Philips Shine-On Award Winner and Hygienist of the Year Sakina Syed shares her thoughts on Ramadan and Oral Health
Ramadan is expected to begin on the evening of Friday 28 February 2025 and will end on the evening of Sunday 30 March 2025, with the exact dates contingent upon the sighting of the crescent moon.
During 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.
Health benefits
Fasting 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. Many health benefits include the reduction of cholesterol levels, aid weight management, stabilisation of glycaemic control, an opportunity for smoking cessation, and prevention of gut microbiome dysbiosis.
Higher risks
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 does 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.
A typical fasting day
Most individuals observing within the UK will fast for approximately 15 hours with an early morning breakfast pre 4.30am and then refrain from eating or drinking until about 6.30pm. Timings change each year with summer periods of Ramadan being much 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 whilst fasting. The entire daily routine can be unbalanced with interrupted sleep patterns and fatigue.
Can you brush your teeth and interdental clean whilst fasting?
Brushing of teeth is allowed with toothpaste provided the toothpaste is not swallowed. Some individuals believe that toothbrushing is not allowed because of the possibility of water being swallowed and they do not want to risk 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
Eating foods with higher sugar or carbohydrates can be risky and unhealthy for the month, especially sugary drinks and foods increasing 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 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.
Dental appointments when fasting
Many people may not want to visit for treatment in case their fast is broken due to water being intentionally 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. 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 the 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.
Miswak Stick
Miswak stick is still commonly used in the Middle East and Africa to complement existing oral hygiene methods. It is 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.
Halitosis and fasting
Halitosis is extremely common when the body is not receiving any fuel; food or drink as the body is put into a state of ketosis releasing ketones. These are chemicals which break down fat for energy and when they mix with plaque bacteria in the oral cavity, they produce a bad odour. This also occurs with dehydration and more ketones are released due to a reduction in salivary function, drying the mouth.
Oral health tips to combat halitosis during fasting
• During the process of ablution (cleansing the body before praying), utilise the rinsing of the mouth with water slowly allowing the full mouth to be lubricated with water.
• Brush teeth twice daily with fluoride toothpaste, in the evening and 1 other time eg. before the fast begins. Wait 30 mins post-opening fast to brush your teeth
• Floss and or use interdental brushes to clean in between teeth, an alcohol-free mouthwash can also be used
• Use a tongue scraper to cleanse the tongue and reduce bad breath.
• Avoid sugary foods and drinks, especially when opening fast
• Eat fruits that are rich in Vitamin C like berries and guavas. Vitamin C helps fight gum diseases and gingivitis which can also cause bad breath.
• Avoid caffeine and excessive salt which can contribute to dehydration.
• Chew sugar-free gum post-evening meal to help with salivary stimulation and targeting bacteria growth. Look out for ones that contain Xylitol.
• Eat balanced meals with fruits, vegetables fibre and protein. Foods high in water content, like watermelon, cucumbers, and celery apples, can naturally wash away food debris and bacteria.
• Low glycaemic Index (GI). Eat slow-release sugar foods such as porridge in the morning.
• Rehydrate: Drink plenty of water, especially after opening the fast to rehydrate the body between 8-10 glasses of water in between fasts.
Medical risks during fasting
There is an increased risk of syncope in the fasting patient, caused by stress on the body and variation in circadian rhythm. Not having sufficient time intervals between fasts can affect regulating the normal body clock and cause fatigue. There is also an increased risk of hyperglycemia due to dietary changes and changes in drug intake and glucose monitoring does not break the fast.
Dental team members and fasting
There may be team members fasting within your dental teams. Regular breaks should still be taken at lunch to rest the body and mind, ensuring the room is well-ventilated.
Ramadan Kareem from Sakina. (a traditional greeting to mark the beginning of Ramadan)
About Sakina
Dental Hygienist & Dental Therapist Sakina Syed works in private practice at Bupa Dental Care, London Bank and Serene by Dr Safa, Knightsbridge, London.
She is an ambassador for EMS and The British Society of Dental Hygiene and Therapy (BSDHT) London Regional chair.
@bank_dentalhygienist (Instagram)
