Ramadan, the ninth month of the Islamic lunar calendar, is the month of fasting for Muslims.
Fasting is one of the five pillars of Islam, and all throughout the Holy month of Ramadan, Muslims fast every day from early dawn to sunset. All physically, mentally healthy and mature Muslims around the world abstain from eating, drinking, smoking and all other physical needs.
When it comes to oral hygiene and dental treatments, what should dental providers and fasting patients know about Ramadan.
So, Dental Surgeons gives us insight on oral health and dental procedures during the Holy Month. In terms of dentistry, which acts are permissible and which ones would nullify the fast.

About  Perceptions  &  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.

About  Fasting  Facts :
Fasting allows learning self-restraint from indulgence in everyday pleasures, developing self-control and self-discipline, purifying the mind and the body, and empathizing with the poor and hungry.
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.

About  Invalidate  Fast :
1. Eating, drinking or smoking deliberately .
2. Deliberately causing oneself to vomit .
3. Beginning of menstrual or post-childbirth bleeding .
4. Sexual intercourse or sexual contact .

About  Not  Invalidate  Fast :
1. 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.
2. Using toothbrush (even with toothpaste) and rinsing the mouth or nostrils with water.
3. Wearing contact lenses or using eye drops.
4. 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.

About  Toothpaste :
Toothpastes are allowed during the holy month of Ramadan, although some scholars of Islam consider the use of toothpaste to be highly undesirable because deliberate or accidental swallowing of them will nullify the fast.

About  Brushing :
You can always brush and floss thoroughly before sleeping at night and I recommend brushing after Suhoor (pre-dawn meal). Brushing twice daily is sufficient for oral disease prevention.

About  Dental  Floss :
Many dentists strongly recommend using a dental floss to eliminate the white residue on your tongue as this is often the reason for bad breath. Flossing will remove bacteria and plaque between your teeth and under the gum line. If you are afraid of the risks of brushing your teeth, flossing is the perfect way to protect your teeth and gums from cavities and gum diseases caused by plaque.

About  Miswak :
According to General Authority of Islamic Affairs and Endowments, the use of miswak is permissible to clean teeth. Miswak is a twig from arak tree used for cleaning teeth. It helps stimulate saliva that will prevent dryness on your throat and eliminates bad breath in your mouth.

About  Mouthwashes :
Mouthwashes are commonly prescribed by dentists as an adjunct to oral hygiene. Some patients may be reluctant to use mouth wash for fear of unintentionally swallowing some. If this is the case, you can use it outside fasting hours as advised by your dental surgeon.

About  Smoking :
Meditate on stopping smoking, reducing the nicotine intake during the day gives an ideal opportunity to think about stopping altogether.

About  Chew  Gum :
This is actually true because chewing gum is seen as eating and that is not allowed during the hours of fasting.
At the times you can eat – the pre-dawn meal of suhoor and the sunset meal of iftar – the focus should be on nourishing meals so chewing gum should not really be a priority but it would be allowed then.

About  Bad  Breath :
The process of fasting, especially avoiding drinking anything during daylight hours, can change oral bacteria, leading to an odorous breath. Although the popular hadith says, “the smell of the mouth of a fasting person is better than the smell of musk in Allah’s Sight,” many people still feel uncomfortable because of their breath during fasting.
If you are uncomfortable with bad breath, you can try rinsing your mouth with water or mouthwash. Technically, this does not break the fast as long as you do not swallow any. However, if you don’t feel comfortable with this practice during daylight hours, you will have to commit yourself to thorough hygiene after the fast breaks, including the use of antibacterial cleaning methods, such as the miswak, which can effectively clean your teeth without the need for toothpaste or even added water.

About  Diseases :
Health-wise, fasting involves powerful therapeutic processes that can help people recover from mild to severe health conditions. Fasting can lower blood sugar, cholesterol and (systolic) blood pressure. In fact, Ramadan fasting would be an ideal recommendation for treatment of mild to moderate, stable, non-insulin diabetes, obesity and essential hypertension.
Diabetic patients must rinse their mouth twice a day with chlorhexidine mouthwash to prevent gum disease. It is also advised to get a thorough check-up done before Ramadan to make sure your gum health is not affected during fasting.

About  Anaesthesia :
Some patients think that actions that take place during dental procedures will nullify their fast but local anesthetics (injections) are permissible forms of treatments for those who are observing Ramadan. However, when patients are reluctant, it is best to re-schedule or delay treatments especially if there is no acute pain/discomfort.

