Ramadhan is back again! It brings joy to all Muslims as it is not only a holy month in the Muslim calendar, but also time to test one’s faith and to say thanks for all the blessings in life. Being one of the five pillars of Islam besides belief, prayer, giving of alms (charity) and pilgrimage, fasting may carry implications for general health and dental care. Lack of understanding and appreciation of these practices may lead to compromise in treatment compliance and inability of dentists to provide a culturally sensitive service for the patients. This short article aims to provide an insight to dental practitioners who may need to carry out treatment or prescribe medication to Muslim patients in the month of Ramadan.
FAST FACTS ON FASTING
Fasting in the month of Ramadan is obligatory to all Muslims except for:
- the very young, the elderly, the sick, the insane.
- menstruating women, pregnant and nursing mothers (must make up for days not fasted later in the following months).
- Travelers may postpone the fast if they wish to During fasting, Muslims refrain from food, drink and sexual intercourse between the hours of sunrise and sunset whilst going about their normal daily lives. As such, they take utmost care to ensure that they do not engage in any activity that may invalidate their fast. It is also useful for the dental practitioner what actions that invalidate the fast and what do not.
Actions that invalidate the fast
- Eating, drinking or smoking deliberately.
- Deliberately causing oneself to vomit.
- Beginning of menstrual or post-childbirth bleeding.
- Sexual intercourse or sexual contact.
Actions that are permissible during the fast (do not invalidate the fast)
- Taking a bath or shower. If water is swallowed involuntarily, it will not invalidate the fast. Most scholars are of the opinion that swimming is allowed.
- Using toothbrush (even with toothpaste) and rinsing the mouth or nostrils with water.
- Wearing contact lenses or using eye drops
- Eating or drinking unintentionally, i.e. forgetting that one was fasting. But one must stop as soon as one remembers and should continue one’s fast.
PERCEPTIONS AND PRACTICE OF FASTING
Some Muslim patients may wrongly perceive that some actions or occurrences that take place within the dental clinic may invalidate their fast. Some examples include the administration of local anaesthetic (injections) or inadvertent swallowing of the water spray from a handpiece during treatment. Some individuals try to not even swallow their own saliva and perceive putting a foreign object such as the toothbrush as invalidating their fast.
As a result, these patients may refuse clinical oral examination and refuse treatment while fasting! During the month of Ramadan especially, dental practitioners need to be aware of possible noncompliance among fasting patients. While the Muslim dentists may be able to convince the patients that suchand-such action or occurrence will not invalidate the fast, for dentists who are not Muslims – perhaps it will be better to make allowances to accommodate the practices for these patients.
The following are some actions that Muslim patients may be reluctant to do while fasting:
1. Perform oral hygiene procedures
- Fail to brush teeth or use floss (this does not actually invalidate fast) as usual.
- Remind patient to brush and floss thoroughly before sleeping at night and recommend brushing after the pre-dawn meal (sahur/sehri). Twice a day brushing is sufficient for oral disease prevention.
2. Take medication
- Fail to take prescribed medication during fasting hours.
- Take all medication outside fasting hours, hence at incorrect intervals.
- Take all medication in one go, particularly if several different medications are prescribed.
Dentists’s options :
(see Table 1)
- Change medication*
- Change dosage*
- Explain necessity of compliance with prescribed medication
*only concerns medication for dental problems; DO NOT CHANGE prescribed medications for systemic problems without first referring to patient’s physician.
Table 1: General principles of prescribing during the fast of Ramadan
3. Carry out dental treatment
Dental treatment is not likely to invalidate the fast. This includes scaling, restorations and extractions. Islam is a religion that does not makes things difficult for its followers; rather the guidelines provided are meant to benefit the people. However, as discussed earlier, some patients may be reluctant to carry out certain procedures due to different perceptions and ways of thinking. So rather than getting into an arguments with their patients, dentists may well try to accommodate their wishes. (But not before we try to educate them, of course! – That way patients get to undergo the necessary treatment and business can go on as usual).
4. Oral malodor (bad breath) and fasting
During fasting, it is not unexpected that the mouth becomes dry. This naturally results in malodor. Poor oral hygiene care will indeed make it even worse. A practical way of overcoming it is to ensure patients, even during fasting, to still brush their teeth and floss as usual to keep the mouth feeling fresh and clean. Mouthrinsing is also permissible as long as patients don’t overdo it! Avoid alcohol-based mouthwash as it will dry out the mouth. Drinking plenty of water and fruits during the night or at sahur/sehri can help to keep the body stay hydrated and healthy. It is also worthy to examine the whole mouth for any dental or oral manifestations that may be contributing to the malodor such like dental caries, infection and/or discharges.
ONE LAST THING
Fasting is a universal custom which is advocated by all the major religions of the world. The Prophet Muhammad (peace and blessings be upon him) said that fasting is a shield which protects a person from sin and lustful desires. When the disciples of Jesus asked him how to cast the evil spirits away, he is reported to have said, “But this kind never comes out except by prayer ad fasting.” (Matthew 17:21).
Ramadan for Muslims means more than just not eating and drinking during the day. It is a time to develop self-restraint, self-purification, God-consciousness, compassion, the spirit of caring, to love all humanity and to love God. Muslim scholars emphasise that fasting for a full month every year trains a person individually, and the community as a whole in piety and self-restraint.
With Muslim smokers already refraining from smoking during daylight hours in Ramadan, a number of health experts and officials say that the fasting is the perfect opportunity to kick the habit for good. Islamic groups around the world including Malaysia are already encouraging Muslims to take advantage of the holy month to quit smoking. And many have succeeded. Caring dentists should also take the opportunity to encourage their smoking patients to quit in Ramadan, and stay quit!