Efficacy of Ozonated Olive Oil in Oil Pulling Technique in Patients with Generalized Chronic Gingivitis To Imporve Oral Hygiene

International Journal of Dental Science and Innovative Research (IJDSIR) IJDSIR : Dental Publication Service Available Online at:www.ijdsir.com Volume – 8, Issue – 5, October – 2025, Page No. : 166 - 171 Corresponding Author: Dr. Sanjna B. Sharma, ijdsir, Volume – 8 Issue - 5, Page No. : 166 - 171 Page166 ISSN: 2581-5989 PubMed - National Library of Medicine - ID: 101738774 Efficacy of Ozonated Olive Oil in Oil Pulling Technique in Patients with Generalized Chronic Gingivitis To Imporve Oral Hygiene 1Dr. Sanjna B. Sharma, Postgraduate Student, Department of Periodontology, Chhattisgarh Dental College and Research Institute, Rajnandgaon 2Dr. Shruti Bhatnagar, Reader, Department of Periodontology, Chhattisgarh Dental College and Research Institute, Rajnandgaon 3Dr. Aniket Sharan, Department of Periodontology, Kasturi Dental Clinic, Ranchi 4Dr. Bhawna Shyamsukha, Postgraduate Student, Department of Periodontology, Chhattisgarh Dental College and Research Institute, Rajnandgaon 5Dr. Shashank Rai, Postgraduate Student, Department of Periodontology, Chhattisgarh Dental College and Research Institute, Rajnandgaon Corresponding Author: Dr. Sanjna B. Sharma, Postgraduate Student, Department of Periodontology, Chhattisgarh Dental College and Research Institute, Rajnandgaon Citation of this Article: Dr. Sanjna B. Sharma, Dr. Shruti Bhatnagar, Dr. Aniket Sharan, Dr. Bhawna Shyamsukha, Dr. Shashank Rai, “Efficacy of Ozonated Olive Oil in Oil Pulling Technique in Patients with Generalized Chronic Gingivitis To Imporve Oral Hygiene”, IJDSIROctober – 2025, Volume – 8, Issue – 5, P. No. 166 – 171. Copyright: © 2025, Dr. Sanjna B. Sharma, et al. This is an open access journal and article distributed under the terms of the creative common’s attribution non-commercial License. Which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given, and the new creations are licensed under the identical terms. Type of Publication: Original Research article Conflicts of Interest: Nil Abstract Introduction: Oil pulling or oil swishing therapy is a traditional procedure in which the patient will rinse or swish oil in their mouth. Ozonated olive oil is known for its anti-inflammatory properties, may be considered for management of gingivitis. The objective of this study was to assess efficacy of ozonated olive oil in oil pulling technique using plaque index and gingival index. Methodology: Total 60 patients with generalized chronic gingivitis were selected and were divided into 2 equal groups (Group 1-control group (30 patients received only oral Clinical parameters used are plaque index and modified gingival index, at baseline & 30th day. Participants have to perform daily oil pulling with ozonated olive oil for 1 mi. Statistical analysis was performed. Results: The results showed decreased in gingival inflammation and plaque score in both the groups at the end of 30 days. The oil pulling shown better improvement compared to SRP alone. Conclusion: Ozone oil can be good anti-gingivitis agent Dr. Sanjna B. Sharma, et al. International Journal of Dental Science and Innovative Research (IJDSIR) ©2025 IJDSIR, All Rights Reserved Page167 Page167 Page167 Page167 Page167 Page167 Page167 Page167 Page167 Page167 Page167 Page167 Page167 Page167 Page167 Page167 Page167 Page167 Page167 Keywords: Oil Pulling, Ozonated Olive Oil, Chronic Gingivitis Introduction Maintaining optimal oral health is paramount for individuals. It is most dependable and widely accepted techniques for preserving oral hygiene globally are mechanical tooth cleaning methods. Nonetheless, the pursuit of adjuvants that aid in reducing plaque formation and sustaining oral hygiene has been ongoing. However, the current chemotherapeutic adjuvants employed for plaque reduction are not without their drawbacks.1 Gingivitis, a reversible inflammatory condition, manifests clinically as redness, swelling, bleeding, and discomfort. In the absence of intervention, it may progress to more severe periodontal disease, resulting in the loss of supporting structures such as periodontal ligaments and alveolar bone.2 Oil pulling techniques have historically been employed to mitigate gum diseases. Kavala