Sakina Syed discusses the potential oral health impacts of fasting during Ramadan and how dental professionals can help their patients combat them.
Ramadan is a significant religious period that involves daily fasting from dawn (suhoor) until sunset (iftar) for approximately one lunar month. During this time, individuals refrain from eating food and drinks between these times.
As dental professionals, an understanding of the physiological and metabolic effects of fasting, particularly on blood glucose regulation, energy metabolism, and hydration, is essential to providing safe, effective, and culturally acceptable care.
Those who are pregnant or medically compromised are exempt from fasting. Fasting alters normal daily routines, which can have both systemic and oral health implications relevant to dental treatment.
Can fasting impact oral health?
While Ramadan offers numerous spiritual and health benefits, such as improved blood sugar regulation and cholesterol levels, it also presents challenges for maintaining oral health. Essential oral care is crucial during fasting to prevent issues, such as halitosis, xerostomia, periodontal disease, and dehydration. Fasting affects the body primarily through metabolic changes. During fasting, the body uses stored energy sources, such as glycogen and fat, to sustain itself. This can aid in improving cholesterol levels and enhancing insulin sensitivity.
Ramadan not only fulfils a spiritual purpose but also instils a disciplined fasting habit, very similar to intermittent fasting, which can help to regulate weight and blood sugar.
Dehydration is a common physical effect felt whilst fasting due to the lack of water intake during fasting hours, which can, in turn, affect energy levels, concentration, and bodily functions. These changes in energy levels may fluctuate as the body adapts to using fat reserves for fuel. Fatigue and weakness can occur initially as the body adjusts, but many people report feeling more alert and focused over time.
The metabolic effects of fasting
Under normal conditions, blood glucose levels are maintained by dietary intake of carbohydrates and glucose production within the body. When fasting, the body goes through a period of change. It first uses up glucose for energy, then switches to burning stored fats and then can also break down proteins if the fasting period is long.
Energy levels and fatigue
Reduced daytime caloric intake and altered sleep patterns can lead to transient fatigue, reduced alertness, and mild dehydration, particularly in the first two weeks of Ramadan as the body adapts. From a dental perspective, this may affect:
- Patient tolerance of lengthy procedures
- Stress responses during treatment
- Postural hypotension when moving from supine to upright positions.
Dental teams should remain attentive to signs of hypoglycaemia, such as dizziness, sweating, confusion, or tremor, especially in diabetic patients.
What oral health impacts should dental professionals look out for?
- Reduced saliva production: fasting reduces the body’s fluid intake, leading to lower saliva production. Saliva is vital for washing away food particles, neutralising acids, and preventing bacterial growth
- Increased risk of bad breath (halitosis): a dry mouth during fasting hours can lead to an overgrowth of bacteria, which may cause bad breath
- Changes in eating habits: consuming sugary or acidic foods during suhoor (pre-dawn meal) and iftar (breaking fast) can contribute to tooth decay and gum issues if oral hygiene is neglected
- Dehydration: limited water intake during fasting hours can increase the risk of gum inflammation and dry mouth.
Does oral care break a fast during Ramadan?
A fast is broken by intentionally eating or drinking between fasting hours. Smoking is also prohibited during fasting hours – this is an excellent time to encourage patients to quit.
The following oral care practices do not break a fast:
- Toothbrushing with toothpaste or miswak stick
- Cleaning between teeth with floss or interdental brushes
- Visiting a dentist. dental hygienist, and dental therapist for checkups or treatments, provided water is not swallowed. Treatment under rubber dam, if applicable, is ideal
- Lightly rinsing the mouth during ablution (cleansing before prayer).
Key advice to share with patients during Ramadan
1. Maintain a consistent oral care routine as normal
- Brush twice daily with fluoride toothpaste – once after iftar (breaking fast) and again before suhoor (in the morning)
- Wait 30 minutes after eating to brush to avoid enamel erosion.
2. Use interdental brushes and/or floss
- Clean between teeth to prevent plaque biofilm buildup/remove food debris, to maintain gum health
- Use alcohol-free mouthwash as an adjunct.
3. Hydrate between fasts
- Drink water between iftar and suhoor to keep your body and mouth hydrated.
4. Combat bad breath
- Use a tongue scraper to reduce bacteria on the tongue
- Chew sugar-free gum (with xylitol) after evening meals to stimulate saliva and fight bacteria.
5. Choose friendly foods
- Eat vitamin-C-rich fruits like berries, guavas, and oranges
- Avoid sugary and acidic foods that can contribute to tooth decay
- Include low glycemic index (GI) foods, such as porridge, lentils or whole grains, yoghurt, eggs and dates for sustained energy and oral health benefits.
6. Avoid caffeine and excessive salt
- These can increase dehydration, exacerbating dry mouth and gum sensitivity.
Ramadan kareem from myself and Dentistry.
