|Year : 2021 | Volume
| Issue : 4 | Page : 255-258
Awareness among dental practitioners about oil pulling – Its effect on the Corona Virus and immunocompromised patients: A questionnaire-based survey
Upasana Jayaram Reddy1, Mithra N Hegde1, Mallikarjuna Rao2, Aditya Shetty1, Jayarama Shetty2, Nidhi Saha3
1 Department of Conservative Dentistry and Endodontics, A.B. Shetty Memorial Institute of Dental Sciences, Mangalore, Karnataka, India
2 Department of Radiation Oncology, Kshema Institute of Medical Sciences, Mangalore, Karnataka, India
3 Private Practitioner, Mangalore, Karnataka, India
|Date of Submission||18-May-2021|
|Date of Decision||16-Aug-2021|
|Date of Acceptance||08-Oct-2021|
|Date of Web Publication||15-Dec-2021|
Upasana Jayaram Reddy
Department of Conservative Dentistry and Endodontics, A. B. Shetty Memorial Institute of Dental Sciences, Deralakatte, Mangalore - 575 018, Karnataka
Source of Support: None, Conflict of Interest: None
Background: The ongoing pandemic has posed limitations to dental practice. In the current scenario of the coronavirus disease-2019 (COVID-19) pandemic, many patients present with symptoms like burning of the eyes, nose, throat, xerostomia, and mouth ulcers. For this, the Ministry of AYUSH is promoting oil pulling as a preventive measure. Aim: The aim of this study was to increase the awareness and confidence of dental practitioners in prescribing a simple technique for ameliorating common symptoms of COVID-19 infection – by oil pulling, in routine clinical practice. Methods: This study entailed designing a standardized web-based questionnaire for conducting a survey among dental practitioners from all specializations. Here, 100 participants answered 14 questions related to the role of oil pulling in treating oral symptoms common among COVID-19 patients and immunocompromised radiation patients. Statistical analysis was carried out after receiving all responses. Frequencies and percentages were calculated. Results: The results of the present survey indicated that 8.6% of total participants had good awareness (>16 Qs); 56.3% of total participants showed moderate awareness (10–16 Qs); while 35.2% had poor awareness (<10 Qs). Conclusion: Oil pulling can be deemed as an effective method of treating oral symptoms of COVID-19. Dentists should acquire adequate knowledge regarding the role and importance of this simple preventive measure.
Keywords: COVID-19, oil pulling, radiation caries, virgin coconut oil
|How to cite this article:|
Reddy UJ, Hegde MN, Rao M, Shetty A, Shetty J, Saha N. Awareness among dental practitioners about oil pulling – Its effect on the Corona Virus and immunocompromised patients: A questionnaire-based survey. J Indian Assoc Public Health Dent 2021;19:255-8
|How to cite this URL:|
Reddy UJ, Hegde MN, Rao M, Shetty A, Shetty J, Saha N. Awareness among dental practitioners about oil pulling – Its effect on the Corona Virus and immunocompromised patients: A questionnaire-based survey. J Indian Assoc Public Health Dent [serial online] 2021 [cited 2022 Jan 24];19:255-8. Available from: https://www.jiaphd.org/text.asp?2021/19/4/255/332539
| Introduction|| |
Coronavirus or COVID-19, was first reported in Wuhan (China) in 2019 and soon declared a global emergency by the World Health Organization. The virus belongs to the Coronaviridae family and infects the respiratory tracts of mammals. Common signs of this infection include – fatigue, muscle pain, sneezing, loss of taste and smell, dry cough, sore throat, mouth ulcers, xerostomia, fever, and shortness of breath. While severe disease can cause pneumonia, serious respiratory syndrome, kidney failure, and even death. The disease spreads by close human proximity or inhalation of respiratory or salivary droplets from an infected person.,
Most dental procedures generate aerosols as they necessitate the use of either an airotor handpiece, ultrasonic scaler, or three-way syringes., Nosocomial transmission of COVID-19 can occur directly through aerosols formed during surgical and dental procedures. The Ministry of AYUSH – an initiative by the Indian Government, has promoted oil pulling as a preventive measure against common oral symptoms of COVID-19, which is easy to perform and noninvasive in nature.
The aim of the survey was to test and impart knowledge about oil pulling to practitioners of all specialties to improve their confidence in prescribing this therapy in routine clinical practice. The questions of this survey were framed heeding the main objective – which is to highlight the antibacterial and antiseptic properties of cold-pressed coconut oil.
| Methods|| |
Study design and population
The ethical clearance for the survey was obtained from the Institutional Ethics Committee of A. B. Shetty Memorial Institute of Dental Sciences, Mangalore. A standardized cross-sectional web-based questionnaire survey was then conducted among a group of 200 practitioners, using the snowball sampling technique, starting from May 1 to May 30, 2020. As the Indian Central Government had recommended the public to minimize physical interaction and to isolate themselves at home, potential respondents were invited to participate through electronic media.
