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 Table of Contents  
Year : 2021  |  Volume : 8  |  Issue : 1  |  Page : 55-58

Ramadan fasting and dental implications: A special review

Department of Conservative Dentistry and Endodontics, Peoples Dental Academy, Bhopal, Madhya Pradesh, India

Date of Submission22-Jul-2020
Date of Decision13-Aug-2020
Date of Acceptance04-Sep-2021
Date of Web Publication25-Feb-2021

Correspondence Address:
Nitish Mathur
Department of Conservative Dentistry and Endodontics, Room No. 301, Peoples Dental Academy, Peoples University, Bhopal, Madhya Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jdrr.jdrr_86_20

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Fasting during the holy month of Ramadan is considered obligatory for all Muslims. It is regarded as one of the five pillars of Islam in which all the followers observe complete abstinence from food and fluid during daylight hours. Such a strict practice has built up hesitations among the followers to go for a dental treatment. This article aims to describe the modifications in the dental practice required for Muslims during this month alongside the oral health-care tips. A dentist should consider these alternatives and appreciate the religious custom so as to provide a compassionate service.

Keywords: Dental treatment, Islamic fasting, oral hygiene, Ramadan

How to cite this article:
Tyagi S, Mathur N. Ramadan fasting and dental implications: A special review. J Dent Res Rev 2021;8:55-8

How to cite this URL:
Tyagi S, Mathur N. Ramadan fasting and dental implications: A special review. J Dent Res Rev [serial online] 2021 [cited 2023 Feb 5];8:55-8. Available from: https://www.jdrr.org/text.asp?2021/8/1/55/310196

  Introduction Top

Islam is the 2nd largest religion in the world,[1] with approximately 138 million adherents living in India.[2] The foundation of Islam lies in its five pillars, namely belief, prayer, giving of charity, fasting, and pilgrimage, which are considered to be mandatory by the believers. Fasting regarded as the fourth pillar is an obligatory act for all Muslims in the month of Ramadan.[3]

Ramadan occurs in the 9th month of Islamic calendar which comes approximately 11 days early every year according to solar calendar. During this month, all Muslims are asked to begin their fast after consuming 1st meal before sunrise known as “suhoor” and end their fast after sunset, followed by 2nd meal known as “iftar.” They are religiously bound to refrain from food and water during daylight hours. Although all Muslims are obliged to keep fast in this holy month, there are certain exemptions such as prepubescent children, travelers, medically compromised, pregnant, and nursing women, and menstruating women.[4],[5]

Many studies in the past have stated the effects of Ramadan fasting on general health,[6],[7],[8],[9] but there is little literature available on its considerations pertaining to dentistry. As Ramadan fasting is a strict abstinence from food and fluids during daylight hours, the dentist should understand and appreciate this custom to deliver a culturally acceptable service. Therefore, this article aims to discuss the implications of Ramadan fasting on dentistry with relevance on treatment recommendations and oral health-care tips for patients.

  Recommendations for the dentists Top

Managing medications during Ramadan

Antibiotics and analgesics are the most common drugs and prescribed in dentistry.[10] Any oral route of drug administration during daylight hours will invalidate the fasting.[11] Antibiotics and analgesics has to be taken after food.so to relieve tooth ache during Ramadan fasting, the person has to break his fast.[12]

The recommended strategies to manage this issue include selecting long-acting formulations such as diclofenac sodium sustained release 75 mg which requires only two doses per day or selecting antibiotics such as amoxicillin which is usually taken every 12 h unlike penicillin V which requires 4 doses/day. These modifications will allow the patient to take the drug outside fasting hours, thus preserving the cultural practice. Systemic conditions and physician consultation should be well considered before changing the medication and dosing regimen.[13]

Scheduling dental appointments

The authors have stated that during the month of Ramadan, several Muslims are afraid to go to dental clinics even at the times of emergency as they perceive that ingestion of water during dental procedure, administration of anesthesia, accidental swallowing of saliva during intraoral examination, or any intraoral procedure will invalidate their fast.[14],[15]

Studies postulate the chances of showing up signs of irritability, tiredness, and inattention in these patients during fasting hours due to sleep disturbances and lack of intake of addictive substances such as nicotine and caffeine.[16]

Taking into consideration the abovementioned studies, it is, therefore, recommended to schedule the elective dental procedures outside fasting hours.

Dental procedures during fasting hours

Local anaesthesia administration whenever required during dental procedure is allowed during the fasting hours of Ramadan.[17],[18]

As mentioned in studies, the use of long-acting anesthetic agents delays the consumption of postoperative analgesics.[19],[20] Thus, it is suggested that any dental procedure requiring local anesthesia should be conducted in the late afternoon with preferably the use of long-acting anesthetic agents which will allow the patients to consume postoperative analgesia in the nonfasting hours.

