Mouth "Oil Pulling"

The other day, I had a patient ask me about "oil pulling." For those who don't know what oil pulling is:

"Oil pulling or oil swishing is a traditional Indian folk remedy that involves swishing oil in the mouth. It is mentioned in the Ayurvedic text Charaka Samhita, where it is called Kavala Gandoosha or Kavala Graha. Ayurvedic literature describes oil pulling as capable of both improving oral health and treating systemic diseases such as diabetes mellitus or asthma. While scientific evidence is lacking to support any systemic benefits of oil pulling, some studies have suggested that it may reduce oral plaque, halitosis, and gingivitis." [Wikipedia]

The oil used to swish the mouth is typically vegetable based like sesame or sunflower and is performed for 15-20 minutes before being spit out (or swallowed depending on what you want to accomplish).

Though there are plenty of testimonials on the internet and explanations for its amazing effects including the oil's alleged ability to suck plaque off teeth, absorb germs into the oil, make teeth whiter, etc I feel the oil's effects are more mundane in nature.

Just as chapstick is an oil-based compound that treats dried and chapped lips by coating the surface allowing the lip mucosa to heal, oil pulling may just provide a protective barrier to provide a similar function. Oils are essential to skin and mucosal health and when such oils are stripped, problems occur (ask anybody who washes their hand with soap multiple times a day).

As such, I personally don't think it can hurt if someone wants to give oil pulling a try to address oral problems. But I would not recommend this type of unproven treatment to address systemic disorders like diabetes or asthma over more established medical management.

Of note, the references listed below are studies published in less-than-authoratative journals.

References:
Tooth brushing, oil pulling and tissue regeneration: A review of holistic approaches to oral health. J Ayurveda Integr Med 2 (2): 64–8. doi:10.4103/0975-9476.82525.

Effect of oil pulling on Streptococcus mutans count in plaque and saliva using Dentocult SM Strip mutans test: a randomized, controlled, triple-blind study. J Indian Soc Pedod Prev Dent 26 (1): 12–7.

Mechanism of oil-pulling therapy - in vitro study. Indian J Dent Res 22 (1): 34–7. doi:10.4103/0970-9290.79971.

Effect of oil pulling on plaque induced gingivitis: a randomized, controlled, triple-blind study. Indian J Dent Res 20 (1): 47–51. PMID 19336860.

Effect of oil pulling on halitosis and microorganisms causing halitosis: a randomized controlled pilot trial. J Indian Soc Pedod Prev Dent 29 (2): 90–4. doi:10.4103/0970-4388.84678.

Tonsil Bad Breath and Tonsil Stones

The Huffington Post published a story on tonsil stones on April 4, 2012 which can lead to bad breath. The author, who is a dentist, gave the perspective of conservative treatment strategies to resolve bad breath whose root cause is due to tonsil stones otherwise known as tonsilloliths.

Such "stones" are produced and ejected from tonsils and consist of mucus, dead cells and other debris that collect in the deep pockets of the tonsils and gradually condense into small, light-colored globs. Bacteria feed on this accumulated matter, giving rise to the odor which is downright foul-smelling (and foul-tasting).

The only known cure for tonsilloliths is tonsillectomy (no tonsils = no tonsil stones), though the article does outline more conservative measures which are encouraged first prior to surgery. More recently, there is a minimally invasive procedure called tonsil cryptolysis which also has the potential to eliminate this problem prior to considering tonsillectomy.

A recent research paper does offer tantalizing clues to address tonsilloliths more conservatively as it found that tonsil stones are more like living biofilms rather than an inert stone. Read the abstract here. 

Source:
The Different Kinds of Bad Breath, Part 2: Tonsil Breath. Huffington Post 4/4/12

Why Do People Have Morning Breath?

The answer is actually pretty straight-forward... The human mouth is actually considered one of the dirtiest mouths among animals. In fact the human mouth contains so much bacteria, a human bite is considered more "dangerous" from an infection standpoint that a bite from a dog.

During the day, we constantly swallow and eat/drink which washes away the bulk of the bacteria. We also brush our teeth and gargle our mouths which also helps.

Unfortunately, during the night, none of these activities occur which allow bacteria to proliferate and produce the smells associated with bad breath.

What makes this situation worse is that you can only smell other peoples' bad breath and not your own. Why is that? It's because our sense of smell becomes desensitized to smells that's around continuously.

In other words, if you smell someone's bad morning breath for a long enough period of time, you will no longer smell it!

Read more about morning breath in the Washington Post here.