Oral Health Management and clinical Relevance in Ramadhan
Healthcare professionals require cultural competence skillsto facilitate appropriate, empathetic management of their patients. In India,the code of ethics for dentists requires that they be courteous andsympathetic, treat the welfare of the patients as paramount to all otherconsiderations, 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 dentistwill be based upon the successful communication of the 'need' for treatment,hence empowering the individual to make the choice which will best serve theirspiritual, religious and medical needs. Good communication between patient anddentist 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 treatmentand further provide guidelines on good clinical practice during Ramadan Theseguidelines are in line with generally accepted Saudi Arabian and United KingdomIslamic opinions; however, it is important to note that opinions will vary fromperson to person, and often depend on an individual's cultural background.
Perceptions and Practice of Fasting
Several authors have postulated that reduced dentalattendance during fasting month was due to reason that they were afraid of inadvertentlybreaking their fast while having dental treatments and even during emergency.Although, most Muslim scholars clearly state that having dental treatmentswhile fasting does not invalidate the fast, Ssme patients may wrongly perceivethat some actions or occurrences that take place within the dental clinic mayinvalidate their fast. Some examples include the administration of localanesthetic (injections) or inadvertent swallowing of the water spray from ahand-piece during treatment. Some individuals try to not even swallow their ownsaliva and perceive putting a foreign object such as the toothbrush asinvalidating their fast hence, they refrain from seeking dental treatment. As aresult, these patients may refuse clinical oral examination and refusetreatment while fasting. Islam is a religion that does not makes thingsdifficult for its followers; rather the guidelines provided are meant to makeit easier for the people.
Management of Oral Hygiene during Fasting
During fasting, the salivation decreases and there isincrease in the concentration of sulfur containing compounds causing a markedhalitosis or bad breath. Toothpastes are allowed unless they do not getswallowed; tooth pastes which are flavor free should be used and some scholars ofIslam consider the use of toothpaste to be highly undesirable becausedeliberate or accidental swallowing of them will nullify the fast. The use of miswaak, the twig of Salvadorapersica tree, is highly recommended. The dental surgeons and the health caregivers should remind the fasting patients to brush and floss thoroughly beforesleeping at night and recommend brushing after the pre dawn meal (sahur/sehri). Patients can be advised to use additional supportive methods, such asmouth rinses, alcohol-based mouth-rinses, however, are not recommended becausethey increase the dryness of the oral mucosa. Patients can be advised toincrease water consumption as well to increase intake of fruits during feastingtimes to maintain the body in a hydrated state.
Ramifications for Medications during Ramadhan
In 1997, a religious-medical seminar was held in Morocco tostandardize the choice of drug routes and the substances that could nullifyfasting. The panel concluded that the following routes do not nullify fasting.
• Eye and ear drops
• Substances absorbed through the skin, for example, creamsand ointments, transdermal patches.
• Injections through any route with the exception ofintravenous feeding (Nutritive)
• Anesthetic gases and local Anesthesia especially duringextraction
• Oxygen/ inhalations
• Sublingual nitroglycerine tablets for angina
• Mouthwash and oral sprays if they are not swallowed.
• Oral Restorative procedures including varnishing andfluoride 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 acceptableduring Ramadan.
Fasting is a universal form of worship which is advocated byall the major religions of the world. There is a need for dental practitionersto update their knowledge. Further research is absolutely warranted in thisrespect.Dr Naseer uddin is a Dentist, Public Health Analyst and PhD scholar of Public HealthManagement in Department of Management Studies ,University of Kashmir.