Graha, an Ayurvedic oral hygiene practice, involves holding or swishing a comfortable amount of oil or medicated oil in the mouth until it becomes thin and milky white, then expectorating it without swallowing. Dr. F. Karach popularized this method. Recent research using sunflower and sesame oils in oil pulling therapy has demonstrated efficacy in reducing plaque-induced gingivitis.3 Olive oil has been acknowledged for its positive impact on general well-being. The synergistic combination of olive oil and ozone presents a comprehensive approach to achieving optimal health and wellness, making it a valuable asset in any health and beauty regimen. Ozonated olive oil is a distinctive natural product that merges the therapeutic attributes of olive oil with the potent effects of ozone. This innovative blend is meticulously crafted by infusing extra-virgin olive oil with ozone gas, resulting in a viscous, gel-like substance that offers a spectrum of health benefits. Olive oil is renowned for its potent antibacterial, antifungal, and antiinflammatory properties.4 The ozonated olive oil is a powerful and versatile natural product that provides a variety of health benefits. Renowned for its wealth of antioxidants, vitamins, and beneficial fats, olive oil serves as an exceptional carrier for ozone. When combined, the ozone interacts with the fatty acids in olive oil, resulting in the formation of ozonides. These compounds have the unique ability to release oxygen when applied to the skin or ingested, enhancing cellular function and facilitating the healing process. Additionally, the inherent antimicrobial properties of this combination make it an effective natural remedy for wounds and ulcers, accelerating healing and reducing the risk of infection. Beyond topical applications, ozonated olive oil can be used for oral hygiene to reduce bacteria in the mouth and promote healthier gums. The ozonated olive oil demonstrates anti-inflammatory, antioxidant, and antimicrobial characteristics. The ozonated water effectively inhibits plaque accumulation in vitro, exhibiting high efficacy against Gram-positive and Gram-negative oral microorganisms. This combination can be effectively utilized in the treatment of microbial-induced inflammatory conditions such as gingivitis.[5] Therefore, this study aims to evaluate the efficacy of ozonated olive oil using the oil pulling technique in patients with chronic generalized gingivitis. Materials and Methodology A prospective clinical study was conducted. A total of 60 patients were recruited from the outpatient department of Periodontology, Chhattisgarh Dental College and Research Institute, Rajnandgaon, Chhattisgarh, India. The patients selected had generalized chronic gingivitis. Ethical approval was obtained from the institutional Dr. Sanjna B. Sharma, et al. International Journal of Dental Science and Innovative Research (IJDSIR) ©2025 IJDSIR, All Rights Reserved Page168 Page168 Page168 Page168 Page168 Page168 Page168 Page168 Page168 Page168 Page168 Page168 Page168 Page168 Page168 Page168 Page168 Page168 Page168 review board. The patients were informed about study procedures and informed consent was provided. Once consent was obtained, the patients were categorized and enrolled according to the selection criteria. G power software, version 3.1.9.7 (Heinrich-HeineUniversitat Dusseldorf, Dusseldorf, Germany was used). Power was kept at 0.80 (as per previous study), confidence interval was kept at 95%, and alpha error was considered to be 0.05. A priori computation was done to calculate for t test, an actual power of 0.802 at effect size of 0.31 yielded a sample size of 60 for two groups (30 per group). Inclusion criteria [i] Patients with generalized chronic gingivitis; [ii] No history of antibiotic or periodontal therapy in previous 6 months. Exclusion criteria [i] Patients taking medications that could affect their periodontal health; [ii] Known allergy to ozonated olive oil; [iii] Patients with aggressive periodontitis; [iv] Patient with adverse habits (i.e. smoking, tobacco, gutka chewing, alcohol consumption); [v] Pregnant or nursing females. Total subjects were divided into two groups i] Group 1Control group [30 patients receiving only oral hygiene routine instructions; Group 2 -Test group [30 patients receiving oral