Oil pulling, also known as oil swishing, is an ayurvedic practice that involves swishing oil in the mouth for oral and systemic health benefits. The concept of oil pulling is not new. It has been discussed in the ayurvedic text “Charaka” Samhita” (circa 3000 BC), where it is referred to as “Kavala graham” or “Kavala gandoosha”.Ayurveda is a well-known and widely accepted complementary and alternative medicine modality. It is the system native to the Indian traditional medicine subcontinent and other parts of the world[1]. Sesame seed oil, which has several medicinal properties and desirable health benefits, is most commonly used. However, sunflower oil and other edible oils can also be used. Sesame oil was highly beneficial to the ancients. It is still helpful to us today; it has been shown to have anti-inflammatory, antifungal, anti-anxiety, and anti-plaque effects due to its impressive array of vitamins, minerals, and healthful compounds. Sesame oil, which is high in zinc, is excellent for longevity and vitality. Sesame oil contains tyrosine, linked to serotonin production, mood enhancement, and anxiety relief. Sesame oil contains chlorosesamone, an antifungal agent, and is high in copper, which reduces inflammation. Other beneficial oil includes sunflower and coconut oil, Sunflower oil has anti-plaque and gingival benefits, and it is effective against Candida albicans (candida). Lauric acid in coconut oil is antimicrobial, anti-inflammatory, and effective against Streptococcus, Candida, and Staphylococcus. It is also antiseptic and works well as a cut cleaner. The effects of oil pulling can often be seen in as little as 7-10 days. However, as with all aspects of the healing process, patience and discipline are essential. [2]
Because of the following reasons, complementary and alternative medicine is gaining popularity over conventional allopathic medicine. Like- Products and practices used are natural and safe. In addition, there is the provision of self-treatment. It is cost-effective, increasing the prevalence of chronic diseases such as diabetes, hypertension, coronary artery diseases, cancer, and the lack of success of the current treatment modality. Oil pulling can be used as an alternative cleaning method in patients who have difficulty brushing their teeth, such as those with mouth ulcers, or in those who gag easily, such as asthmatics and people with severe coughs. A teaspoonful of any oil is swished around the mouth for about 15-20 minutes in the morning, preferably before breakfast. If the oil pulling guidelines are followed correctly, the viscous oil should become milky white and thinner after being ‘pulled’ and forced around the oral cavity. It is then expectorated; the mouth is thoroughly washed with warm saline or regular tap water, and routine tooth brushing is performed. If the jaw aches, the therapy can be limited to five to ten minutes.
Mechanisms of action
The precise mechanism of action of oil pulling therapy is unknown. It was claimed that swishing oil in one’s mouth activated enzymes and drew toxins out. Oil pulling cannot pull the toxins out of the blood because the oral mucous membrane does not act as a semipermeable membrane. The sesame seed oil contains a high concentration of polyunsaturated fatty acids and is high in vitamin E. Sesamin, sesamolin, and sesamol are the antioxidants found in it. These lignans have specific actions on the living tissues like- Detoxification of toxins, antioxidant effect, potentiates the activity of vitamin E, prevents lipid peroxidation and antibiotic impact. It helps in the destruction of microorganisms. Sesamin has been found to inhibit cholesterol absorption and its production in the liver, reduce lipogenesis, and exhibit an antihypertensive action. Oil pulling is said to prevent and heal a wide range of oral-systemic diseases such as diabetes, cancer, migraine, hypertension, ischemic heart disease., liver, respiratory, renal problems, etc[3]
Radiotherapy and chemotherapy-induced mucositis
Head and neck cancers (HNC) are the sixth most common cancers worldwide, with cancers of the lip and oral cavity, pharynx, larynx, tongue, salivary glands, nasal cavity, and paranasal sinus most common. The primary treatment strategies for head and neck cancers are radiotherapy and chemotherapy. When ionizing radiation passes through biological systems, it produces reactive oxygen species (ROS). ROS are highly reactive molecules that attack critical macromolecules in cells such as DNA, causing cell damage and death. It is the ninth leading cause of death on a global scale. Mucositis is classified into four stages: the initial inflammatory/vascular phase, the epithelial phase, the ulcerative/bacterial phase, and the wound-healing stage. In the first stage, irradiation or chemotherapy harms cells and DNA strands in the basal epithelium and submucosa by producing free radicals and ROS, resulting in lesions. ROS also activate transcription factors, which leads to cell death later on. In the following stage, ROS and damaged cells and DNA initiate a chain reaction in the subsequent stage.