A link was sent to the participants – that contained a brief introduction on the background, the objective of this study, voluntary nature of participation, declarations of confidentiality and anonymity and instructions for filling in the questionnaire. All practicing dentists working in private clinics and lecturers in dental colleges and hospitals were invited to participate in the study. Details of participants were recorded, such as their age. A minimum of 3 years of clinical experience was the criteria for inclusion in participation.
Institutional ethical clearance was obtained (cert. No: ABSM/EC 07/2020). The questionnaire of this survey was developed by the authors after reviewing relevant published literature and the most recent available information on COVID-19 from international guidelines., The questionnaire was initially designed pertaining to the basic knowledge of dentists toward oil pulling and its significance, which was then assessed by all the authors for the relevance of the items regarding dentists' knowledge and practice.
A close-ended questionnaire was designed so as to include 14 multiple choice questions in English. Face validity and content validity were done to ensure standardization of the questionnaire.
The responses obtained for each question were recorded and frequencies and percentages were calculated to assess the knowledge and awareness among participants [Table 1].
The sample size was calculated considering 80% power.
The collected data were then entered into a Microsoft excel worksheet and further analyzed using the software IBM SPSS Statistics, Version 22 (Armonk, NY, USA: IBM Corp). The frequencies and percentages of the correct and the incorrect responses were assessed. A comparison of the categorical values was done using ANOVA.
| Results|| |
The results depicted the percentage of right and wrong answers for each question and the overall awareness percentage among dental practitioners pertaining to the role of oil pulling in attenuating common COVID symptoms. Responses were later recorded and tabulated.
It was found that only 17.2% of dental practitioners had tried oil pulling themselves, and 12.5% had already recommended it to at least one patient. Although 90.6% of the participant dentists were aware of the oil pulling method, most (59.4%) believed that the ability of oil to bind to proteins present in the skin and mucous membranes aids in the preventive action against coronavirus infection. Overall, only 8.6% of the participants had the desired awareness (>16 Qs) regarding oil pulling, whereas 56.3% had moderate awareness (10–16 Qs) and 35.2% had little or poor awareness (<10 Qs) [Table 2].
| Discussion|| |
This survey was conducted among dentists of all specialties to assess the awareness and knowledge related to oil pulling therapy, particularly with VCO.
Oil pulling is an ancient practice that can effectively maintain oral hygiene, and this practice has gained remarkable importance in several developed countries. The procedure involves swishing one tablespoon of oil in the mouth on an empty stomach, for about 20 min, preferably in the morning. If performed correctly, the oil turns milky-white and less viscous. Then, it should be spat out; caution must be taken to avoid swallowing the oil. Thereafter, the mouth should be thoroughly washed with warm saline water, and the teeth should be cleaned with fingers or routine tooth brushing should be performed.
Oil pulling must be performed in a seated position with chin up and can be practiced thrice daily on an empty stomach. It is even advised for children above the age of 5 years; children should use one teaspoon of oil. In patients with oral ulcers, fever, vomiting tendency, asthma, and in conditions where brushing is difficult or contraindicated, oil pulling is said to be beneficial and can be advised for maintaining oral hygiene.
In the present study, VCO was selected as it has shown efficacy in restoring and reversing common oral symptoms experienced by patients during radiation therapy, which are very similar to symptoms elicited by those positive with the coronavirus.
Oil pulling with coconut oil can aid in stimulating the immune system. In addition, coconut oil is known to confer numerous health-related benefits, which also include its antioxidant action - owing to the high content of mineral ions. Thus, oil pulling is being propagated as a preventive measure against common symptoms of COVID-19. Scientists speculate that oil pulling benefits through alkali hydrolysis of fat, which renders saponification and emulsification, enhancing the mechanical cleansing action of oil.
The results of a 2017 randomized controlled trial conducted in Hyderabad, India, among 40 dental students found that oil pulling is effective in controlling plaque levels. The presence of medium-chain fatty acid in coconut oil makes it a preferred option for eradicating germs from the oral cavity. Coconut oil contains 92% saturated acids, of which about 50% is lauric acid. The latter is known to harbor antibacterial and antifungal effects. Evidence suggests that VCO inhibits the growth of Staphylococcus aureus through – the destruction of the bacterial cell wall and increasing phagocytosis mechanism of immune cells.
