A concise review of oil pulling as a precautionary measure in COVID-19 pandemic

Twinkal Mahakale1, Gaurav Sawarkar*1, Vaishali Kuchewar2, Pramod Khobragade3 1Department of Rachana Sharir, Mahatma Gandhi Ayurved College Hospital and Research Centre, Datta Meghe Institute of Medical Science (Deemed to be University), Wardha, Maharashtra, India 2Department of Kaychikitsa, Mahatma Gandhi Ayurved College Hospital and Research Centre, Datta Meghe Institute of Medical Science (Deemed to be University), Wardha, Maharashtra, India 3Department of Dravyaguan, Datta Meghe Ayurved Medical College Hospital and Research Centre, Wanadongri, Nagpur, Maharashtra, India


INTRODUCTION
Ayurveda is an ancient medical science gift from Old sages. It is not only a system of medicine in the sense of curing disease. Several types of modes are in force to prevent a pandemic situation like Yoga Pranayama, consumption of immunomodulatory drugs (Gurmule, 2020;Rajput, 2020), antiviral herbal drugs (Rathi et al., 2020), take care of health with proper diet (Lohi and Sawarkar, 2020) is one of the crucial factors which directly affect the individual health. It is also a way of life that teaches us how to maintain and protect health. Kawal and Gandush (oil pulling) are incorporated in Kriyakalpa by Sharangdhara (Bhat, 2016). 'Kriya' mean therapeutic procedures used to cure the disease and 'Kalpa' means practicable, manner of acting a prescribed rule mean kriya Kalpa speci ic formulation used for therapy in Ayurveda in mainly Shalakyatantra (Bhutada, 2019). Oral health and essential in COVID-19, Kawal, and Gandush, maintain the strength of all kinds of organ present above the suprasternal notch (Naseem et al., 2017). Its humble attempt to review oil pulling therapy in the context of oral hygiene as a precautionary measure in the COVID-19 pandemic.

Mode of transmission
The virus is transmitted to direct contact with an infected person's respiratory droplet through coughing and sneezing. An individual can also be affected by touching a surface contaminated with the virus and touching their face, eye, nose mouth (Fadanavis and Sawarkar, 2020). COVID-19 may survive on the surface for several hours, but simple disinfectants can kill the virus. COVID-19 get affect through the nose, mouth, eyes (Modes of transmission of virus causing COVID-19, 2020). Airborne transmission via aerosols are particles under 100 µm in diameter, minute size and suspension in the air may ease direct contraction of the virus. Aerosols may be formed during various surgical and dental procedures or formed as droplet nuclei while talking, coughing, and sneezing by an infected patient. Aerosolized SARS-CoV-2 remains viable in the aerosols for three hours and on different surfaces for 4-72 h, so a better way to avoid unnecessary contact with other things and avoid sharing toilets risk transmission of the virus (Karia et al., 2020).

Importance of oil pulling
The Kriyakalpa is mainly used in urdhwagata roga (Diseases above suprasternal notch) (Naseem et al., 2017). It increases the immunity power of surrounding organs and avoids favorable conditions to get infected. It is readily responsive to clear nasal and oral route and decrease Kapha Dosha. According to Dosha, various types of drugs can be used and cure diseases related to the respiratory tract. Oil gargling or holding in the oral cavity is advantageous to the strength of jaws, voice, the softness of face skin, upgrade the functioning of sense organs. Get relief from the dryness of throat, cracked lips as well as teeth disorders (Matrashiteeya Adhyaya, 2020). Recent researches revealed the connection of saliva with systemic health. The non-invasive nature and effortless collection of salivary luid may be the choice for diagnostic and critical health surveillance determinations. Saliva and related oral luids help to maintain the functions in the oral cavity. The juices reduce oral biomass and facilitate mechanical cleaning of teeth with an optimal pH, which ef iciently enables verbal tasks and comprises an array of antimicrobial components. Saliva is not just an ultra iltrate of plasma, but it contains the complete collection of proteins, hormones, antibodies, and other molecular compounds that can easily measure through routine blood tests (Tiwari, 2011).