Tooth extraction should be postponed after the holy month of Ramadan. It should only be considered as a last resort to relive pain with the use of high volume suction tips so as to avoid inadvertent swallowing of blood.[21] Blood glucose level should be monitored before and after the extraction. Informed consent must be taken before the procedure for oral glucose administration if the hypoglycemic situation comes up.[22] Suturing the extraction sockets will forestall the use of liquid hemostatic agents that could be accidentally gulped. Lasers can also be taken into consideration for achieving hemostasis.[21],[22]

Since tooth extraction causes inadvertent swallowing of blood, therefore alternatively, pulp extirpation procedures can be carried out under a strict rubber dam isolation alongside high volume suction and upright positioning of patient.[21],[22]

The efficiency of transdermal patches following extractions has been investigated in a study in which transdermal patches containing 100 mg of diclofenac applied once every day were compared with 50 mg of oral diclofenac taken 3 times each day which concluded potent analgesia and better patient compliance of transdermal patch over oral diclofenac.[23]

Therefore, for coping up with the postoperative pain after extraction and endodontic procedures, a transdermal patch of diclofenac or tramadol fills in as a swap for the conventional dosing system, keeping away from the requirement for an oral route of drug administration.[24]

Dry socket is one of the most widely recognized and disappointing postoperative complications following extractions.[25] For managing such a situation, placement of topical medicament such as Alvogyl on the dry socket is permitted during Ramadan.[14]

For managing acute pulpitis, pulp capping medicaments such as calcium hydroxide, Ledermix, and formocresol paste can be placed directly on to the pulp. This is permitted during fasting and does not refute the fast.[26]

  Oral Health Tips for the Patients Top

Oral hygiene

If oral hygiene measures are not taken properly during the month, it could impact the gingival and periodontal status.[27],[28]

A few researchers of Islam believe the usage of toothpaste to be exceptionally unwanted in light of the fact that intentional or coincidental swallowing of them will invalidate the fast.[29]

Some Muslims keep on carrying out a traditional technique for oral cleanliness. The “miswaak” is a little twig with a frayed end from the plant Salvadora persica which is utilized to rub against the surfaces of the teeth.[30] A patient utilizing this strategy may exhibit gingivitis and periodontitis, and moreover, it is less effective than toothbrushing in plaque removal.[31] A distinctive yellow staining, abrasions, and gingival recession are other disadvantages of using miswak.[32],[33],[34]

As the American Dental Association suggests brushing the teeth two times daily; therefore, the dental specialists ought to remind the fasting patients to brush and floss completely before sleeping and after Suhoor.[14]

Mouthwashes, for example, chlorhexidine, can be used, yet patients might be hesitant because of the possibility of incidental swallowing. Hesitant patients might be encouraged to perform the mouthrinse outside the fasting hours.[35]


Due to reduced saliva production during fasting, anaerobic putrefaction will build, causing the nonpathological form of halitosis.[36] Tongue coating, gum disease, and periodontitis will aggravate this situation.[37],[38] Consequently, it is prescribed to rehearse oral cleanliness approaches outside fasting hours. It would be normal that caffeine had a huge influence on lessening salivary flow. This impact has been an acknowledged belief of the treatment of hyposalivation.[39] Moreover, salty and spicy food can cause hyposalivation.[40] Hence, it is encouraged to stay away from tea, coffee, and other caffeinated refreshments at the “suhoor” feasting time. Alcohol-based mouthwashes should be avoided as it causes dryness of the mouth.[41] Increased water intake and dietary modifications are other significant variables to be considered for preventing bad breath.[42]

  Conclusion Top

Ramadan for Muslims implies something beyond not eating and drinking during the day. It prepares an individual exclusively in devotion and self-control. A dentist ought to know about any strict and social customs so as to treat the patient with fellow feeling and comprehension.

A few Muslim patients might be hesitant for some dental procedures and oral hygiene methods as they negate the fast. Various dental treatment approaches and oral hygiene measures that are viewed as alternatives during fasting have been described here. The dentist must know about this and modify their endorsing practice or counsel appropriately. Moreover, they should instruct and urge their patients to experience suggested treatment modalities.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

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Sakr AH. Fasting in Islam. J Am Diet Assoc 1975;67:17-21.  Back to cited text no. 3
Azizi F. Medical aspects of Islamic fasting. Med J IR Iran 1996;10:241-6.  Back to cited text no. 4
Azizi F. Research in Islamic fasting and health. Ann Saudi Med 2002;22:186-91.  Back to cited text no. 5
Alkandari JR, Maughan RJ, Roky R, Aziz AR, Karli U. The implications of Ramadan fasting for human health and well-being. J Sports Sci 2012;30 Suppl 1:S9-19.  Back to cited text no. 6
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[PUBMED]  [Full text]  
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