|
|
REVIEW ARTICLE |
|
Year : 2021 | Volume
: 8
| Issue : 1 | Page : 55-58 |
|
Ramadan fasting and dental implications: A special review
Sanjeev Tyagi, Nitish Mathur
Department of Conservative Dentistry and Endodontics, Peoples Dental Academy, Bhopal, Madhya Pradesh, India
Date of Submission | 22-Jul-2020 |
Date of Decision | 13-Aug-2020 |
Date of Acceptance | 04-Sep-2021 |
Date of Web Publication | 25-Feb-2021 |
Correspondence Address: Nitish Mathur Department of Conservative Dentistry and Endodontics, Room No. 301, Peoples Dental Academy, Peoples University, Bhopal, Madhya Pradesh India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jdrr.jdrr_86_20
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 |
Introduction | |  |
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 | |  |
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 | |  |
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]
Halitosis
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 | |  |
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
Nil.
Conflicts of interest
There are no conflicts of interest.
References | |  |
1. | |
2. | |
3. | Sakr AH. Fasting in Islam. J Am Diet Assoc 1975;67:17-21. |
4. | Azizi F. Medical aspects of Islamic fasting. Med J IR Iran 1996;10:241-6. |
5. | Azizi F. Research in Islamic fasting and health. Ann Saudi Med 2002;22:186-91. |
6. | 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. |
7. | Leiper JB, Molla AM, Molla AM. Effects on health of fluid restriction during fasting in Ramadan. Eur J Clin Nutr 2003;57 Suppl 2:S30-8. |
8. | Roky R, Houti I, Moussamih S, Qotbi S, Aadil N. Physiological and chronobiological changes during Ramadan intermittent fasting. Ann Nutr Metab 2004;48:296-303. |
9. | Benaji B, Mounib N, Roky R, Aadil N, Houti IE, Moussamih S, et al. Diabetes and Ramadan: Review of the literature. Diabetes Res Clin Pract 2006;73:117-25. |
10. | Maslamani M, Sedeqi F. Antibiotic and analgesic prescription patterns among dentists or Management of dental pain and infection during endodontic treatment. Med Principles Practice 2018;27:66-72. |
11. | Grindrod K, Alsabbagh W. Managing medications during Ramadan fasting. Can Pharm J (Ott) 2017;150:146-9. |
12. | Mikhael EM, Jasim AL. Antibiotic-prescribing patterns for Iraqi patients during Ramadan. Patient Prefer Adherence 2014;8:1647-51. |
13. | Anees K, Bedi R. Transcultural oral health care: 4. Dental medication for Muslim patients. Dent Update 2000;27:449-52. |
14. | Peedikayil FC, Thomas A, Naushad MC, Narayanan A. Management of Muslim dental patient while fasting. Europ J General Dent 2014;3:82. |
15. | Mohd FN, Said AH. Dental procedures during fasting: Perceptions among Muslims in Malaysia. J Int Dent Med Res 2019;12:597-601. |
16. | Kadri N, Tilane A, El Batal M, Taltit Y, Tahiri SM, Moussaoui D. Irritability during the month of Ramadan. Psychosom Med 2000;62:280-5. |
17. | Recommendations of the 9 th Fiqh-Medical seminar “An Islamic View of Certain Contemporary Medical Issues,” Casablanca, Morocco; 14-17 June, 1997. |
18. | |
19. | Marković AB, Todorović L. Postoperative analgesia after lower third molar surgery: Contribution of the use of long-acting local anesthetics, low-power laser, and diclofenac. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006;102:e4-8. |
20. | Diaz-Abele J, Luc M, Dyachenko A, Aldekhayel S, Ciampi A, McCusker J. Lidocaine with epinephrine versus bupivacaine with epinephrine as local anesthetic agents in wide-awake hand surgery: A pilot outcome study of patient's pain perception. J Hand Surg Global Online 2020;2:1-6. |
21. | Shaeesta KB, Prabhuji ML, Shruthi JR. Ramadan fasting and dental treatment considerations: A review. Gen Dent 2015;63:61-6. |
22. | Uppal N, Shikha D. Minor oral surgery in fasting Muslim patients during Ramadan. J Can Dent Assoc 2013;79:d155. |
23. | Bhaskar H, Kapoor P, Ragini . Comparison of transdermal diclofenac patch with oral diclofenac as an analgesic modality following multiple premolar extractions in orthodontic patients: A cross over efficacy trial. Contemp Clin Dent 2010;1:158-63.  [ PUBMED] [Full text] |
24. | Tejaswi DV, Prabhuji ML, Khaleelahmed S. Comparative evaluation of transdermal diclofenac patch and oral diclofenac as an analgesic modality following root coverage procedures. Gen Dent 2014;62:68-71. |
25. | Cardoso CL, Rodrigues MT, Júnior OF, Garlet GP, de Carvalho PS. Clinical concepts of dry socket. J Oral Maxillof Surg 2010;68:1922-32. |
26. | |
27. | Narayanan A, Praveen PP, Firoz KM, Kumar EGA, Mathur R, Bhat MS. Effect of Ramadan fasting on gingival status: A comparative study. Int J Oral Care Res 2016;4:104-6. |
28. | AL-Duliamy MJ. The effect of Ramadan fasting on plaque count of Streptococcus Mutans in patients wearing fixed orthodontic appliance. A clinical study. Mustansiria Dent J 2017;14:87-91. |
29. | Sheikh A, Gatrad AR. Caring for Muslim Patients. Kannur (Cannanore), Kerala: Radcliffe Medical Press; 2000. |
30. | Darwish S. The management of the Muslim dental patient. Br Dent J 2005;199:503. |
31. | Norton MR, Addy M. Chewing sticks versus toothbrushes in West Africa. A pilot study. Clin Prev Dent 1989;11:11-3. |
32. | Touyz LZ, Khan MN, Goga E. A note on the miswaak. Diastema 1985;13:34-6. |
33. | Radentz WH, Barnes GP, Cutright DE. A survey of factors possibly associated with cervical abrasion of tooth surfaces. J Periodontol 1976;47:148-54. |
34. | Eid MA, Selim HA, Al-Shammery AR. The relationship between chewing sticks (Miswaak) and periodontal health. III. Relationship to gingival recession. Quint Int 1991;22:61-4. |
35. | Sirois ML, Darby M, Tolle S. Understanding Muslim patients: Cross-cultural dental hygiene care. Int J Dent Hyg 2013;11:105-14. |
36. | Bollen CM, Beikler T. Halitosis: The multidisciplinary approach. Int J Oral Sci 2012;4:55-63. |
37. | Roldán S, Herrera D, Sanz M. Biofilms and the tongue: Therapeutical approaches for the control of halitosis. Clin Oral Investig 2003;7:189-97. |
38. | Association between oral malodor and adult periodontitis: A review. Morita M, Wang HLJ Clin Periodontol 2001;28:813-9. |
39. | Siegel MA, Silverman SJ, Sollecito TP .Clinician's guide to treatment of common oral conditions,8th edition. American Academy of Oral Medicine.USA.2017.p.30-32 |
40. | Yellowitz JA, Schneiderman MT. Elder's oral health crisis. J Evid Based Dent Pract 2014;14 Suppl: 191-200. |
41. | Silverman S Jr., Wilder R. Antimicrobial mouthrinse as part of a comprehensive oral care regimen. Safety and compliance factors. J Am Dent Assoc 2006;137 Suppl: 22S-26S. |
42. | da Silva L, Kupek E, Peres KG. General health influences episodes of xerostomia: A prospective population-based study. Community Dent Oral Epidemiol 2017;45:153-9. |
|