About Intramuscular and Intravenous Injections :
Intramuscular and intravenous injections are generally allowed. Examples that may be of particular importance to dentists are the insulin injections for diabetics and antibiotics given by the intramuscular or intravenous routes. However, the use of IV fluids for nutrition is prohibited while fasting as it energizes the fasting patient.

About  Dental  Treatments :
Dental treatments and preventative procedure (including restorations, scaling and extractions) do not invalidate the fast, but some patients are unwilling to have procedures done due to difference in their views.
Patients who require immediate or advanced treatment, like those who suffer from deteriorating chronic illness or those who face dental emergencies, could break the fast. If it is possible, the dentist can delay or re-schedule treatments for their patients.

About  Dental  Care :
As with mouth rinsing, dental care is often allowed as long as you don’t swallow anything. This means that oral sedation is not allowed, but injectable and topical anesthesia are both allowed.
During a regular cleaning and checkup, your dentist can take special care to ensure you don’t swallow materials. But if you are too uncomfortable with the risk, your dentist can usually reschedule your appointment.
In cases where you’re experiencing a dental emergency such as an infected tooth, breaking the fast is allowed for care. However, people who want to avoid this situation should schedule dental checkups shortly before the fast to avoid unexpected issues arising during Ramadan.

About  Denture :
If you have dentures, before going to bed, use an antiseptic solution to clean them. This will help keep bad breath at bay.

About  Tongue  Scraper:
Use a tongue scraper or a cleaner to get rid of the white residue that coats the tongue. This is often the culprit for bad breath. A tongue scraper or a cleaner can be purchased at any pharmacy.

About  Oral  Medications :
Oral medications are not permissible and invalidate the fast. If you fall ill and avoiding medication could result to harm and is life-threatening, it’s allowable to break the fast.
When a dental problem occur during the holy month of Ramadan and medications are needed, you can discuss with your dental surgeon. He or she may be able to adapt your medications and/or the dosage.

About  Intra  Oral  Gels :
Intra-oral gels and lozenges are mainly prescribed for ulcers, oral thrush, and denture stomatitis. If this is applied during the fasting hours, it will invalidate the fast. Therefore, use of these medications will be poor in fasting patients. So, it is recommended to schedule these medications after fasting hours.

About  Sublingual  Medications:
Sublingual nitroglycerine tablets (GTN) – Taken sublingually for angina, and does not invalidate the fast.

About  Topical Medications:
Topical medication – Substances absorbed through the skin, for example, creams, ointments, transdermal patch do not invalidate the fast.

About  Gases, Inhalers:
Gases, inhalers – Anaesthetic gases, oxygen, nebulized gas and inhalers do not invalidate the fast.

About  Eye Drops :
The International Glaucoma Association (IGA) says people must continue using eye drops for the treatment of glaucoma – and there is a way to do it without breaking the daily fast.
Stopping drops even for a short period of time can cause permanent loss of vision, it warns.
Subhash Suthar, IGA development manager, said: “We want to reassure the Muslim community that drops can be taken before dawn and after sunset, when food and drink can be consumed.
“This is achieved by putting finger pressure at the corner of the eye next to the nose (punctual occlusion) immediately after instilling drops.
“It is distressing when patients realise through a follow up appointment at their ophthalmologist or optometrist that their vision has been damaged through stopping drops.”
Muslim Council of Britain has confirmed that all Islamic schools of thought agree that taking eye drops does not invalidate the fast unless the eye drops reach the throat, which is unlikely.
“We also suggest that patients close the tear duct when taking eye drops (known as punctual occlusion) as this means that fluid stays in the eye and does not drain into the throat and so cannot be tasted.

About  Exercise :
One common question that gets asked is if you can work out or exercise during Ramadan. Some believe it’s forbidden – or at least a bad idea because you would be unable to refuel with food or drink if you do a fitness session during fasting hours.
The answer is yes, you can exercise, but you have to plan it accordingly. It’s vital to remember that your body won’t have the same amount of energy that you would have on a normal day.
Try to do light exercise like walking and meditative exercises in any spare time you have; this can help to keep the system working and blood circulating.
Step outside, cycle, play a game, go to the gym for a light workout session, or do some gardening. Even helping out in the kitchen would be better than just sitting down and waiting for the iftar time, or at least do something that keeps you moving and that you enjoy.
Cardiovascular exercises like walking and cycling, full body stretching and mat exercises are great at helping to burn calories and improve stamina.
Avoid high intensity exercises like sprinting or heavy lifting as this could cause injury and lead to dizziness and low blood pressure, and you could end up feeling weak or sick.
If you exercise within eating times, make sure you have allowed enough time for food to be digested before you exercise and that you drink plenty of water during iftar and suhoor times. Keep workouts short to between 30-60 minutes.

