Sjögren’s is an autoimmune disorder often presenting with numerous oral complications including dry mouth, rampant dental decay, inflammation of the gums (gingivitis), yeast infections (candidiasis), reduced (hypogeusia) or distorted (dysgeusia) ability to taste, reduced ability to swallow (dysphagia), and subsequently wreaking havoc on quality of life. While drinking water seems to help make the mouth moist for a few seconds while the water is in contact with the oral tissues, many patients have stated that as soon as it is swallowed, the mouth returns to its dry state. In fact, sometimes the mouth may even feel drier than before the sip of water, since whatever saliva had been in the mouth has now been swallowed along with the water. Although there are several commercial products available in the form of rinses, sprays, gels, and toothpastes whose aim is to relieve dry mouth, many offer only temporary relief. During a literature search a few years ago to find agents that could either rehydrate or at least prevent further oral dehydration of dry mouth patients, a description of the ancient Ayurvedic oil-pulling technique was discovered, claiming several benefits to oral health (Asokan S. Oil-pulling therapy. Indian J Dent Res. 2008 Jun;19(2):169.) This was quite intriguing and thus a research project was launched.
The idea was to place a small amount of virgin coconut oil (VCO) in the mouth, let it soften, then “pull” and “push” it through the mouth and teeth, i.e., what we would call “swish”. The complicating feature was that this was to be done first thing in the morning on an empty stomach, for 15 minutes! Before testing this on any patients, this author tried it. Once over the yucky feeling of placing an oily substance in the mouth, the technique really wasn’t so bad, but the length of time required was quite onerous at first. For the study, twelve Sjögren’s patients and twelve otherwise healthy salivators were enlisted to participate in the study. Samples of saliva, tongue scraping samples, and plaque samples were collected from each of the participants. The samples were tested for levels of the usual oral decay-causing bacteria, Streptococcus mutans (S. mutans) and Lactobacillus as well as for yeast (Candida), a type of fungus, a common resident of the mouth, but which tends to be more abundant in a dry mouth.
The participants diligently did the oil-pulling with the VCO daily for 15 minutes per day for three weeks. At the end of the three weeks, similar samples of saliva, tongue scrapings, and plaque were also collected and tested for levels of the same micro-organisms. In addition, the participants completed questionnaires about the technique. A surprising result was that the levels of both S. mutans and Candida in the Sjögren's patients were reduced by a hundred-fold! In other words, if there had been a million organisms before the oil-pulling, now there were ten thousand, using a logarithm scale. Even the non-Sjögren's salivators had slight decreases in the bacterial and fungal numbers even though their initial counts were much lower than the Sjögren's patients. The comments from the participants were very positive: “My teeth are brighter”, “I don’t have that sour dough smell anymore”, “I can taste again”, “my gums don’t bleed after flossing anymore”, etc.
The technique has now been modified such that one 15-minute swish can be replaced by several swishes over the 15-minute period first thing in the morning, thereby ensuring that the oil-pulling is being done with clean VCO rather than VCO that is getting progressively dirtier. The current instructions are as follows:
Virgin Coconut Oil (VCO) Rinse Instructions: Particularly Useful for Those with Dry Mouth
• Use Virgin Coconut Oil (VCO), cold-pressed, in solid state.
• Place ½ tsp VCO in mouth and let it soften.
• “Pull and push”, i.e., “swish”, it through the teeth and around the mouth.
• Ideally this would be done on an empty stomach first thing in the morning for 15 minutes once per day. You may stop, spit out, and start again with new VCO during this time as frequently as you wish. However, if this proves to be too onerous a task, only do the “oil-pulling” for 1-2 minutes prior to your usual oral hygiene routine each and every time you do the routine.
• Do not swallow this and do not spit it down the sink drain as it may clog the drain. Instead, spit it out into a tissue, down the toilet, or into the garbage.
• Rinse the mouth with warm water.
• Continue with your usual oral health routine, e.g., brush, floss, etc.
• If desired, at bedtime, to prolong the rehydration of the VCO, swish once more after brushing. This amount of VCO can be swallowed since the mouth now is relatively clean. This last “swish” will help keep the oral tissues lubricated while you sleep.
While not replacing toothbrushing and flossing, the oil-pulling technique offers the dry mouth patient a more pleasant oral condition and a somewhat protective effect against dry mouth-related demineralization of the dentition.