Key Takeaway
Large meta-analysis (25 trials, 1,184 participants) found oil pulling improved gingival health versus non-chlorhexidine mouthwashes (SMD -1.14) but chlorhexidine was superior for plaque reduction (SMD 0.33).
Summary
This systematic review and meta-analysis compared oil pulling to chlorhexidine and other mouthwash interventions across 25 RCTs with 1,184 total participants. It is one of the largest pooled analyses of oil pulling to date. Oil pulling showed clinically significant improvement in modified gingival index compared to non-chlorhexidine interventions. However, chlorhexidine consistently outperformed oil pulling for plaque reduction. Sesame oil was used in approximately half of the included trials. The authors identified a probable benefit of oil pulling for gingival health while noting very low certainty in the overall evidence, highlighting the need for higher-quality trials.
Methods
- Systematic review and meta-analysis of RCTs
- Searched Medline and Embase through April 2023
- Included RCTs of 7+ days comparing edible oil pulling to chlorhexidine or alternative mouthwashes
- Outcomes: plaque index, gingival index, modified gingival index, bacterial counts
- Used inverse-variance random-effects modeling
Key Results
- 25 trials included (1,184 participants); 21 meta-analyzed
- Oil pulling vs non-chlorhexidine: significant gingival improvement (SMD: -1.14, 95% CI: -1.31 to -0.97)
- Chlorhexidine vs oil pulling: superior plaque reduction (SMD: 0.33, 95% CI: 0.17 to 0.49)
- Intervention duration ranged 7-45 days
- Sesame oil used in ~50% of trials
Limitations
- Very low certainty in the evidence overall
- Most participants had no baseline oral health issues
- Heterogeneity in oil types and pulling protocols
- Relatively short intervention durations (7-45 days)