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ORIGINAL ARTICLE
Year : 2017  |  Volume : 15  |  Issue : 3  |  Page : 200-204

The effect of oil pulling with pure coconut oil on Streptococcus mutans: A randomized controlled trial


1 Department of Public Health Dentistry, Rajah Muthiah Dental College and Hospital, Annamalai University, Chidambaram, Tamil Nadu, India
2 Department of Public Health Dentistry, Career Postgraduate Institute of Dental Sciences and Hospital, Lucknow, Uttar Pradesh, India
3 Department of Public Health Dentistry, Royal Dental College and Hospital, Iron Hills, Palakkad, Kerala, India
4 Department of Public Health Dentistry, Sharad Pawar Dental College, Wardha, Maharashtra, India
5 Department of Microbiology, Krishandevaraya College of Dental Sciences, Bengaluru, Karnataka, India
6 Department of Public Health Dentistry, VSPM Dental College and Research Center, Nagpur, Maharashtra, India

Date of Web Publication18-Sep-2017

Correspondence Address:
Varsha Komath Pavithran
“KOMATH”, 4th Cross, Ayappa Nagar, S.M. Road, Jalahalli West, Bengaluru - 560 015, Karnataka,
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaphd.jiaphd_29_17

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  Abstract 


Introduction: Oil pulling as described in ancient Ayurveda involves the use of edible vegetable oils as oral antibacterial agents. It is a practice of swishing oil in the mouth for oral and systemic health benefits. Pure coconut oil has antimicrobial properties and is commonly available in all Indian households. Aim: This study aims to assess the effect of oil pulling therapy with pure coconut oil on Streptococcus mutans count and to compare its efficacy against sesame oil and saline. Materials and Methods: A randomized controlled concurrent parallel- triple blinded clinical trial was conducted. Thirty participants in age range of 20–23 years were randomly allocated into Group A (coconut oil), Group B (sesame oil), and Group C (saline), with 10 in each group. The participants were instructed to swish and pull 10 ml of oil on empty stomach, early morning for 10–15 min. Unstimulated saliva collected before and after oil pulling procedure was analyzed for colony forming units (CFU) per ml saliva of S. mutans. The data were analyzed using paired t-test, ANOVA, and post hoc analysis using Tukey's honest significant difference. Statistical significance was set at P < 0.05. Results: A statistically significant reduction in S. mutans CFU count after oil pulling with pure coconut oil (P = 0.001) was found. There was no statistically significant difference between sesame oil and coconut oil (P = 0.97) and between sesame oil and saline (P = 0.061). When efficacy of coconut oil against saline was evaluated, a statistical significant difference (P = 0.039) was found. Conclusion: Oil pulling is an effective method for oral hygiene maintenance as it significantly reduces S. mutans count in the saliva.

Keywords: Coconut oil, dental caries, sesame oil, Streptococcus mutans


How to cite this article:
Pavithran VK, Krishna M, Kumar VA, Jaiswal A, Selvan AK, Rawlani S. The effect of oil pulling with pure coconut oil on Streptococcus mutans: A randomized controlled trial. J Indian Assoc Public Health Dent 2017;15:200-4

How to cite this URL:
Pavithran VK, Krishna M, Kumar VA, Jaiswal A, Selvan AK, Rawlani S. The effect of oil pulling with pure coconut oil on Streptococcus mutans: A randomized controlled trial. J Indian Assoc Public Health Dent [serial online] 2017 [cited 2017 Oct 22];15:200-4. Available from: http://www.jiaphd.org/text.asp?2017/15/3/200/215058




  Introduction Top


The concept of oil pulling has been described in the ancient Ayurvedic text “CharakaSamhita” as “Kavalagraha” or “KavalaGandoosha.” It involves use of pure oils as antibacterial agents for inhibiting harmful bacteria, fungus, and other organisms of the mouth, teeth, gums, and throat.[1] Ukranian physician Fedor Karach popularized the concept of oil pulling in 1992 in Russia.

