ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Oil Pulling as an Effective Adjunct to Brushing in Reducing Plaque-Induced Gingivitis
Clinical Question In dental patients, does oil pulling, compared to chlorhexidine, produce equal improvement in oral health?
Clinical Bottom Line Pulling oil through your teeth for 10-15 minutes in conjunction with brushing your teeth is as effective at reducing plaque induced gingivitis as a 1 minute pre-brush of 0.12% chlorhexidine rinse. Oil-pulling can be an adequate and affordable oral hygiene tool for preventative home care in conjunction with normal brushing. (See Comments on the CAT below)
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 19336860Asokan/200920 age-match patients all with a similar plaque induced gingivitis score. Randomized Controlled Trial
Key resultsAll patients had similar pre-trial home care routine. 20 patients divided into 2 groups of 10. Group A (sesame oil-pulling for 10-15 minutes) and group B (.12% Chlorhexidine rinse for 1 minute) Each group was evaluated with three metrics; Plaque index, modified gingival index score, and total colony count. The pre-trial scores for each plaque index, modified gingival index score and total colony count were not statistically significant between groups 1 and 2, each group consisting of 10 patients. Group 1 (PI: 1.89 +- .22, MGI: 1.262+-.324, TC: 2.25+-.707) for Group 2 (PI: 1.28 +- .341, MGI: 1.308 +- .311, TC: 2.22+-.833). P-values calculated with a T-test. After 10 days of either rinsing with Chlorhexidine or oil-pulling new metrics were recorded and analyzed again with a T-test. Group 1 (PI: .200 +- .169, MGI: .210+-.155, TC: 1.75+-.463) for Group 2 (PI: .294 +- .206, MGI: .289 +- .187, TC: 1.67+-.707). Both groups showed a statically significant reduction in all three metrics, and continued to show no statically significant difference between the two groups.
Evidence Search (“oil-pulling” [MESH]) AND (“Gingivitis” [MESH]) AND (“Chlorhexidine” [MESH])
Comments on
The Evidence
The evidence indicates that the oil-pulling with sesame oil is as effective against plaque-induced gingivitis as.12% chlorhexidine rinse. At one-third of the price, it could be a valuable home prevention tool. The methodology of the study is good though the sample size is very small and limited to patients aged 16-18 years old. This is a good gate-way study to show some correlation between the benefits of Chlorhexidine rinse and those of pulling oil. The study was triple-blind and had a consistent periodontist as an examiner to prevent any observation bias. Future studies should include a larger patient pool that is also more diverse ethnically, by age, and gender. Also, the trial was run for only 10 days recording the three metrics at the beginning and again at the end. A longer trial with more follow-ups would be useful to see if there are any long-term benefits or disadvantages of one or the other. It would also be useful to determine if different types of edible oils are more effective than others.
Applicability Applicable to all clinicians providing comprehensive care including periodontal counseling. Clinicians should understand that oil-pulling is only beneficial if used in conjunction with quality brushing and needs to be performed at least 10-15 minutes/day.
Specialty/Discipline (Public Health) (Endodontics) (General Dentistry) (Orthodontics) (Periodontics)
Keywords oil, pulling, oil-pulling, chlorhexidine, rinse, home-care, home, care, alternative.
ID# 2754
Date of submission: 07/21/2014spacer
E-mail jeffrey.holt@ucdenver.edu
Author Jeffrey Holt
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Ethelyn Thomason, DMD
Faculty mentor/Co-author e-mail ethelyn.thomasonlarsen@ucdenver.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
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Comments on the CAT
(FOR PRACTICING DENTISTS' and/or FACULTY COMMENTS ON PUBLISHED CATs)
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by Jeffrey Holt (Aurora, Colorado) on 02/25/2015
Thanks for the updates and insights. This continues to be an interesting topic to me due to the demographic and social trends of the population I treat. It's nice to be able to have evidence to share with them.
by John P. Hatch, PhD (San Antonio, TX) on 02/25/2015
A Randomized controlled trial (Sood et. al. (2014; PMID: 25584309) compared chlorhexidine and oil-pulling versus a placebo. Neither treatment was superior to placebo as measured by post-treatment gingival index and plaque index scores.
by Blaine Calahan, DDS (San Antonio, TX) on 12/14/2014
A PubMed search conducted in December 2014 using keywords provided in the published CAT revealed no new evidence of the effect of oil-pulling versus Chlorhexidine as an adjunct to tooth brushing in the reduction of plaque-induced gingivitis. Additional Information: Two articles were published in 2011 by the primary author of the originally cited article, Asokan, and further explore the effects of oil-pulling: PubMed 21911944: This pilot RCT explores the effect of oil-pulling with sesame oil on halitosis compared to chlorhexidine, and indicates no significant difference between the two modalities in the reduction of modified gingival index, plaque index, BANA test, or subjective breath testing by an examiner or the test subject. PubMed 21525674: This in vitro study explores the mechanism of action of oil-pulling using sesame oil indicating no antibacterial effects of the sesame oil and proposing that oil-pulling over a period of 30 minutes results in progressive emulsification of the oil that may alter bacterial adhesion to the tooth and assist in their mechanical removal.
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