Sir, as you will be aware the holy month of Ramadan is fast approaching, from early May until early June. Within the UK there is a large Muslim demographic who will be fasting during this month. In addition to this, intermittent fasting has become a recent health trend in the general population. As dental practitioners we need to be aware of the impact this will have on our patients' overall care.

Studies have shown that fasting has many beneficial effects on general health, including improvements in glycaemic control, weight loss, blood pressure and even advantageous changes in the gut microbiome.1

However, patients who are in a state of fasting may be hypoglycaemic, dehydrated and may be more prone to have postural hypotension or suffer from dizziness.2 For some patients the use of local anaesthetic or water spray may not be acceptable. It is important to ask the patient whether they are comfortable with proceeding with treatment and outlining all the steps that will be involved in their care. Perhaps it may be more convenient to rearrange elective treatment to a later date. In emergency cases, if the patient is in pain and extraction is indicated, pulp extirpation may be considered instead.3

Some studies suggest that during Ramadan there may be changes in drug compliance as patients tend to alter the timings of their medications. This needs to be taken into consideration when prescribing postoperative medications.2 Moreover, with regards to oral hygiene some patients prefer not to brush their teeth whilst fasting in order to prevent swallowing water and breaking the fast. Hence, dental practitioners should advise their patients to brush before sleeping and again after Suhoor (the pre-dawn meal).

As healthcare providers we have a responsibility to make our patients feel at ease. By respecting cultural and religious sensibilities we can improve the overall experience the patient has which in turn increases their confidence in us and the profession.