Coconut oil has significant antimicrobial activity against Helicobacter pylori, Escherichia vulneris, Enterobcater spp. and Candida spp. – Candida albicans, Candida glabrata, Candida tropicalis, Candida parapsilosis, Candida stellatoidea and Candida krusei. In developing countries like India – with limited healthcare infrastructure in most regions – coconut oil pulling can be an effective measure for pulling infection – bacteria, toxins, and pus – out of the tissues and can aid in the maintenance of oral hygiene.
The results of this study revealed that 8.6% of the participating dentists had good awareness (>16 Qs) of oil pulling, and 56.3% had moderate awareness (10–16 Qs). Although 35.2% had poor awareness (<10 Qs), 90.6% of the participant dentists were aware of the method of oil pulling. The survey also disclosed that only 17.2% of dental practitioners had tried oil pulling themselves, while12.5% had already recommended it to at least one patient. Most dentists (59.4%) believed that the ability of oil to bind to proteins present in the skin and mucous membranes aids in the preventive action against coronavirus infection.
Based on the results of this study, we conclude that although most practitioners are aware of benefits of oil pulling and its significance in maintaining oral hygiene, yet hey hesitate in recommending and prescribing it routinely. A clinical trial to show the in vivo effects of oil pulling is the need of the hour – as the saying goes, “prevention is better than cure.”
Our study had some limitations. Due to the lockdown, we adopted the snowball sampling strategy which was not based on a random selection of the sample. The questions were framed and vetted by a team of practitioners from different specialties for external validation to ensure standardization of the questions.
| Conclusion|| |
Dental professionals are at a high risk of exposure to infectious diseases. The emergence of COVID-19 has brought about new challenges and responsibilities for dentists.
Yet, most dentists had limited comprehension of the preventive strategies that protect patients from this virus. Our findings have important implications which can be used for the development of prevention programs, by implementation of special precautions for preventing the spread of this virus and may serve as a guide for managing other immune-compromised conditions rendering similar symptoms, in the future.
Financial support and sponsorship
Nonfinancial support from Nitte Deemed to be University and C. P. C. R. I. Kasargod.
Conflicts of interest
There are no conflicts of interest.
| References|| |
Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al
. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med 2020;382:727-33.
Ali I, Alharbi OM. COVID-19: Disease, management, treatment, and social impact. Sci Total Environ 2020;728:138861.
Harrel SK, Molinari J. Aerosols and splatter in dentistry: A brief review of the literature and infection control implications. J Am Dent Assoc 2004;135:429-37.
Karia R, Gupta I, Khandait H, Yadav A, Yadav A. COVID-19 and its modes of transmission. SN Compr Clin Med 2020:1-4.
Cleveland JL, Gray SK, Harte JA, Robison VA, Moorman AC, Gooch BF. Transmission of blood-borne pathogens in US dental health care settings. J Am Dent Assoc 2016;147:729-38.
Nasser Z, Fares Y, Daoud R, Abou-Abbas L. Assessment of knowledge and practice of dentists towards coronavirus disease (COVID-19): A cross-sectional survey from Lebanon. BMC Oral Health 2020;20:281.
Khader Y, Al Nsour M, Al-Batayneh OB, Saadeh R, Bashier H, Alfaqih M, et al.
Dentists' awareness, perception, and attitude regarding COVID-19 and infection control: Cross-sectional study among Jordanian dentists. JMIR Public Health Surveill 2020;6:e18798.
Shanbhag VK. Oil pulling for maintaining oral hygiene – A review. J Tradit Complement Med 2017;7:106-9.
Ripari F, Filippone F, Zumbo G, Covello F, Zara F, Vozza I. The role of coconut oil in treating patients affected by plaque-induced gingivitis: A pilot study. Eur J Dent 2020;14:558-65.
Asokan S, Rathinasamy TK, Inbamani N, Menon T, Kumar SS, Emmadi P, et al.
Mechanism of oil-pulling therapy – in vitro
study. Indian J Dent Res 2011;22:34-7.
] [Full text]
Nagilla J, Kulkarni S, Madupu PR, Doshi D, Bandari SR, Srilatha A. Comparative evaluation of antiplaque efficacy of coconut oil pulling and a placebo, among dental college students: A randomized controlled trial. J Clin Diagn Res 2017;11:ZC08-11.
Naseem M, Khiyani MF, Nauman H, Zafar MS, Shah AH, Khalil HS. Oil pulling and importance of traditional medicine in oral health maintenance. Int J Health Sci (Qassim) 2017;11:65-70.
[Table 1], [Table 2]