Minor Oral Surgery in Fasting Muslim Patients during Ramadan

Dental considerations for treating patients in accordance with the guidelines of Islam have been well summarized.¹ Fasting among Muslim patients during Ramadan poses unique challenges for oral surgery.

While elective procedures can be scheduled for after Ramadan, dental extraction—if it does not violate a fasting patient’s beliefs—may occasionally be indicated for urgent pain relief. Although gluconeogenesis may make syncope less likely than expected,¹ it is prudent to use a glucometer before and during treatment. The supine position may also prevent syncope during dental extraction. Informed consent is required should the need arise to urgently administer glucose orally. Because swallowing of saliva and blood is forbidden during Ramadan, extraction may be deferred by pulpal extirpation. High-volume suction, rubber dam and upright position are advisable to avoid inadvertent swallowing. Extraction, when unavoidable, may be followed by suturing of sockets to eliminate the need for liquid hemostatic agents. Lasers are a valuable means to achieve hemostasis.

Long-acting local anesthetic injections delay the need for analgesics. Afternoon appointments permit oral analgesic dosing after dusk. Oral and intramuscular analgesics may completely be avoided by the use of transdermal patches of diclofenac or tramadol. Nonsteroidal anti-inflammatory drugs (NSAIDs) may be substituted by opioids like tramadol since daily fasting is associated with gastric ulcers.² Chlorhexidine mouth rinses after dusk and before dawn reduce the need for postoperative antibiotics. Antibiotics, if indicated, should have a long duration of action.

Fasting Muslim dentists could offer short-term locums to provide replacement coverage during Ramadan. Duty rosters for replacements to staff after-dusk “Ramadan clinics” would mutually benefit Muslim patients and fasting dentists. Ill, pregnant or menstruating patients are exempt from fasting and receive routine treatment. Pre-Ramadan dental checkups may be organized. These considerations optimize dental treatment of Muslim patients during Ramadan while respecting their religious practices.