The charm of snake oil

Alternative oral-hygiene practices have strident supporters online. Make sure your patients know that nothing beats the products and practices rigorously tested by the scientific community, writes Meg Crawford

Strident voices on the internet would have us believe that everything from stained teeth through to heart disease can be remedied with simple, cheap and natural home remedies. Professor Eric Reynolds, CEO of the Oral Health Cooperative Research Centre, helps us unpack some of these claims.

Oil pulling

Oil pulling has been used in Ayurvedic (traditional Hindu) medicine for more than 3,000 years. It involves swilling oil (usually sesame, coconut or vegetable) around the mouth. A common contemporary oil-pulling practice consists of holding coconut oil in the mouth for 20 minutes, while it is swished through the teeth and around the mouth, before being spat out. Proponents claim that the bacteria which leads to dental decay will bind to the oil before being expelled. It’s said to cure everything from gum disease to acne.

“Oil pulling is an ancient method that humans used before toothbrushes and toothpaste, but technology has moved on considerably,” Professor Reynolds says. “There are toothpastes on the market that major companies have spent years developing with detergents in them, and detergents are much better at disrupting plaque than oil pulling. When you combine abrasives, flossing and regular brushing with a modern toothpaste, you will reduce more plaque than you will just swilling around coconut oil.”

While the research is limited at this stage, a few studies have examined regular oil pulling in comparison with mouth rinse, in terms of measuring its anti-plaque effect. “There’s no strong evidence that it has a strong anti-plaque effect, although one study claims that it has a slight anti-plaque effect,” Professor Reynolds notes of the findings. “However, a slight reduction in plaque is unlikely to have a significant impact on dental caries, tooth decay and periodontal disease, and no studies show that regular oil pulling is going to reduce the risk of dental decay.”

The other issue is that if patients use the practice instead of conventional methods, they’re not getting the benefits of fluoride in their toothpaste. “If someone doesn’t change their diet and frequently has sugar, they put themselves at real risk of not only dental decay, but periodontal disease,” Professor Reynolds explains.

Charcoal-based dental pastes and powders

If you’ve visited a juice bar recently, chances are you encountered a beverage containing charcoal, with the purported benefit of ‘detoxing’ the body. It’s also become a popular method for whitening teeth. Professor Reynolds has significant qualms about the practice. “You can see the rationale: charcoal has a high surface area and will absorb molecules such as salivary molecules that may discolour teeth,” he says. “The problem is that with tooth discolouration, stains can be both extrinsic and intrinsic. With intrinsic stains, you need something like peroxide to whiten them. Charcoal won’t touch intrinsic stains.”

“The problem is that with tooth discolouration, stains can be both extrinsic and intrinsic. With intrinsic stains, you need something like peroxide to whiten them. Charcoal won’t touch intrinsic stains.”—Professor Eric Reynolds, CEO, Oral Health Cooperative Research Centre

There are other reasons to discourage the practice: if a patient is cleaning his or her teeth with an uncontrolled and highly abrasive substance like charcoal, there’s the prospect of dental damage. Plus, if it’s a substitute for toothpaste, the patient misses out on the benefits of fluoride, putting themselves at risk of dental disease.

If patients want to whiten their teeth, Professor Reynolds’s first inclination is to send them to the dentist, but he is also happy to suggest a good tooth-whitening toothpaste. “In my opinion, that will work much better than cleaning your teeth with charcoal. Those toothpastes have been extensively clinically trialled and they’re the ones that dentists recommend.”

Tongue scraping

While Professor Reynolds says there’s no necessity for patients to use or purchase special tongue-scraping implements, he is a fan of regular tongue cleaning. “I firmly believe in cleaning the dorsum of the tongue as part of normal oral hygiene. We know that organisms associated with destructive periodontal disease can get around using the tongue as a platform and will reside in the crypts of the dorsum of the tongue. So cleaning your tongue is really important.”

Professor Reynolds says tongue scraping per se is “old fashioned, but well motivated”. Instead of tongue scraping, he recommends that patients gently clean the dorsum tongue with their toothbrush and some of the remaining toothpaste slurry in their mouth after cleaning their teeth. “I do it twice a day,” he says. “It keeps your tongue very healthy and aerated and significantly improves breath and taste. The detergent is the key because it breaks up bacteria. It literally dissolves them.”

Baking soda

Using baking soda to make a tooth-cleaning paste has been practised for donkey’s years. Acknowledging its efficacy as an abrasive, bicarb is included in many contemporary toothpastes with whitening properties. “My recommendation here is to use a toothpaste that contains bicarb, so you get the combination of fluoride and bicarb,” Professor Reynolds says. “It’s much better than trying to do it yourself.” As with the other methods, if people scrape their tongues without using a modern toothpaste, they run the risks associated with the absence of detergent to break down bacteria and fluoride to protect against periodontal disease.

Apple cider vinegar and baking soda

Proponents claim that apple cider vinegar (ACV) can regulate stomach acid and relieve reflux, as well as populate the gut with good bacteria. People are also adding it to baking soda to combine the tooth-whitening properties of baking soda with ACV’s purported anti-bacterial properties. Professor Reynolds gives short shrift to this practice.

“My recommendation here is to use a toothpaste that contains bicarb, so you get the combination of fluoride and bicarb. It’s much better than trying to do it yourself.”—Professor Eric Reynolds, CEO, Oral Health Cooperative Research Centre

“If you put bicarb in vinegar, it’ll just gas, producing CO2 and bubble away like crazy: you’re neutralising the acid in the vinegar,” he says. “The benefit of bicarb is that it buffers acid, so if you have acidic saliva, brushing with a bicarb toothpaste can give you pH buffering while you’re doing it, but it doesn’t last for long. But if you mix it with ACV, you’re just counteracting the benefit, if any, of the bicarb. I’m not quite sure what the benefit of the vinegar would be, unless they’re saying that’s its acidic and can kill bacteria, but the bacteria causing tooth decay quite like a low pH.”

What should I say when a patient asks me about these practices?

At the end of the day, if a patient wants to oil pull, Professor Reynolds says, “it’s up to them, provided they continue to clean their teeth with a modern toothpaste.” As for the other methods, aside from the practice of gently cleaning the tongue, Professor Reynold’s suggests dentists advise patients to steer clear.

“Reinforce that there are no clinical trials on these products, except for oil pulling where there is some rationale for it. Even though these things may have some effect on reducing plaque, no-one has been able to show that they affect the prevalence of oral disease, and that’s what’s important. Modern fluoridated toothpastes reduce the incidence of oral disease; if you give up that for these alternative methods, you’re putting yourself at risk.”

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