Is oil pulling better than mouthwash?

Several trials have compared oil pulling with chlorhexidine, a prescription-strength antibacterial rinse:

• A 2016 systematic review found two trials showing no significant difference in gum inflammation scores between oil pulling and chlorhexidine, and no significant plaque differences in three trials against various controls.
• A 2011 pilot trial with 20 teenagers found sesame oil pulling and chlorhexidine both reduced bad breath over 14 days.
• A 2020 review of coconut oil trials noted one study where oil pulling caused less tooth staining than chlorhexidine.

"No significant difference" in small trials is not the same as "works as well". These studies were too small and too short to show equivalence, and reviewers rated their risk of bias as high. Chlorhexidine is also prescribed for specific situations, not as an everyday rinse.

The ADA separates rinses into two types:

• Cosmetic rinses leave a pleasant taste and temporarily mask bad breath. They do not treat anything.
• Therapeutic rinses contain active ingredients: cetylpyridinium chloride for bad breath, essential oils or chlorhexidine for plaque and gingivitis, fluoride for decay prevention.

So the fair comparison is oil pulling versus a therapeutic rinse chosen for your goal. The ADA notes that cetylpyridinium chloride and chlorhexidine can stain teeth, and that children under 6 should not use mouthwash unless a dentist advises it.

Most bad breath comes from sulfur gases made by bacteria on the tongue and around the gums. The ADA says antimicrobial rinses may help control it longer than cosmetic rinses, which only cover it up. Cleveland Clinic adds that if you brush, floss and clean your tongue well, you probably do not need mouthwash daily, and that alcohol-based rinses can dry the mouth.

Neither oil pulling nor mouthwash removes the coating on the tongue as directly as a tongue scraper or brush does. For persistent odor, our mouthwash for bad breath guide and bad breath test can help.

• Cavity prevention: fluoride toothpaste first; a fluoride rinse if your dentist suggests it. Oil pulling has no role.
• Gum health: brushing and flossing, plus a therapeutic rinse with the ADA Seal if recommended. See a dentist for bleeding gums.
• Fresher breath: tongue cleaning and flossing, with an antibacterial rinse if needed.
• Enjoying a traditional ritual: oil pulling is fine as an extra if you do it safely.
• Dry mouth: choose an alcohol-free rinse. Oil pulling will not increase saliva.

Yes. If you oil pull, do it first, spit, rinse with water, brush and floss, then use mouthwash at a different time of day if your dentist recommends one. Using mouthwash at a separate time from brushing avoids rinsing away the fluoride from your toothpaste straight after you brush. Neither step replaces brushing twice a day and cleaning between your teeth.