GANDUSHA AND KAVALA (OIL PULLING) IN ORAL HEALTH: CLASSICAL BASIS, CLINICAL EVIDENCE AND SAFETY
Background: Gandusha (holding liquid in the mouth) and Kavala (swishing liquid in the mouth) are Ayurvedic oral procedures described in classical texts as part of the daily regimen and as treatments for oral diseases. Oil pulling, a popular form of Gandusha and Kavala using sesame or coconut oil, has gained worldwide interest as a natural oral hygiene measure. Objective: To review the classical description of Gandusha and Kavala, the clinical evidence for oil pulling in plaque, gingivitis and oral bacteria, and its safety. Methods: Narrative review of classical Ayurvedic texts, systematic reviews, meta-analyses and randomised trials of oil pulling. Results: Classical texts describe Gandusha with sesame oil as strengthening the teeth, jaws and voice and preventing dryness and cracking of the lips and mouth. Several randomised trials, many from India, report reductions in plaque, gingival inflammation and Streptococcus mutans counts with oil pulling. A 2022 meta-analysis of nine trials found reduced salivary bacterial counts but no significant effect on plaque or gingival indices. A 2023 meta-analysis of 25 trials found chlorhexidine superior for plaque, with possible benefit of oil pulling for gingival health, but rated the certainty of all evidence as very low. Lipoid pneumonia due to aspiration of oil has been reported. Conclusion: Oil pulling is a low-cost, culturally acceptable practice that may modestly benefit gingival health and oral bacterial load. It should complement, not replace, tooth brushing, interdental cleaning and professional dental care. People at risk of aspiration should avoid it.
KEYWORDS: Gandusha; Kavala; oil pulling; sesame oil; coconut oil; gingivitis; dental plaque; Streptococcus mutans