About  Swim :
Yes, you can swim – but you must take care not to swallow the water.A bath or shower, or swimming, has no effect on the fast.However, no water should be taken in during any of these activities, as that would break the fast.Before and after fasting, drinking plenty of water is essential.So be sure to stay hydrated during night time hours – experts advise to drink as much water as possible during iftar and suhoor times, especially if hot weather is expected during the day.Have at least two litres of water during the night before the next day’s fast begins.

Health tips for people during fasting:
• Don’t skip Suhoor(Pre Dawn Meal).
• Don’t overeat during Iftar (dinner).
• Avoid eating fried foods, salty foods and high-sugar foods.
• Drink as much water as possible.
• Keep your meals healthy.
• Whenever possible, opt for steaming, grilling or baking.
• If you use oil for cooking, settle for healthy options like canola oil.
• Drink plenty of water (Drink of choice), juices, milk and soups.
• Cut down on coffee, tea, soda and all other caffeinated drinks – they have diuretic effects and thus dehydrate the body.
• Try to avoid sticky foods, such as chocolate, some types of cereals and cheese. Some of these foods might get stuck in between your teeth and then not be removed if you aren’t brushing carefully.
• If your iftar or suhoor meal includes fish or milk, brush immediately after eating these foods. Fish and milk contain specific proteins which can lead to bad breath as they are being broken down in the mouth.
• Begin iftar with dates, providing you with an immediate source of energy. Rehydrate yourself with plenty of water.
• Isotonic drinks or natural juice drinks when breaking the fast are a good source of minerals, salts, and vitamins.
• Resist the urge to feast as much as you can, as quickly as you can! Research has shown that even food associated words appear much brighter to the hungry.After a day of fasting and discipline, resist this instinct and illusion aim to eat in moderation.
• Avoid high fat, high sugar content, and highly processed food (e.g. white wheat) fried food, ghee, pakoras, biryanis, Indian sweets, halawas (and the list goes on..!). By Iftar time, our bodies are working to preserve as much energy possible. Therefore, excessive fatty food and sugars will be rapidly added to body fat reserves.
• Salty food at Iftar and Suḥur will cause dehydration and make you feel increasingly thirsty.
• After Maghrib Ṣalāh, have a well-balanced meal containing all of the food groups mentioned in this article.
• Meals with slow release carbohydrates will keep you well energised for a night of ʿIbadah. Include sources of fibre, which will keep your bowels working and healthy after resting during the day.
• Fibre and proteins keep you feeling full for longer – an important part of your meal plan.
• Staying well hydrated and eating sources of fibre will help prevent constipation in Ramaḍan.
• Cereals, salads, fruit and vegetables are excellent replacements for oily curries and fried snacks.
• Eat in moderation, a heavy stomach rarely agrees with a night of fruitful ʿIbadah.
• The hadith regarding the breath of the fasting person does not justify poor dental hygiene. Brushing, flossing before tarawīḥ is advised, for the sake of fellow worshippers too! Excessive sugary snacks and drinks are also harmful for teeth.
• After Iftar, stay well hydrated by taking regular sips of water every half hour, or a cup full or more every hour.
• Physical exercise immediately after iftar may not be a good idea, as our blood flow is being directed to our digestive system at that time.
• Please be mindful of the sugar content in caffeinated energy drinks. With tea and coffee, again moderation is key.
• Take the strength and discipline developed during fasting to give up smoking this Ramaḍān. Smoking cessation services in the NHS can help you reach this goal.
• Do not skip Suḥūr An important sunnah and opportunity to nourish your body with a balanced diet containing complex carbohydrates, fibres, proteins, good fats we have discussed earlier.
• Try to fit in adequate time for napping. Planning rest well will allow us to make the most of our time in Ramaḍan. Even sleep can be rewarded if intended to recuperate in preparation for more ʿIbadah!
• If you are taking any regular medication, have any health conditions, are pregnant or breastfeeding, it is very important to consult with your GP first before planning your fasts. Please make sure you encourage family members to do the same.
• Our Deen excuses those who are unwell or ill from fasting. Please spend time learning the fiqh of fasting from a trusted local imam, and ask when faced with any questions.
• Introduce a couple of fruits and boiled veggies at the time of breaking fast that have high fiber content which will help in remineralize your teeth naturally. Because fasting people stay almost 14.5 hours (varies depending upon the location) without eating and drinking water which builds up bad odor in the mouth and dryness that can accelerate decay process when you have sugary foods while breaking fast. So, to reverse the decay process you must have fiber rich food which will deposit minerals in teeth to stay healthy.