Oral Health Management and clinical Relevance in Ramadhan
Healthcare professionals require cultural competence skills to facilitate appropriate, empathetic management of their patients. In India, the code of ethics for dentists requires that they be courteous and sympathetic, treat the welfare of the patients as paramount to all other considerations, and not permit considerations of religion, nationality, race, or any other social barrier to interfere with their duties toward patients.
The success of any treatment regimen prescribed by a dentist will be based upon the successful communication of the ‘need’ for treatment, hence empowering the individual to make the choice which will best serve their spiritual, religious and medical needs. Good communication between patient and dentist will increase co-operation and develop an atmosphere of mutual trust, in which the patient’s needs can be met with appropriate treatment.
This article aims to provide an insight to dental practitioners as well as patients who may need to carry out treatment and further provide guidelines on good clinical practice during Ramadan These guidelines are in line with generally accepted Saudi Arabian and United Kingdom Islamic opinions; however, it is important to note that opinions will vary from person to person, and often depend on an individual’s cultural background.
Perceptions and Practice of Fasting
Several authors have postulated that reduced dental attendance during fasting month was due to reason that they were afraid of inadvertently breaking their fast while having dental treatments and even during emergency. Although, most Muslim scholars clearly state that having dental treatments while fasting does not invalidate the fast, Ssme 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 anesthetic (injections) or inadvertent swallowing of the water spray from a hand-piece 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 hence, they refrain from seeking dental treatment. As a result, these patients may refuse clinical oral examination and refuse treatment while fasting. Islam is a religion that does not makes things difficult for its followers; rather the guidelines provided are meant to make it easier for the people.
Management of Oral Hygiene during Fasting
During fasting, the salivation decreases and there is increase in the concentration of sulfur containing compounds causing a marked halitosis or bad breath. Toothpastes are allowed unless they do not get swallowed; tooth pastes which are flavor free should be used and some scholars of Islam consider the use of toothpaste to be highly undesirable because deliberate or accidental swallowing of them will nullify the fast. The use of miswaak, the twig of Salvadora persica tree, is highly recommended. The dental surgeons and the health care givers should remind the fasting patients to brush and floss thoroughly before sleeping at night and recommend brushing after the pre dawn meal (sahur/ sehri). Patients can be advised to use additional supportive methods, such as mouth rinses, alcohol-based mouth-rinses, however, are not recommended because they increase the dryness of the oral mucosa. Patients can be advised to increase water consumption as well to increase intake of fruits during feasting times to maintain the body in a hydrated state.
Ramifications for Medications during Ramadhan
In 1997, a religious-medical seminar was held in Morocco to standardize the choice of drug routes and the substances that could nullify fasting. The panel concluded that the following routes do not nullify fasting.
• Eye and ear drops
• Substances absorbed through the skin, for example, creams and ointments, transdermal patches.
• Injections through any route with the exception of intravenous feeding (Nutritive)
• Anesthetic gases and local Anesthesia especially during extraction
• Oxygen/ inhalations
• Sublingual nitroglycerine tablets for angina
• Mouthwash and oral sprays if they are not swallowed.
• Oral Restorative procedures including varnishing and fluoride applications, pupal procedures (Use of Rubber dam may be preferred).
• Intra oral gels, lozenges and pastilles nullify the fast
• Localized placement of Alvogyl or a similar substance, often used in the treatment of dry socket after extraction, is acceptable during Ramadan.
Fasting is a universal form of worship which is advocated by all the major religions of the world. There is a need for dental practitioners to update their knowledge. Further research is absolutely warranted in this respect. Dr Naseer uddin is a Dentist, Public Health Analyst and PhD scholar of Public Health Management in Department of Management Studies ,University of Kashmir.