Oil pulling therapy can be done using edible vegetable oils such as sesame oil, sunflower oil, coconut oil, olive oil, and almond oil. Oil pulling is a powerful detoxifying traditional Indian folk technique that has recently become popular as a complementary and alternative remedy to prevent decay, oral malodor, bleeding gums, and for strengthening teeth, gums, and jaws.[2],[3]

Coconut (Cocos nucifera L.) is one of the major commercial crops in southern India, which gives many useful products to the inhabitants.[4] Pure coconut oil is produced by crushing copra, the dried kernel, which contains about 60%–65% of the oil. The lauric acid (one of the fatty acids) in coconut oil is a proven antimicrobial as it can kill bacteria, viruses, and fungi that make it especially well-suited for oral health.[5] The taste of coconut oil is also fairly pleasant compared to other oils.[6]

Over, 400 microbial species can be found in the human mouth, and in general, this ecosystem is maintained at homeostasis, with each microbe inhabiting in its own ecological niche.[7] Changes in the oral cavity caused by an increase in glucose consumption can shift the homeostasis of this ecosystem to particularly acidophilic bacteria known to be damaging to the teeth, resulting in dental caries.[8] The most virulent of these species is Streptococcus mutans, which is considered crucial for the initiation and progression of dental caries as they have more acidogenic and acidophilic properties than those of other oral bacteria.[9],[10],[11],[12]

Oral infectious diseases are painful conditions which are expensive to treat specially in a country like India where oral health care is still beyond the reach of rural population. Therefore, some economical methods are required to reduce the cost of dental treatment which can be attained by the practice of oil pulling therapy.[13] Oil pulling using coconut oil has shown to reduce plaque-induced gingivitis and oral malodour but scientific research related to the effect of coconut oil on bacteria (S. mutans) responsible for the initiation and causation of dental caries is scarce. Hence, this present study was aimed to assess the effect of oil pulling therapy with pure coconut oil on S. mutans count in saliva and to compare the effect of oil pulling therapy with sesame oil and saline.


  Materials and Methods Top


The trial followed a randomized controlled concurrent parallel triple blind clinical trial design. This study is in accordance with the ethical standards on human experiments and with the Helsinki Declaration of 1975, as revised in 2000. Ethical clearance was obtained from the Institutional Review Board of the Dental College. Detailed explanation of the nature, purpose, and material risks of the proposed procedures was given to the study participants in a language that they understand. Informed consent was obtained from the subjects who were willing to participate before starting the study. The anonymity of the participants was maintained throughout the study.

In this study, 54 participants were assessed for eligibility, and 24 were excluded for various reasons during enrollment procedure. The allocation ratio for the present study was taken as 1:1. A total of thirty subjects were included in the study based on a previous study.[14] There were three study groups - Group A (Coconut oil), Group B (Sesame oil), and Group C (Saline). Thirty subjects aged 20–23 years were selected based on inclusion and exclusion criteria and were assigned randomly into Group A (10 – experimental group), Group B (10 – positive control), and Group C (10 – negative control). The subjects of all the three groups were instructed to perform oil pulling for a day which was monitored. The study participants were the students of a Dental College, and the study was conducted in the Department of Public Health Dentistry of the same college [Figure 1].
Figure 1: Flowchart of the study protocol according to CONSORT 2010

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The study presents information based on CONSORT Statement 2010 checklist [Figure 1].

Subjects willing to participate in the study were included. Subjects with a history of antibiotic usage for the past 1 week or who have used any antimicrobial mouthwash for the past 15 days, smokers (past and current), subjects undergoing orthodontic treatment or having a dental prosthesis and are allergic to the oil used were excluded.

In the present study, the pure coconut oil used is extracted from dried coconut kernels, which are also called Copra. It is crude, unrefined, and without any additives. It was mainly extracted by compression of copra in a mill using expeller. On the day of the study, thirty subjects aged 20–23 years assembled in the Department of Public Health Dentistry of the dental college. Each subject was allocated to a group by simple random technique using lottery method by the secondary investigator (RR). Group A (Coconut oil), Group B (Sesame oil), and Group C (Saline) included 10 subjects each.

The unstimulated saliva was collected by spitting method in which the subject allows saliva to accumulate in the mouth and then expectorates into a preweighted plastic sterile container, usually once every 60 s for 5–15 min.[15] The subjects were instructed to come to the department without performing any type of oral hygiene measures. Before the practice of oil pulling therapy, subjects of all three groups were instructed to collect samples of 2 ml unstimulated saliva each in a plastic sterile container labeled “before.”

