Coconut oil-pulling therapy is used for maintaining oral health. The procedure has benefits for the prevention of oral disease, including dental caries, oral malodor, bleeding gums. However, virgin coconut oil (VCO) has unsatisfying oily taste. Therefore, coconut oil mouthwash (CoMW) was recently developed. This in vitro study aimed to evaluate the anti-inflammatory activity of coconut oil mouthwash consisting of 60% v/v virgin coconut oil (VCO), 30% v/v propylene glycol (PG), and 10% v/v distilled water on human gingival fibroblast (HGF) cells compared with the activity on murine macrophage (Raw 264.7) cells. The cytotoxicity of CoMW, 0.12% chlorhexidine gluconate (CHX), VCO, and PG was assessed. IC50 concentration of CoMW, CHX, and PG were 1:8 (v/v), 1:32 (v/v), and 1:16 (v/v), respectively. All tested concentrations of VCO had no impact on cell viability. Their anti-inflammatory effects of each IC50 concentration were further studied. Notably, the IC50 concentration of CHX also significantly inhibited nitric oxide production in lipopolysaccharide (LPS)- activated Raw 264.7 cells. Moreover, the IC50 concentrations of CoMW, VCO, PG, and CHX could suppress the interleukin-1 beta (IL-1β), interleukin-6 (IL-6) and cyclooxygenase-2 (COX-2) gene expressions in LPS-activated HGF cells, while also enhancing the cell migration of HGF cells as likely to the effect observed with the IC50 concentration of CHX. Wound healing ability of CoMW was also demonstrated after testing with a scratch assay. These findings indicated promising potential for coconut oil mouthwash as an effective agent in reducing inflammation and facilitating wound healing.

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Background/Objectives: Fungal and bacterial infections are major contributors to oral diseases in older adults. Although chlorhexidine (CHX) is widely recognized for its antimicrobial efficacy, its prolonged use is constrained by adverse effects. Virgin coconut oil (VCO) possesses antimicrobial properties; however, its high viscosity reduces acceptability. This study aimed to develop a flavor-enhanced coconut oil-based mouthwash (FCoMW) and evaluate its clinical safety, antimicrobial efficacy, and user satisfaction. Methods: A 14-day randomized controlled trial was conducted in older adults at the Faculty of Dentistry, Chiang Mai University, Thailand (April–July, 2024). Participants were randomly allocated by simple randomization to FCoMW, CHX, and normal saline solution (NSS). The evaluator was blinded. Assessments included burning sensation, oral mucosal alterations, changes in oral Candida and bacterial counts, and user satisfaction. Results: Among 51 participants (NSS: 17; CHX: 16; FCoMW: 18), FCoMW significantly reduced oral Candida counts by Day 14 (p < 0.0001), with efficacy comparable to CHX. CHX achieved greater bacterial reduction (p < 0.05). No adverse effects occurred with FCoMW. User satisfaction was high for scent, freshness, and overall acceptability. Conclusions: FCoMW is safe, well-accepted, and efficacious against oral Candida, offering a natural alternative to chlorhexidine for long-term use in older adults.