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What are the potential risks and benefits of the “ancient practice” of oil pulling, in which oil is swished or pulled between the teeth for like 15 minutes, and then spit out? There are wild, unsubstantiated claims online, and even in the medical literature. I can believe it’s “good exercise” for your tongue and cheek muscles, but “heal[ing]…all organs simultaneously”? That statement seems a bit of a tongue-in-cheek exercise right there!

Respondents in the British Medical Journal expressed surprise reading that swishing some oil around in the mouth could “effectively treat [diseases like] meningitis [and heart/kidney/hormone] disorders.” Oh, did I mention “cancer, AIDS, etc.”?

Look, it may help in some way, but for things to enter into evidence-based medicine, we actually need a little something called evidence, “without being distracted by illusory effects ascribed…by their advocates,” especially when another set of respondents shared their experience of a case of “severe inflammatory” gingivitis that worsened after oil pulling. She stopped, and it got better. They were thinking maybe some of the oil got like stuck under her gums. Regardless, maybe people should hold off until we actually have some evidence.

Thankfully, there’s a Centre for Evidence-Based Medicine at Oxford that recently compiled all the controlled trials. Why is it so important there’s a control group? Because maybe the reported declines in gingivitis and plaques with oil pulling are just because, in the study, they had dentists looking over their shoulders, with constant check-ups. So, maybe the study subjects just upped their brushing-and-flossing game.

This is the kind of study we need. No changes before and after in the control group, but a drop in plaque and gingivitis scores in the oil-pulling group. That’s more like it. Okay, so there does seem to be an effect.

But, what do those numbers mean? When you test a new drug, it’s not enough to show it works better than nothing—better than a sugar pill. What you ideally want to know is does the new drug work better than the current best drug out there, for the same condition? Otherwise, what’s the point of a new therapy? That’s why drug companies are often forced to use so-called active controls; comparing their drug not just compared to nothing, a placebo, but head-to-head against the leading drug. Here, oil pulling is compared to doing nothing. How about oil pulling compared to chlorhexidine, an antiseptic chemical used in medicated mouthwash, which is considered to be “a gold standard” in the fight against plaque, cavities, and gingivitis?

So, here we go. Ladies and gentlemen—in one corner, we have oil pulling. In the other, chlorhexidine, measuring their ability to lower the number of cavity-producing bacteria on people’s teeth. And…chlorhexidine worked faster, a significant drop within just 24 hours, whereas, it took a week for the oil pulling to really start working. But, by two weeks, the oil pulling may end up just as efficacious as the gold standard. In fact, they appeared to work so similarly that skeptical me is critically thinking, “Wait a second, maybe it’s just the physical act of swishing that disrupts the plaque?” It would have been cool if they included a third group that just swished with water. A,nd they did! And, swishing with water had…no effect.

Now, it wasn’t exactly fair; they had the oil-pulling group swishing for 10 minutes, whereas the other two groups only swished for one. So, for all we know, swishing with water for 10 minutes might be as good as the oil.

And, one could look at this and argue that chlorhexidine actually worked 10 times better, since it got the same effect swishing for one-tenth the time. But, chlorhexidine has side-effects—potentially serious side-effects—like painful desquamation, meaning peeling of the mucous membranes in your mouth, as well as discoloration of the teeth or tongue.

So, “oil…has certain benefits over commercially available mouthrinses.” It’s “non-chemical, non-alcoholic, low cost, and non-staining, yet the effectiveness…[is] unclear.” But wait, oil pulling has been shown to significantly drop the number of cavity-causing bacteria on the teeth.

Yeah, but does that translate out into fewer actual cavities? That’s what we really care about, but it hasn’t been studied. They did pair up oil pulling versus chlorhexidine against plaque and gingivitis, and did find they were both able to help to a similar degree. And, plaque-induced gingivitis is a reasonable predictor of future dental health, thereby explaining the Oxford Center’s conclusion that “oil pulling may [indeed] have beneficial effects on [oral and] dental health.”

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