How does Ramadan impact oral health?

How does Ramadan impact oral health?
As the holy month of Ramadan starts for Muslims around the world, Sakina Syed explains how fasting can impact oral health, how to support colleagues and patients who are celebrating, and gives tips for a healthy mouth during Ramadan.

The month of Ramadan will begin in March 2023 for 30 days.

In Arabic, fasting means ‘sawn’ or abstinence. During this time 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.

The benefits of fasting

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 increasing charity, compassion and care.

Within recent years, intermittent fasting has become a health trend around the world.

Fasting has many health benefits, including:

  • Reduced cholesterol levels
  • Aid weight management
  • Stabilisation of glycemic control
  • Opportunity for smoking cessation
  • Improved gut microbiomes.

This does, however, need to be observed in a sensible and carefully managed diet, so not to overindulge at the early morning breakfast, before sunrise and especially the evening meal post-sunset.

Rehydration and replenishment of energy supplies is important during fasting.

In addition, 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.

A typical fasting day

Most individuals observing within the UK will fast for between 15 to 17 hours, with an early morning breakfast before 4:30am and then fasting until about 6.30pm.

Timings change each year with summer periods of Ramadan being longer in duration.

As the 30 days progress, the timings increase by a few minutes each day depending on sunset.

Water can be consumed before beginning the fast and after opening the fast, but not while fasting.

Can you brush your teeth while fasting?

Brushing of teeth is allowed with toothpaste, provided the toothpaste is not swallowed.

However, some individuals believe that brushing your teeth is not allowed because of the possibility of water being swallowed. They do not want to risk breaking their fast, so they refrain from doing it.

It’s advisable to brush your teeth before the fast begins and before bed, with some patients happy to brush again before they start their day later on in the morning.

Dietary habits can change

It is human nature to crave certain foods or drinks when fasting all day, especially as this month brings people together and encourages seeing friends and family for dinner parties.

Eating foods with higher sugar or carbohydrates can be risky and unhealthy for the month, especially sugary drinks and foods, which increase the risk of dental caries.

It is best to follow a low carbohydrate, medium fat and high protein diet and stay as normal as possible eating  balanced meals.

Traditionally, dates are eaten to open fasts; they are high in fibre which help regular bowel movements and high in potassium to aid nerves and muscles movements.

They are also very high in sugar and have a high glycaemi index (GI). This means 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 one to two.

Can you still go to the dentist when fasting?

There is no reason why dental appointments can not be attended while fasting.

However, many people may not want to visit for treatment in case their fast is broken due to water being unintentionally swallowed.

There should be no reason why 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 advised that such treatment is necessary. They should electively complete the treatment and make up the missed fast at the end of the ramadan.

This needs to be handled in a sensitive manner, with empathy and understanding in order to avoid offending the patient’s religious belief.

However, it should also be stressed that the treatment is in the best interest of the patient.

In addition, 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. 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.

Swallowing saliva

This does not break the fast as saliva is a natural oral secretion.

Smoking

It is prohibited to smoke while fasting and it will invalidate the fast.

With some patients it could be the perfect time to support and aid their smoking cessation process. 

Miswak stick

You may be familiar with miswak which is a natural chewing stick thought to be one of the oldest types of natural toothbrushes.

It is still commonly used in the Middle East and Africa, but it’s also becoming quite prominent to use in the western world, especially within the month of ramadan.

The sticks are extracted from a particular tree called Salvadora Persica, or Arak tree. Some people may use it to compliment their existing oral hygiene methods.

Its 100% biodegradable, natural and very affordable. It’s encouraged to use in the holy month as it can help to reduce bacterial plaque, but may not be entirely effective on all surfaces of the teeth due to the single length of the filaments on each branch.

Some people peel back the stick to open the filaments and others chew the stick for the filaments to separate.  Either way, electric toothbrushes are still the number one choice for plaque control and technique.

Possible consequences of fasting that can affect treatment delivery

Dehydration and halitosis

This is extremely common when the body is not receiving any fuel, as the body is put into a state of ketosis releasing ketones.

These are chemicals which break down fat for energy. When they mix with plaque bacteria in the oral cavity they produce a bad odour – bad breath.

This also occurs when dehydrated, and more ketones are released due to a reduction in salivary function, therefore drying the mouth.

Dry mouth

Due to a reduction in stimulating saliva it’s common to experience dry mouth.

The situation is exacerbated due to the lack of water. Therefore, when not fasting it’s important to rehydrate.

In some patients this can increase their risk of dental decay, especially if they are already medic-comprised.

Alterations in medication and possible medical emergencies

There is an increased risk of syncope in the fasting patient. Fasting can cause stress on the body and variation in circadian rhythm.

Not having sufficient time intervals between fasts can have an impact on regulating the normal body clock, causing fatigue. Therefore, it is recommended to take a nap during the day where possible. But on a busy working day it’s hard to do.

There is also an increased risk of hyperglycaemia due to dietary changes. In addition, the change in drug intake and glucose monitoring does not break the fast.

Fasting should be sensitivity discussed and gently discouraged in patients with poorly managed diabetes or those with frequent episodes of hyperglycaemia or hypoglycaemia episodes.

Local mosques and community projects begin campaigns before Ramadan and even run specific diabetes management classes to address this issue within the local communities.

Dental team members and fasting

There may be team members fasting within your dental teams.

With fasting and working,  you should always ensure that patient care and a good working environment is taken into account during Ramadan. This is especially important in dentistry where attention, focus and precision is key.

Regular breaks should still be taken even at lunch to rest the body and mind.

Ensure the room is well ventilated and that fresh air breaks and rest is taken.

How to have a health mouth in Ramadan

Tips for a healthy mouth in Ramadan are not much different to what is normally encouraged.

  • Brush teeth twice daily with fluoride toothpaste – in the evening and one other time, eg when fast begins
  • Floss/use interdental brushes to clean in between teeth
  • Use a mouthwash after evening meals, not straight after toothbrushing
  • Use a tongue scraper to cleanse the tongue and reduce bad breath
  • Avoid sugary foods/drinks
  • Avoid caffeine and excessive salt which can contribute to dehydration
  • Chew sugar-free gum after your evening meal to help with saliva stimulation
  • Eat a balanced meals with fruits, vegetables, fibre and protein
  • Eat slow-release foods such as porridge in the morning
  • Drink plenty of water, especially after opening the fast to rehydrate the body.

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