hygiene instructions+ oil pulling by ozonated olive oil. The patients were asked for swishing 2 ml ozonated olive oil in the morning for 1 min daily after brushing of teeth for 30 days. Clinical Parameters The clinical parameters included were:  Silness and Loe plaque index [PI][1964]  Loe and Silness gingival index [GI] [1963] All the parameters were recorded at baseline and 30th day. Clinical examination was carried out by the same Periodontist. On baseline the clinical parameters were recorded in both groups. Group 1-control group-patients received, only oral hygiene routine instructions and Group 2-Test group-patients received oral hygiene instructions + oil pulling by ozonated olive oil. Clinical changes were expressed using the mean difference from initial recording of parameter at baseline to final outcome after the therapy at 30th day. This was done for the clinical parameters. (Flow chart 01) Results The results showed that there is decrease in gingival inflammation and plaque score in both the groups at the end of 30th day. The intergroup comparison showed that SRP + oil pulling had superior effect as compared to SRP alone. (Table 1 & 2) Discussion The development of plaque-induced gingival disease is a complex interplay between plaque, the gingival tissues, and the host's inflammatory response. It is associated with subtle microbial changes as plaque matures.6 By employing chemico-mechanical procedures, oral hygiene measures effectively reduce the occurrence of plaque-related diseases through attenuation of plaque accumulation. In this study, we utilized ozonated olive oil to evaluate effectiveness of the ozonated olive oil pulling technique in plaque score assessment and to gauge the efficacy of ozonated olive oil in oil pulling for gingival inflammation. Olive oil is primarily composed of monounsaturated fats, predominantly oleic acid (65-85%), linoleic acid, and palmitic acid (up to 18-21%). It is also rich source of bioactive substances such as tocopherols and phenolic compounds. When exposed to ozone, the double carboncarbon bonds in unsaturated fatty acids undergo reactions Dr. Sanjna B. Sharma, et al. International Journal of Dental Science and Innovative Research (IJDSIR) ©2025 IJDSIR, All Rights Reserved Page169 Page169 Page169 Page169 Page169 Page169 Page169 Page169 Page169 Page169 Page169 Page169 Page169 Page169 Page169 Page169 Page169 Page169 Page169 that result in the formation of various oxygenated compounds, including peroxides, aldehydes, and ozonides. These compounds contribute to increased biological activity of ozonated olive oil (OZO), particularly its antimicrobial properties.7 The extent of these reactions and the resulting biological activity are influenced by several factors, including the duration of the ozonation process, temperature, ozone concentration, flow rate, and the type and value of the olive oil. Ozonated olive oil has demonstrated anti-inflammatory, antioxidant, and antimicrobial properties. Ozone's ability to eliminate bacteria, viruses, fungi, and other pathogens makes it a potent antimicrobial agent.8 Nagayoshi et al. demonstrated the remarkable efficacy of ozonated water in inhibiting plaque accumulation in vitro. This innovative approach exhibits, exceptional effectiveness against both Gram-positive and Gramnegative oral microorganisms.9 Furthermore, our studies on oil pulling with sunflower oil have yielded promising results, indicating a significant reduction in plaque index and gingival index over a 45-day period. Additionally, the findings of Dr. Asokan and colleagues suggest that oil pulling therapy utilizing sesame oil can be equally effective as chlorhexidine in mitigating plaque-induced gingivitis. 