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2011 Student Essay #3
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Coconut Oil and Gingivitis:
A Case Study
An Essay on Compounding
in Patient Care

Eusra R. Shams
PharmD Candidate, Class of 2013
Appalachian College of Pharmacy
Oakwood, Va.


Our recent relocation to Oakwood in Southwest Virginia gave me the opportunity to participate in the Remote Area Medical (RAM) camp in the region as a volunteer through the Appalachian College of Pharmacy. Through this involvement I have realized that dental decay is a wide spread problem in Appalachia, particularly amongst children. I know I will not be able to solve this problem on my own but I became motivated to explore the prospect of alternative ways to prevent tooth decay. After a brief literature search I was able to identify a few dietary components that may serve my purpose. This essay is to report a case-based study where coconut oil was used in patients with gingivitis.

I selected a group of 10 children, between age group 10 – 15 years for this pilot study.  All of these children have the chief complaint of bleeding gums. They also had swollen gums and they all admitted to have mild to moderate pain during brushing. The overall oral hygiene status was good with minimal deposition around the teeth.

A treatment plan was designed which included, brushing teeth immediately after meal, followed by therapeutic application of extra virgin coconut oil all around the bleeding gum. I called for an awareness meeting and discussed my plan with the parents of the selected children. At the end of the session I gave everybody a dental care tote containing a soft brush,  tooth paste, and a small jar of coconut oil. I have shown them how to use the brush properly to get maximum benefit. I have also asked them to keep the coconut oil in the refrigerator so that it stays in its solid form.

The use of coconut oil on oral diseased tissue is a common practice in Polynesian countries where coconut is found in abundance.  Oil pulling with coconut oil, that is the practice of swishing 1 tablespoon of coconut oil in your mouth and through your teeth for 15 minutes each day, has been used extensively as a traditional Indian folk remedy for many years for strengthening teeth, gums, and the jaw and to prevent decay, oral malodor, bleeding gums, dryness of the throat, and cracked lips.

I anticipated compliance of the group to the dental hygiene would be my biggest challenge. Just to avoid noncompliance, I involved the children in a pleasure reading and role playing activity, so that I had time to ask everyone about their routine, and I asked the children to bring their brushes. These children are often on food stamps. I always met the group with a bag full of sandwiches which they ate during reading and story telling. As they finished their sandwich, I asked them to brush their teeth and apply a fresh layer of coconut oil on their teeth around their gum. This gave me the opportunity to observe the bleeding status of their gum.

On the initial appointment I created a dental hygiene log for every child and recorded every status on the first day as well as on subsequent days. I have asked them to do the same for their records.

On the following week’s clinical outcome, like pain and discomfort were recorded. During this screening study, I was not able to make any assumptions based on pathological or clinical evaluation, because these children do not have access to healthcare.

My intention was to gather some qualitative data. If it is deemed promising then I have the intention to submit a Health & Wellness proposal, obtain approval of the Institutional Review Board (IRB), compound a viable dental preparation with coconut oil, and then start the project in collaboration with either a periodontist or at least with a dental hygienist.

Results
After about 72 hours of application of coconut oil on gingival lesion physical observation demonstrated a slightly reduced gingival inflammation. The bleeding had almost disappeared after or during brushing. Pain was also reported to be reduced.

Discussions
This essay reports a possible benefit of coconut oil therapy on gingival inflammation and on bleeding gum after short-term applications.  Gingivitis is usually caused by bacterial plaque that accumulates in the small gaps between the gums and  the teeth and in calculus (tartar) that forms on the teeth. These accumulations may be tiny, even microscopic, but the bacteria in them produce foreign chemicals and toxins that cause inflammation of the gums around the teeth. This inflammation can, over the years, cause deep pockets between the teeth and gums and initiate loss of bone around teeth, an effect otherwise known as periodontitis.

A previous study on coconut oil reveals its antiviral, antifungal and antibacterial property1. It attacks and kills viruses that have a lipoidal coating. Saturated fatty acids of coconut oil have medicinal properties. Roughly 45 to 50% of fatty acids of coconut oil form lauric acid which is known to kill viruses and bacteria that are enveloped in a phospholipid membrane. Health benefits of coconut oil have always been debatable due to its high lipid content. However, many researchers have reported that coconut oil lowers cholesterol. The cholesterol-lowering properties of coconut oil are a direct result of its ability to stimulate thyroid function. In the presence of adequate thyroid hormone, cholesterol (specifically LDL-cholesterol) is converted by enzymatic processes to the vitally necessary anti-aging steroids, pregnenolone, and progesterone. These substances are required to help prevent heart disease, senility, obesity, cancer and other diseases associated with ageing and chronic degenerative diseases2.

The local use of coconut oil by oil pulling therapy showed a reduction in the plaque index, modified gingival scores, and total colony count of aerobic microorganisms in the plaque of adolescents with plaque-induced gingivitis3. Oil pulling has been documented to reduce gingivitis from 52-60%, as compared to the 13% reduction experienced from brushing and flossing combined4.

Future Plan
Since our community has numerous patients suffering from tooth decay, and coconut oil seems to have therapeutic property, I have the intention to formulate several dental preparations with coconut oils. For example, I may compound dental paste with coconut oil and baking soda to keep mouth clean and free from inflammation. I also can compound dental gel or biodegradable dental dressing, or lozenges with coconut oil to relieve dental pain and to kill bacteria.

Conclusion
The outcome of the present case study demonstrated a potential benefit from coconut oil therapy on gingival inflammation and bleeding gum, improved patient-centered outcomes, improved clinical sign of inflammation, less bleeding, and pain relief.  The observed potential benefits, if supported by higher level of evidence with compounded preparations in the future, can provide a scientific rationale behind coconut oil therapy and its incorporation in modern practice of dentistry.

References
1. Kabara J.J. (Professor Emeritus, Mich State University and Consut) Health oils from the tree of life (Nutrition and health aspects of coconut oil).
2. Lim Sylianco C.Y., Anticarcinogenic effects of coconut oil. Phillip. J. Coconut Studies, 1987 12 (2) 89-102.
3. http://www.azwellness.info/symptoms/gingivitis.htm
4. http://www.offthegridnews.com/2010/11/29/coconut-oil-timeless-miracle-food/

 

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