Procedure to practice oil pulling:[3],[4],[14],[16] One tablespoon (10 ml) of respective group oil (coded in similar bottles) was measured and distributed by RR to each subject, and then, the primary investigator (VK) instructed the participants to pour the oil into the mouth on an empty stomach in the morning. With the mouth closed and chin up, without speed or effort, the subjects were instructed to sip, suck, swish, and pull the oil in the mouth between the teeth in a relaxed way, and also exercise the jaw as if chewing action for a period of 10–15 min. They were instructed not to gargle the oil in the throat.

Initially, the oil was viscous but slowly loses its viscosity and turns into thin and milky white color. The subjects were instructed to spit it out and wash the mouth and teeth thoroughly with water for 30 s. The subjects were instructed to relax for 2 min and then collect 2 ml of unstimulated saliva sample in the plastic sterile container labeled “after.” The participants, principle investigatorand the analyser were blinded throughout the study. They were blinded to the allocated groups and the interventions provided for the same. In the end of the study, RR revealed the coded bottles for interpretation of the results.

The “before” and “after” saliva samples were immediately taken to the Department to Microbiology of the dental college. Each saliva sample was vortexed in the vortex mixer (REMI CM 101) for 1 min. Then, 100 μl of this specimen was transferred to 9.99 ml sterile brain heart agar broth and vortexed again for 1 min. Later, 100 μl of the diluted specimen was transferred to a sterile Mitis Salivarius Bacitracin Agar (HIMEDIA, Mumbai, Maharashtra, India) and spread uniformly using a sterile L spreader (TARSONS, Kolkata, West Bengal, India). The inoculated culture media were incubated at 37°C in a candle extinction jar for 48 h. The colonies on the agar plate were observed. Small convex deep blue colonies were further studied by gram stain and identification tests.

S. mutans were identified by gram stain morphology of Gram-positive cocci occurring in chains. They were confirmed by a positive mannitol and sorbitol fermentation tests. The colonies were counted using a Digital Colony Counter (Labtronics, D. Haridas and Company, Pune, Maharashtra, India) and the colony forming units (CFU) per ml of saliva was calculated.

The data were entered into the computer (MS-office, Excel) and were subjected to statistical analysis using the statistical package - SPSS version 20 (IBM). Proportions, means, standard deviation, and confidence interval for each group before and after oil pulling were calculated. Paired t-test was applied to assess the mean CFU/ml before and after oil pulling procedure in each group separately. ANOVA was applied to compare mean differences between and within groups. Post hoc analysis using Tukey's honest significant difference (HSD) was applied to determine the best among the three groups. Statistical significance value was set at P < 0.05 for this study.


  Results Top


A total of thirty individuals participated in the study with ten subjects in each group. The mean age of study subjects in Group A was 21.7 years, in Group B was 22.3 years, and in Group C was 21.20 years. In Group A, there were 3 (30%) males and 7 (70%) females. In Group B, there were 4 (40%) males and 6 (60%) females. In Group C, there were 2 (20%) males and 8 (80%) females.

The difference in the total number of S. mutans colonies formed before and after swishing of each of the oils was estimated using the CFU count. The mean baseline CFU in the Group A and B was found to be reduced after swishing with coconut oil and sesame oil, respectively. There is a statistically significant reduction (P < 0.05) in S. mutans CFU count before and after oil pulling with pure coconut oil (P = 0.001) and sesame oil (P = 0.001). The Group A and B show effectiveness in CFU compared to baseline and after oil pulling therapy with coconut oil and sesame oil [Table 1].
Table 1: Comparison of mean number of colonies (colony forming units/ml × 103) and paired differences before and after oil pulling therapy among Group A, B, and C

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There was no statistically significant difference in S. mutans CFU count at baseline, between, and within the groups (F = 0.167; P > 0.05). A statistically significant difference in S. mutans count was seen in CFU count after oil pulling between and within the groups (F = 4.158; P= 0.027) [Table 2].
Table 2: Comparison of colony forming units/ml × 103 before and after oil pulling in between and within groups (original)

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Tukey's HSD post hoc secondary analysis was done to show multiple comparisons between the Groups A, B, and C for baseline CFU and after CFU. A statistically significant reduction in S. mutans CFU was seen with Group A after oil pulling with coconut oil when compared to saline group (P = 0.039) whereas no statistically significant reduction was noticed between Group B (sesame oil) and Group C (saline) (P = 0.061). Between sesame and coconut oil groups, there was no statistically significant reduction in S. mutans count (P = 0.976).