10 Ozonated olive oil has demonstrated greater efficacy in diminishing clinical indicators (plaque index and modified gingival index) and enhancing general oral health, potentially attributable to its anti-inflammatory properties.11 In addition to the notable characteristics of ozone gas broken down in oil, it is plausible that oil pulling's independent mechanism of action could be attributed to the oil's viscosity, potentially impeding bacterial adhesion and plaque co-aggregation. Additional mechanisms may include saponification, or the "soapmaking" process resulting from the alkaline hydrolysis of fat. Furthermore, emulsification significantly increases the oil's surface area, enhancing its cleansing effect.12 Peedikayil et al1, Sezgin Y et al12 indicates that the oil pulling technique using coconut oil may be an effective complementary procedure in reducing plaque formation and plaque-induced gingivitis. Furthermore, Akash N. suggests that ozonated olive oil is equally effective in reducing plaque and gingivitis as chlorhexidine mouthwash.13 The positive outcomes of the present study align with existing literature. Consequently, further research should be conducted, taking into account the limitations of this traditional, cost-effective, and advantageous technique. It can be safely utilized as an adjunct to maintain proper oral hygiene when consistently combined with tooth brushing and flossing. Conclusion Ozonated olive oil has demonstrated greater efficacy in ameliorating clinical parameters, including plaque index and modified gingival index, while simultaneously enhancing overall oral health. This favorable impact is potentially attributed to its remarkable anti-inflammatory properties. Results Table 1: Intra-Group Comparison Mean Std. Deviation Mean difference t P value Control Plaque index Baseline 1.99 0.49 0.56 7.035 0.000 30 days 1.43 0.30 Gingival index Baseline 2.03 0.55 0.83 9.161 0.000 Dr. Sanjna B. Sharma, et al. International Journal of Dental Science and Innovative Research (IJDSIR) ©2025 IJDSIR, All Rights Reserved Page170 Page170 Page170 Page170 Page170 Page170 Page170 Page170 Page170 Page170 Page170 Page170 Page170 Page170 Page170 Page170 Page170 Page170 Page170 30 days 1.19 0.48 Test Plaque index Baseline 2.02 0.58 0.90 8.806 0.000 30 days 1.11 0.39 Gingival index Baseline 1.94 0.56 1.12 12.985 0.000 30 days 0.81 0.50 Table 2: Inter-Group Comparison Study Outline Flow chart 1: Reference 1. Peedikayil, Faizal C.; Sreenivasan, Prathima1; Narayanan, Arun2. Effect of coconut oil in plaque related gingivitis — A preliminary report. Nigerian Medical Journal 56(2):p 143-147, Mar–Apr 2015. | DOI: 10.4103/0300-1652.153406 2. Rathee M, Jain P. Gingivitis. [Updated 2023 Mar 27]. In: Stat Pearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan. 3. Radzimierska-Kaźmierczak M, Śmigielski K, Sikora M, Nowak A, Plucińska A, Kunicka-Styczyńska A, Czarnecka-Chrebelska KH. Olive Oil with OzoneModified Properties and Its Application. Molecules. 2021 May 21;26(11):3074. doi: 10.3390/ molecules 26113074. 4. Ugazio E, Tullio V, Binello A, Tagliapietra S, Dosio F. Ozonated Oils as Antimicrobial Systems in Topical Applications. Their Characterization, Current Applications, and Advances in Improved Delivery Techniques. Molecules. 2020 Jan 14;25(2):334. doi: 10.3390/molecules25020334. 5. Sezgin Y, Memis Ozgul B, Alptekin NO. Efficacy of oil pulling therapy with coconut oil on four-day supragingival plaque growth: A randomized crossover clinical trial. Complement Ther Med. 2019 Dec; 47:102193. doi: 10.1016/j.ctim.2019.102193. Epub 2019 Sep 4. 6. Newman MG, Takei HH, Klokkervold PR. Carranza's Clinical Periodontology. 10th edition. Elsevier; 2006. p. 241. 7. Jimenez-Lopez C, Carpena M, Lourenço-Lopes C, Gallardo-Gomez M, Lorenzo JM, Barba FJ, Prieto MA, Simal-Gandara J. Bioactive Compounds and Quality of Extra Virgin Olive Oil. Foods. 2020 Jul 28;9(8):1014. doi: 10.3390/foods9081014. PMID: 32731481; PMCID: PMC7466243. T Sig. (2-tailed) Mean Difference between test and control Std. Error Difference Baseline Plaque index -.162 .872 -.02267 .14022 Gingival index .650 .518 .09433 .14510 30 days Plaque index 3.490 .001 .31800 .09112 Gingival index 2.978 .004 .38100 .12793 Dr. Sanjna B. Sharma, et al. International Journal of Dental Science and Innovative Research (IJDSIR) ©2025 IJDSIR, All Rights Reserved Page171 Page171 Page171 Page171 Page171 Page171 Page171 Page171 Page171 Page171 Page171 Page171 Page171 Page171 Page171 Page171 Page171 Page171 Page171 8. Indurkar MS, Verma R. Effect of ozonated oil and chlorhexidine gel on plaque induced gingivitis: A randomized control clinical trial. J Indian Soc Periodontol. 2016 Jan-Feb;20(1):32-5. doi: 10. 4103/0972-124X.170806. PMID: 27041835; PMC ID: PMC4795130. 9. Nagayoshi M, Fukuizumi T, Kitamura C, Yano J, Terashita M, Nishihara T. 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