A quick preface before I get this party started. My old friends call me Rogelio, new friends Roger, and colleagues Rog. I went to UCLA for both undergraduate and dental school. I opened up this Dental office on Santa Monica blvd. along with another Bruin, friend, and UCLA Dentistry alum, WiIl Cheng.

Our goal is very simple. We want to make sure our patients have a welcome and comfortable experience. We want to make sure our patients are well informed of all options and treated with the best care available while getting to know them along the way. This blog is a small way to do that, to keep our patients and followers connected and informed about what’s out there. Now, where was I?

Ah, yes. My fiance is an optometrist. She came home the other day talking about how they tried an unconventional treatment involving tea tree oil that helped one of her patients that had been struggling with blepharitis(inflammation of eyelids) for years. Turns out it wasn’t a bacterial related blepharitis, the symptoms only presented themselves that way and the tea tree oil resolved the underlying cause, which I won’t get into. After all, eyes are not my area of expertise.

Tea tree flower

Tea tree flower, used from cellnique.com

Tea tree flower
Image taken from Cellnique.com

She then asked me if there are any uses for tea tree oil in dentistry. That same morning I had a patient ask me of a homeopathic process known as “oil pulling.” The week prior, I had a patient making her own organic dentrifice and asked which oils she should use, if any. I couldn’t say I knew much, only some general research of essential oils, so my curiousity forced me to get to the bottom of it so I could give my patient’s answers, and maybe more importantly, my fiance. Let’s start with tea tree oil.

So here’s the nitty gritty. Tea tree oil is an essential oil known for its anti-inflammatory and antiseptic properties. It has a laundry list of anecdotal/home remedy uses and and can even kill MRSA in vitro(in a petri dish.) A review by the National Institue of Health (NIH) in 2012 has officially deemed tea tree oil as a possible treatment for acne treatment and athlete’s foot. That’s all well in good but what can it do for the mouth and my oral health?

The Australian Dental Journal published an article in 2004 using a triple blind study to evaluate the effectiveness of using a 2.5% tea tree oil gel, a placebo gel, and chlorohexidine in treating gingivitis/gum disease. Tea tree oil was nearly as effective in all categories as chlorohexidine except in plaque reduction, so in essence, only treating the symptoms of the disease but not the underlying cause.

Another study evaluated the effectiveness of the ability of a 0.05% tea tree oil solution in conjunction with alpha-bisabolol in killing the bacterium associated with halitosis in vitro. It worked quite well in killing the associated bacterium when they were used together. Keep in mind this was all done in a lab, and never in a person’s mouth.

It can’t all be good news, right? What’s the bad news? Well, according to The American Cancer Society, tea tree oil is very toxic when ingested, especially at concentrations higher than 5%, resulting in drowsiness, rashes, confusion, unsteadiness, weakness, vomiting, diarrhea, upset stomache, and in extreme cases, blood cell abnormalities, hallucinations, and coma.
Tea tree oil is also a skin irritant at higher concentrations, and like any compound, can cause allergic reactions, most commonly delayed type IV reactions.

So okay, maybe this essential oil didn’t make the cut for oral use. Maybe it needs a little more research and fine tuning for oral application. The good news is that we’ve been using essential oils in dentistry for almost 100 years. Listerine uses menthol, thymol, eucalyptol, and methyl salicylate and has a proven track record of reducing gingivitis along with brushing and flossing. In 2008 Patel and Maki did an evidence based review of essential oil mouthrinses (such as Listerine) was done, distilling and analyzing hundreds of articles to ensure consistent data and results so that we as Dentists can recommend, prescribe, and use with great results and predictability.

The research on oil pulling is even more obscure. Oil pulling is the act of rinsing with a small amount of oil (usually coconut or sesame oil) for an extended period of time. Oil pulling claims to strengthen teeth, gums, reduce plaque, decrease malodor, and improve systemic health. A quick google search will bring up a full page of links with countless anecdotes of amazing improvement in oral health and countless natural remedy websites.

Research has only recently been surfacing on “oil pulling,” and mostly by Asokan, et al. Their research has been positive and has been comparable to chlorohexidine mouth rinses in reducing plaque and even the bacteria responsible for causing cavities, Strep. mutans. So what’s the best thing to do?
Knowing what’s best is the tricky part. “Best” is very subjective when it comes to any given situation. That’s why we use evidence based research to guide our decision-making.

That’s really what I’m getting at. A research article here or there does not tell the entire story. Good research is reiterated multiple times, by independent labs. There’s a lot of information missing from the puzzle before tea tree oil and oil pulling can be utilized safely to its fullest potential. I’m of the opinion that home remedies have some merit. They’ve been helping generations of people long enough to last until now, but that doesn’t necessarily make it safe, or even effective. The placebo effect is one of the greatest contenders in research.

Be sure to speak with your dentist about any unconventional treatments or home remedies, because great gums are meaningless when you’re in a coma.

-Roger Garcia, D.D.S.
Vision Dental

Roger Garcia @ Vision Dental

Roger Garcia in the lab at Vision Dental

Vision Dental
10700 Santa Monica Blvd., Suite 140
Los Angeles, CA 90025

Resources and references
S. Soukoulis, R. Hirsch, The effects of a tea tree oil-containing gel on plaque and chronic gingivitis. Australian Dental Journal 2004;49:(2):78-83
Patel RM, Malaki Z. The effect of a mouthrinse containing essential oils on dental plaque and gingivitis. Evid Based Dent. 2008;9(1):18-9. doi: 10.1038/sj.ebd.6400566.
Asokan S, Kumar RS, Emmadi P, Raghuraman R, Sivakumar N. Effect of oil pulling on halitosis and microorganisms causing halitosis: a randomized controlled pilot trial. J Indian Soc Pedod Prev Dent. 2011 Apr-Jun;29(2):90-4. doi: 10.4103/0970-4388.84678.
”Tea Tree Oil”. American Cancer Society. November 2008. Retrieved September 2013.
http://www.cancer.org/treatment/treatmentsandsideeffects/complementaryandalternativemedicine/herbsvitaminsandminerals/tea-tree-oil
Marcel Forrer, Eva M. Kulik, Andreas Filippi, Tuomas Waltimo, The antimicrobial activity of alpha-bisabolol and tea tree oil against Solobacterium moorei, a Gram-positive bacterium associated with halitosis. Archives of oral biology 1 January 2013 (volume 58 issue 1 Pages 10-16 DOI: 10.1016/j.archoralbio.2012.08.001)
http://www.nlm.nih.gov/medlineplus/druginfo/natural/113.html