Have your patients asked you about the use of so-called essential oils? Used in the mouth, these oils will kill bacteria.
Alvin Danenberg, DDS.In fact, published research shows that essential oils may work as well as chlorhexidine, which is the gold standard to kill mouth bacteria. These oils have advantages over chlorhexidine in that they often taste better and do not stain teeth.
So, while it appears that essential oils could be a boon for oral health, there are some drawbacks that contribute to these essential oils not being used on a daily basis.
One of these drawbacks is that certain essential oils in high concentrations may kill bacteria indiscriminately, like chlorhexidine. Also, high amounts of some essential oils may damage healthy gum tissue cells, again just like chlorhexidine.
What is an essential oil?
Let's back up -- what is an essential oil?
They are highly concentrated versions of the natural oils in plants, such as lavender, rosemary, cedarwood, rose, peppermint, and cypress. The term essential is correct in the sense that these oils are the essence of the plant they are extracted from. However, essential oils are not really oils, since they do not contain lipids. Instead, they are highly complex compounds, which may consist of several hundred different components of alcohols, aldehydes, terpenes, ethers, ketones, phenols, and oxides. These oils are an essential part of plants and function as the plant's immune system to protect them from microbes and pests.
One example of a study that shows that different types of essential oils will reduce gum infection effectively by killing bacteria, reducing bleeding, and decreasing inflammation was published in Clinical Oral Investigations in 2015 (January 2015, Vol. 19:1, pp. 97-107).
This and other research suggests that essential oils may be as effective or almost as effective as chlorhexidine. They even help with bad breath (Journal of Applied Oral Science, November-December 2016, Vol. 24:6, pp. 582-589). Therefore, either antimicrobial mouthwashes -- those containing essential oils or those containing chlorhexidine -- could help with acute infection.
Some issues
While this research sounds great, there are some caveats.
The U.S. Food and Drug Administration does not have controls in place to regulate the purity and concentrations of essential oils used for therapeutic purposes (American Journal of Health-System Pharmacy, May 2017, Vol. 74:9, pp. e153-e162). Therefore, if one of your patients was putting together their own concoction of essential oils for a mouthwash, they might not know what was really in that mouthwash. Not to mention that some essential oils are more potent than others.
Some published studies show that chlorhexidine could be toxic to gum tissue cells around teeth, and these studies suggest that some essential oils could be toxic as well. These ingredients might prevent healthy gum tissue cells from functioning properly and reproducing normally (Toxicology in Vitro, August 2016, Vol. 34, pp. 88-96).
It is not healthy to kill bacteria indiscriminately anywhere in or on the body. Healthy plaque contains a bacterial population that balances acids around the teeth, assists in remineralization of the tooth surface, and kills pathogenic bacteria that might try to cause disease around the tooth.
Healthy bacteria on the tongue are necessary to change nitrates from healthy foods to eventually nitric oxide for the health of the cardiovascular system and the health of gum tissues around the teeth.
Bottom line
Many companies that manufacture and sell essential oils state that essential oils will only kill bad bacteria and leave good bacteria alone. The current medical research suggests that some essential oils will kill microbes effectively but indiscriminately, especially in high concentrations.
Studies show that essential oils may enhance healing following active treatment of dental disease (Interventional Medicine and Applied Science, June 2015, Vol. 7:2, pp. 78-84). But, when some are used on a daily basis in high concentrations and not along with professional treatment of acute infection, they could do harm to healthy bacteria and healthy gum tissues.
In my mind, I see dental disease as mainly a disease of diet and lifestyle. Why not first investigate and incorporate healthier ways of eating, living, and cleaning our mouths instead of just looking for chemicals in mouthwashes to solve our dental ills?
A version of this column first ran on Dr. Danenberg's blog. DrBicuspid.com appreciates the opportunity to reprint it. His book Crazy-Good Living from Elektra Press is available here.
Alvin Danenberg, DDS, practices at the Bluffton Center for Dentistry in Bluffton, SC. He is also on the faculty of the College of Integrative Medicine and created its integrative periodontal teaching module. He also spent two years as chief of periodontics at Charleston Air Force Base earlier in his career. His website is drdanenberg.com.
The comments and observations expressed herein do not necessarily reflect the opinions of DrBicuspid.com, nor should they be construed as an endorsement or admonishment of any particular idea, vendor, or organization.