Pro-inflammatory cytokines cause lesions and basal cell apoptosis during these reactions. . At this stage, the tissue appears normal, with only minor erythema. Painful lesions appear in the third stage and are colonized by bacteria. Bacterial colonization can result in the release of new pro-inflammatories. The respiratory and gastrointestinal tracts are covered by mucosal tissue. The oral mucosa is the part of this tissue that covers the mouth. One of the most vulnerable tissues to chemotherapy and radiation is the oral mucosa. The pain and inflammation are caused by mucositis. Due to mucositis pain, most patients receiving radiation therapy for head and neck cancer cannot continue eating by mouth. They must rely on a gastrostomy tube or intravenous line for nutrition. It has been shown that patients with oral mucositis are significantly more likely to experience severe pain and a 5% weight loss.. Oral mucositis lesions are frequently painful, compromising nutrition and oral hygiene and increasing local and systemic infection risk. Oral mucositis is the first symptom experienced by approximately 40% of patients undergoing chemo-radiation treatment. Oral mucositis affects nearly 80% of patients with head and neck cancer who receive radiotherapy. Because of these side effects, approximately 15% of patients who receive high doses of radiotherapy in the mouth region must be hospitalized. Due to their high cell proliferation rate, younger people are more likely to develop oral mucositis due to chemotherapy and radiotherapy. According to one study, the frequency of acute mucositis is roughly 33.3 per cent at the end of the first week of chemo-radiation. It gradually increases to 93.3 per cent at the end of the fifth week. Patients typically report oral soreness, severe pain, discomfort, and gastrointestinal distress, regardless of the grade or severity of mucositis. Mucositis can directly affect the appetite, resulting in weight loss; it can also cause difficulty speaking and swallowing, severe dehydration, and systemic infections, indirectly impacting the patient’s quality of life and financial burdens associated with its treatment. In addition, extreme cases of oral mucositis can obstruct radiotherapy delivery, reducing its effectiveness.
Head and neck cancer”s patients who receive radiation therapy receive an approximately 200 cGy (centigray) daily dose of radiation, five days per week, for 5–7 weeks. As a result, almost all of these patients will develop oral mucositis. Severe oral mucositis occurred in 29–66% of all patients receiving radiation therapy for head and neck cancer. The incidence of oral mucositis was exceptionally high in patients with primary tumours of the oral cavity, oropharynx, or nasopharynx, those who received concurrent chemotherapy, those who received a total dose of more than 5000 cGy, and those who were treated with altered fractionation radiation schedules. Therefore, oral Mucositis can affect other parts of the digestive tract as well; for example, gastrointestinal (GI) mucositis can cause diarrhoea. As a result, mucositis is a significant and sometimes dose-limiting complication of cancer treatment.
The most common treatment for such symptoms is Magic mouthwash, which is given to patients to alleviate the oral symptoms associated with cancer treatment. The formulation contains a topical analgesic, steroid, antifungal, antibacterial, and (possibly) a mucosal coating agent. Still, there is no standard recipe for this preparation. Essential oils have antibacterial and antifungal properties and have been used to treat infections of the skin and mucosa. For oral mucositis, a mixture of Melaleuca alternifolia (1 drop), Citrus bergamia (1 drop), and Pelargonium graveolens (1 drop) in half a glass of boiled warm water five times per day is beneficial. Although there were few benefits discovered when this mouthwash was added, patients preferred this plant mouthwash for routine oral care in the treatment of radiation mucositis because it caused minor burning discomfort when compared to regular mouthwash for managing oral mucositis. In a double-blind clinical trial study, 40 patients with colon or rectum cancer were randomly assigned to two groups: placebo or peppermint essential oils. Three times a day, patients were given ten drops of peppermint essential oils in an oral rinse4[4]. The vital oils group had a 15% incidence of oral mucositis, whereas the placebo group had a 50% incidence. The mean scores of oral mucositis in the essential oil– and placebo-treated groups were 0.2 and 0.8, respectively. Thus, Peppermint essence is an effective, safe, and well-tolerated product for the prophylactic treatment of chemotherapy-induced oral mucositis.