  Discussion Top


The present study was planned to evaluate the effect of oil pulling therapy in reducing S. mutans. A study showed that there is a definite indication of a possible saponification and emulsification process during oil-pulling therapy, which enhances the mechanical cleansing action of the oil during oil-pulling therapy.[17] Thus concluding that even one time swish with edible vegetable oils can reduce the microorganisms in the oral cavity. Hence, this present study was conducted for 1 day duration.

Sesame oil is found to be effective in reducing bacterial growth and adhesion.[18] It contains high amounts of linoleic acid and oleic acid (unsaturated fatty acids).[19] Oil pulling therapy with sesame oil was proved to have an effect in the reduction of S. mutans count in plaque and saliva.[2],[14],[16] Hence, it was used as positive control. Saline solution was used as a negative control to rule out the noncausal interpretations of the results obtained.

In the present study, there was a definite reduction in S. mutans count after oil pulling with coconut oil (P = 0.001) and sesame oil (P = 0.001). This finding was in accordance with the in vitro study which showed that coconut oil (P = 0.008) and sesame oil (P = 0.039) showed significant reduction in antibacterial activity against S. mutans on prepared biofilm models.[19]

In a study, sesame oil showed reduction in mean S. mutans count in saliva in 24 h (1.7 ± 1.3–0.9 ± 1.1; P= 0.07).[14] Another study showed decline in mean number of colonies of microorganisms after 45 days of sesame oil pulling therapy (37.1 × 103–31.0 × 103; P < 0.01).[16]

The viability of S. mutans was not affected by any of the vegetable oils.[20] At the highest concentration (416 mg/ml), olive oil inhibited the growth of S. mutans by 30%, followed by palm oil which inhibited up to 27% of growth. Coconut oil and sunflower seed oil inhibited bacterial growth by 26% and 23%, respectively. A study showed the antibacterial effect of sesame oil on total bacteria. The reduction of total count of bacteria ranged from 10% to 33.4%.[18] The average reduction of total count of bacteria was 20% after 40 days of oil-pulling. Therefore, the sesame oil is found to be effective in reducing bacterial growth and adhesion.

Another study showed that there was a net decline in mean plaque scores from baseline to 45 days amounting to 0.81 ± 0.41 (P < 0.01). There was also a net decline in gingivitis which was 0.39 ± 0.17 (P < 0.01).[21] The results of the comparisons of the pre- and post-therapy values of plaque index score and modified gingival index score showed a statistically significant difference in the study group that used sesame oil (P < 0.001).[22]

A study found that sesame oil, olive oil, coconut oil along with chlorhexidine gel showed a significant reduction in values of S. mutans and Lactobacillus count.[13] In a recent study, the effect of coconut oil in plaque-related gingivitis was assessed.[23] There was a steady decline in both the plaque index and the gingival index values from day 7. The average gingival index score on day 30 was down to 0.401 and the plaque index score was 0.385 from 0.91 and 1.19 at baseline, respectively. A study reported no significant reduction in S. mutans after 2 weeks of oil pulling twice daily with sesame oil on 6–12-year-old.[24] whereas another study observed that oil pulling with sesame oil was as efficient as chlorhexidine mouthwash in reducing oral malodor and microorganisms, but the procedure took a long duration of time to be performed.[25]

Although the oil pulling therapy with coconut and sesame oil has shown reduction in the number of CFU/ml of saliva in day duration, the increase in the duration of the study to at least 2 weeks would have given reliable results. Hence, in the future, studies with longer durations are needed to assess the in vivo effect of oil pulling therapy with coconut oil over time.


  Conclusion Top


Oil pulling with both coconut oil and sesame oil was found to be more effective when compared to swishing with saline. Coconut oil was equally effective as sesame oil on S. mutans in saliva. Oil pulling therapy assures to be an improved preventive home remedy adjunct to routine oral hygiene practices in developing countries like India.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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