeneration: A review of holistic approaches to oral health (2011)
Mechanism of oil-pulling therapy -In vitro study (2011)
Effect of oil pulling on plaque induced gingivitis: A randomized, controlled, triple-blind study (2009)
The chemistry and physiological functions of sesame (2009)
Oil Pulling Therapy (2008)
Effect of oil pulling on Streptococcus mutans count in plaque and saliva using Dentocult SM Strip mutans test: A randomized, controlled, triple-blind study (2008)
Effect of oil-pulling on dental caries causing bacteria (2008)