Natural Oil pulling Products
1.Leptospermum scoparium
Leptospermum scoparium, also known as manuka, is a flowering plant in the myrtle family. The Myrtaceae family is indigenous to New Zealand and southeast Australia. Sesquiterpene hydrocarbons are found in this herb. These compounds have antifungal, antibacterial, and anti-inflammatory properties. Nineteen adult patients were gargled with two drops of a 1:1 mixture of manuka essential oils in a randomized placebo-controlled trial study5. Overall, patients tolerated the active gargle well, with no evidence of toxic or side effects related to its swallowing. Compared to the placebo, patients in the essential oil gargle group had a delayed onset of mucositis and reduced pain and oral symptoms. However, the study’s small sample size was a limitation. They proposed that essential oils could help to improve oral health by causing bacterial lysis and reducing bacterial load. Because of the small sample size in their study, the recommendation to use it for mucositis requires confirmation in large randomized clinical trials. . According to recent research, the antimicrobial activity of manuka oil is related to flavesone and leptospermone[5].
2.Matricaria chamomilla
Chamomile, Matricaria recutita Linnaeus (Asteraceae), has been studied for years for its agronomic and phytochemical properties. It is a plant with a long history of use in traditional medicine due to its antioxidant, antimicrobial, and anti-inflammatory properties. There are over 200 constituents, including terpenoids, flavonoids, coumarins, fatty acids, alkaloids, polysaccharides, and glycosides derivatives7[6]. In addition, this plant has been used to treat oral mucositis to provide relief and comfort to the patient’s painful symptoms. It has been claimed that it promotes granulation and epithelialization, which leads to the normalization of the oral environment and speeds up the reepithelialization of oral tissue. Recent research looked into its role in preventing and treating oral mucositis caused by chemotherapy and radiotherapy. Chamomile (Kamillosan Liquid oral rinse) can postpone the onset of mucositis caused by radiotherapy and chemotherapy. Sixty-six patients with head and neck cancer were given chamomile drops in water three times per day. In most patients, Kamillosan Liquid Oral Rinse delayed the onset of radiation mucositis and reduced its severity.T. Matricine and its product of transformation M chamomilla’s main constituents are Chamazulene. Chamazulene, which inhibits leukotriene synthesis and has antioxidative properties, may contribute to the anti-inflammatory activity of chamomile extracts.
3.Isatis indigotica
Although Isatis indigotica is widely used in Chinese Traditional Medicine for the clinical treatment of virus infection, tumour, and inflammation, its antiviral activity is unknown8[7]. Nevertheless, the use of indigo wood root significantly reduced the severity of radiation-induced mucositis, anorexia, and swallowing difficulties. In addition, this extract improved the patients’ appetites, eating abilities, and, ultimately, their quality of life. The primary mechanism for indigowood’s anti-inflammation effect on mucositis caused by radiation was anti-inflammation due to compounds like Indirubin and indigotone. Indirubin’s unique structure allows it to inhibit cyclin-dependent kinases and glycogen synthase kinases, resulting in cell cycle arrest and apoptosis. Thus, Indirubin’s kinase inhibitor activity is a significant cause of cellular proliferation and immune function. Indirubin is also a potent agonist of the aryl hydrocarbon receptor (AhR). The AhR is a cytosolic protein that is translocated to the nucleus upon ligand binding and acts as a transcription factor for genes involved in oxidative stress.
CONCLUSIONS
The vast majority of synthetic agents used to prevent or treat oral lesions caused by cancer treatment have side effects and interact with other drugs. However, natural medicines are presented as a promising alternative; however, few studies evaluate these agents’ products in reducing injuries. Natural products, such as herbal medicine, have the potential to reduce patients’ oral mucositis. Many clinical trials have been conducted to evaluate natural products for the treatment of mucositis, with promising results. Currently, a standard preventive agent for mucositis is not available from natural products that have been thoroughly studied in multiple multicenter clinical trials. Oil pulling is an effective way to treat the side effects that arise due to chemotherapy. In addition, it proves to efficient in several chronic diseases, including cancer. Unfortunately, no specific study indicates that it can treat cancer, but it can relieve the problems that arise due to the hazardous treatment.
