During the month of Ramadan Muslims fast, abstaining from eating and drinking during the hours between sunrise and sunset. Pregnant women, nursing mothers, the elderly, young children, and those with medical illnesses are exempt however, many still choose to fast. As dental professionals the whole team should be aware of how fasting can affect a person’s diet, their oral hygiene and what possible oral complications or situations can arise.
Fasting has many health and spiritual benefits. It encourages the learning of self-discipline, empathy, kindness, and mental strength and can help to purify the body as well as increase charity, compassion, and care. Within recent years intermittent fasting has become popular with several health benefits such as reducing cholesterol levels, aiding weight management and stabilisation of glycemic control
This does however need to be observed in a sensible and carefully managed diet so as not to overindulge both at the early morning breakfast, before sunrise and especially the evening meal post sunset. Rehydration and replenishment of energy supplies are important during fasting. A sudden change in diet for such a long period lasting 30 days can increase cravings for sweeter foods and an unhealthy diet can negatively affect the oral cavity and the whole body.
Can you brush your teeth and interdental clean whilst fasting?
Brushing teeth is allowed with toothpaste, provided the toothpaste is not swallowed. Some believe toothbrushing is not allowed because of the possibility of water being swallowed and the risk of breaking their fast so refrain from toothbrushing. It’s advisable to brush teeth before the fast begins and before bed, with some patients happy to brush again before they start their day later in the morning.
Dietary habits can change.
It is natural to crave certain foods or drinks when fasting all day, especially as this month brings people together and encourages family gatherings at dinner parties.
Eating foods with higher sugar or carbohydrates can be unhealthy for the whole month, especially sugary drinks and foods that increase the risk of dental caries. It is best to follow a low carbohydrate, medium fat and high protein diet and maintain a healthily as balanced diet.
Traditionally dates are eaten to open fasts; they are high in fibre (which helps regular bowel movements) and high in potassium to aid nerves and muscle movements. They are also very high in sugar and have a High GI index so they release energy quickly which can be useful post-fasting but due to the high sugar content, it’s advisable not to eat too much and limit the daily intake to 1-2.
Can you still go to the dentist when fasting?
Can you still go to the dentist when fasting?Dental appointments can be attended whilst fasting however, many choose not to elect treatment in case their fast is broken due to water being intentionally swallowed. There is no reason it would affect a dental examination, hygienist appointment, restorative treatment, or extractions but treatments involving water may cause some patients to think twice about their appointment scheduling. If there is no active pain or pressing need for treatment and the patient is reluctant it is best to delay or reschedule treatments if safe to do so. It should be stressed that if a patient is in pain and needs urgent dental treatment, they should be supported that such treatment is necessary, and they should electively complete the treatment and make-up missed fast at the end of Ramadan. This needs to be handled sensitively, with empathy and understanding not to offend the patient’s religious belief but also to stress the treatment is in the best interest of the patient. For some patients, the use of local anaesthetic or any form of water in the mouth whether it is swallowed or not may not be acceptable, and, in such cases, elective treatments may need to be delayed even though local anaesthetics are permissible. Disagreements may arise so respect the patient’s beliefs in an understanding manner to ensure a more comfortable patient journey.
What will break your fast?
- Intentionally eating and drinking
- Smoking (it’s the perfect time to offer smoking cessation support)
What does not break your fast?
- Brushing your teeth with toothpaste
- Brushing your teeth with a miswak stick
- Cleaning in between with teeth with dental floss or interdental brushes
- Visiting the dentist /Dental therapist for a dental examination
- Seeing the dental hygienist / dental therapist for professional mechanical plaque removal
Possible consequences of fasting and how it can affect treatment delivery.
| Dehydration & Halitosis
| The body goes into ketosis, releasing ketones due to a lack of food /drink. Ketones are back down fat for energy when mixed with plaque biofilm they release bad odours. This also occurs when dehydrated and more ketones are released due to a reduction in salivary function, drying the mouth.
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| Dry Mouth
| Due to a reduction in stimulating saliva, and lack of water, Elevated risk of dental decay especially if medically compromised patients
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| Alterations in medication and possible medical emergencies
| Increased risk of syncope in the fasting patient due to stress on the body and variation in circadian rhythm. Long fasting window can make it difficult to regulate the normal body clock and cause fatigue. There is an increased risk of hyperglycemia due to dietary changes and changes in drug intake and glucose monitoring does not break the fast.
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| Team members fasting
| Consideration of a good working environment and support. Regular breaks should still be taken at lunch to rest the body and mind, ensuring the room is well-ventilated. |
Local mosques and community projects begin campaigns before Ramadan and even run specific diabetes management classes in Ramadan campaigns to address this within the local communities.
The miswak stick is a natural chewing stick thought to be one of the oldest types of natural toothbrushes and is still widely used. However, the Curaprox 1006 solo brush, although difficult to master in technique, can be a perfect brush to aid plaque removal in patients who do not wish to use toothpaste and can be shown to dry brush.
Tips for a healthy mouth in Ramadan are no different to what is already encouraged.
- Brush teeth twice daily with fluoride toothpaste, in the evening and 1 other time eg. before the fast begins. The Curaprox Solo 1006 can be used for dry brushing in the daytime and is perfect for this.
- Use interdental brushes or floss to clean in between teeth.
- Use a mouthwash after the evening meal not straight after toothbrushing.
- Use a tongue scraper to cleanse the tongue and reduce bad breath.
- Avoid sugary foods/drinks pre-dawn but especially when opening fast.
- Avoid caffeine and excessive salt which can contribute to dehydration.
- Chew sugar-free gum post-evening meal to help with salivary stimulation.
- Eat balanced meals with fruits, vegetables fibre and protein.
- Eat slow-release foods such as porridge in the morning.
- Drink plenty of water between fasts, especially after opening the fast, to rehydrate the body.
Ramadan Kareem from Sakina – (a greeting used to mark the beginning of Ramadan)
Sakina Syed
Dental Hygienist & Dental Therapist
BSc, (Hons), Dip DH, Dip DTh
iTop Instructor -UK
@bank_dentalhygienist