Mechanism of oil pulling
The oral cavity is continuously lushing saliva and facilitates the low of the food debris to keep clean the mouth. Salivary secretions are comparably slow down during sleep; that's why the bacterial growth increases in the mouth resulted in the foul smell of breath in the morning. Salivary enzymes are carried out lyses of so many bacteria that prevent the microbial population's excessive growth in the oral cavity. Because of this phenomenon, researchers suggested salivary luid analysis to predicts or to diagnose or to avoid health-related issues and overcome future unwanted illnesses. The variety of molecules freely travel through the cells and can have assessed in the salivary ducts, which can be analyzed in the assay of salivary luid. These small molecules are hormones, a chemical indicator of health, various types of enzymes, toxins (Tiwari, 2011). It is hypothesized that the tongue, a sense organ, is connected with vital organs like the lungs, heart, intestine, kidney. Oil pulling helps to excrete toxic metals through saliva, where salivary enzymes absorb blood toxins like chemical, bacterial, and environmental and expelled through the tongue (Shanbhag, 2017). It is a simple mechanism that works in oleation therapy (Sawarkar and Prasad, 2017).

Drugs used for oil pulling
The various drugs are used for oil pulling like milk, cow urine, olive oil, mango pulp, gooseberry extract, sun lower oil, sesame oil, coconut oil, medicinal decoctions, etc. Speci ically, oils work on pulling techniques of bacteria, viruses, and protozoa. Traditionally sesame oil is frequently used for oil pulling (Hebbar et al., 2010;Shanbhag, 2017).

DISCUSSION
In COVID-19, the disease having cardinal symptoms as like Vatasleshmak Jwar. They are fever (Jwar), cold (Pratishya), cough (Kasa), etc. and having related causative factors. In this case, the Vatasleshmak Jwar treatment can help manage the corona disease to some extend (Vaidya and Sawarkar, 2020). The lung is the main vital organ affected in the disease, composed of blood and its frothing part, playing an essential role in maintaining the body's water level (Gupta et al., 2020). Oil pulling is a form of retention of luid in the mouth for a speci ic period till the occurrence of lacrimation and nasal discharge. After that, the patient is advised to spit out. Regular use of oil pulling facilitates strength to voice, jaws, face and better taste perception, strong and healthy teeth, and protect the oral cavity from other diseases. The medicated liquid or oil's active ingredients and chemical constituents stimulate the chemo receptors and mechano receptors and produce the salivary nuclei in the brain stem. As a result, the parasympathetic nervous system activates and increases impulses through motor ibers in facial and glossopharyngeal nerves. All the process forcefully increases the output of salivary secretion, which predominantly watery. That helps to dislodge the metabolic toxins, food debris, depositions, and microorganisms present in the oral cavity, mixed with retained medicated liquid or oil, and removed from the oral cavity (Mohan and Sawarkar, 2019).
The saliva helps digest the food, protects teeth from various infections, and controls microbes in the oral cavity. If saliva doesn't make secret, the oral cavity becomes dry and which will be very prone to any infection (Altamimi, 2014). The oil pulling is useful for dryness of the mouth. It facilitates to get the oral cavity moister (Kavala (Gargling)-Gandusha (Holding luid inside the mouth/Oil Pulling), 2020). Oil pulling develops antioxidant elements for damaging the bacterial cell wall, attract them and pulled into the area of oil, the site gets increased due to emulsi ication processes during oil pulling (Shanbhag, 2017). This procedure helps prevent airborne disease by ceasing the growth of pathogenic and non-pathogenic organisms in the oral cavity. Researchers found the effect of oil pulling on halitosis and its microorganisms as effective as chlorhexidine (Asokan et al., 2011). On review of various research studies, it is observed that regular and correct use of oil pulling helps keep oral hygiene well. Still, enough research studies are not detected, which can conclude the promising effect of oil pulling on microbes. Beholding the bene its of oil pulling, the regular and judicial practice provides a healthy oral cavity setting. It increases the immunity of besides organs, which ultimately plays a precautionary role in the present COVID-19 pandemic situation.

CONCLUSIONS
Oil pulling therapy is a straightforward and costeffective treatment that provides a healthy oral cavity and easy to accept due to its less follow-up regime and precautions. Regular use of oil pulling can prevent airborne diseases up to some extent and take apart to combat COVID-19 situation.
ACKNOWLEDGEMENT I am very grateful to Datta Meghe Institute of Medical Sciences (Deemed to be University) to provide research support and inancial assistance for the publication.

Funding Support
The authors declare that they have no funding support for this study.