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The constant wearing of masks during fasting, when outside, triggers rampant bad breath, plaque accumulation on teeth surfaces. Image Credit: Shutterstock

Dubai: Orthodontists and dentists have specially cautioned residents to be mindful or oral hygiene this Ramadan as constant wearing of masks at the workplace can aggravate bacteria build-up in the oral cavity.

Why do we have a higher bacterial activity in the oral cavity when fasting?

Dr Sanjay Jyothish

Dr Sanjay Jyothish, dentist and specialist orthodontist at the Prime Health care Group explained, “When you wear a mask for a long time, the mouth tends to get dry. With both nose and mouth ensconced behind the fabric, people tend to open their mouth more, which results in more dryness. As it is, during Ramadan with the long hours of fasting without water, there is dehydration and the mask triggers more dryness. Saliva in our mouth neutralises the acid but wearing the mask reduces saliva production. Therefore, the Ph level of our oral cavity gets unbalanced. The Ph is the acid balance and our saliva keeps the Ph balance at neutral level of 6.2-7.6 in the oral cavity. In the absence of optimal levels of saliva, the PH balance is disrupted, triggering a proliferation of bacteria in our mouth causing poor bad breath, more plaque build-up and gum inflammation.”

You are twice as likely to suffer from a mask mouth during Ramadan

Dr Megan Murray

Dr Megan Murray, oral hygienist of the Dental studio, Dubai explained, “Wearing masks constantly has created a new oral condition, which is being dubbed “mask mouth”. Wearing masks naturally leads to breathing through your mouth more than ever, and this can lead to one’s oral cavity drying out. An excessively dry mouth causes changes in the microbiome causing inflammation and an increase in oral bacteria. With this in mind, during Ramadan, all dentists request everyone, especially those fasting to make one’s oral health a top priority.”

Fasting in some can trigger acid refliux?

Dr Chandan Bagde, aesthetic orthodontist at Dermalase Clinic, Jumeirah, seconded that. “In many places during Ramadan this year, people will be fasting for over 12-14 hours. The constant wearing of masks during fasting, when outside, triggers rampant bad breath, plaque accumulation on teeth surfaces. Once we add a hungry stomach to this, it also causes acid reflux where the acid in stomach is regurgitated into the oral cavity with long hours without food, causing the bacteria to multiply easily.”

How to maintain optimum oral hygiene during Ramadan?

Dr Chandan Bagde

According to Dr Bagde, people require to be vigilant of their oral hygiene before Ramadan. “If you are suffering with dental issues like cavities in teeth or painful tooth which needs extraction or root canal; it is advisable to get it done beforehand. There are two reasons for it. Scaling of the plaque, controlling any inflammation or infection before observing the fast will mean better dental health and help maintain a higher standard of oral hygiene. Besides, that, in most procedures, one is required to take some kind of protective or infection control medication, which is difficult especially when one is fasting for more than 12 hours. Therefore, it is advisable to visit the dentist and make sure to maintain a good standard of dental hygiene. This is especially recommended for diabetics, hypertensive patients and others who suffer from any other metabolic syndromes, who are planning to observe the fast as they have poor immunity and are more prone to gum inflammation,” she explained.

Foods to avoid during Suhour for better oral hygiene

In order to maintain optimum oral hygiene one has to be mindful of the food one consumes during Suhour in the predawn hour. Dr Jyothish explained, “A lot of younger people who follow an altered sleeping pattern, usually tend to stay awake until predawn hours. To do this, they consume excessive coffee and other caffeine drinks. Now coffee is not only dehydrating it is also acidic. So, later in the day, overconsumption of coffee will trigger greater dehydration, disturb the Ph balance of your mouth, cause greater bacteria build up and with the mask all these issues will be magnified many times over.”

Caffeine can dry out your mouth

Dr Jyothish advised people to drastically cut down on coffee and caffeinated beverages, include generous portions of fresh fruits, fresh vegetables and whole foods in the suhour meals, have plenty of water and brush teeth as well as use an antibacterial mouthwash before the beginning of the fast each day. “Being well-hydrated, brushing teeth to clear any residue of food that might cause tooth decay and use of antibacterial mouth wash will help greatly in minimising the bacterial build up. Diabetics who fast during Ramadan are specially advised to use antibacterial mouthwash at least three times a day. For best dental hygiene during Ramadan, it is advisable for all to brush teeth twice daily after suhour and iftar, floss teeth in the night after brushing in the night and use the antibacterial mouth wash three times a day.”

Your oral hygiene routine during Ramadan

Dr Jyothish also added that those who felt a bad breath was inevitable by evening during fast gave a simple remedy for it. “While brushing teeth after suhour meal predawn, it is also advisable for people to brush the tongue lightly. The fuzzy bacterial growth on the tongue is the reason why people get bad-breath. Tongue cleaning will ensure no food residue and the mouth wash will further reinforce oral hygiene.”

Dr Bagde also advised changing the face mask every four hours. “As per Centre of Disease Control (CDC) guidelines, disposable face masks need to be changed every 4-6 hours. During Ramadan, I would recommend changing the face mask, which gets damp and contaminated, every four hours. “I would advise all those going to work during the fasting hours, keep a spare mask to replace one that becomes wet from moisture in your breath. If it is a disposable one, discard it properly in a sealed bag in a designated dustbin. If it is a reusable variety, store it in a plastic bag until you reach home and wash it thoroughly. Wash it as early as possible to prevent from bacterial growth. It’s better to wash the reusable masks everyday unless indicated by the manufacturer.”

Specific nutritional advice for Iftar meals

Dr Bagde explained, “Combating dehydration is particularly important in avoiding bad breath. In addition to drinking plenty of liquids and avoiding salt, caffeine and diuretics during non-fasting hours, there are measures to prevent a dry mouth.”

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Refined carbohydrates are detrimental to one’s health causing too much acid reflux, which can further trigger bacterial growth in the mouth. Image Credit: Shutterstock

Smokers are advised to cut out smoking completely even during non-fasting hours as smoking results in poor dental hygiene and acid build up that triggers bad breath, which is further aggravated with the constant wearing of mask during the day.

It is best to stay away from caffeinated drinks which may lead to sleep problems as dehydration We can train ourselves to quit it before even Ramadan starts.

Avoid refined carbs, high salt and high sugar

People must avoid refined carbohydrates and high sugar foods. Refined carbohydrates that one finds in tinned, canned and processed food items are stripped off nutrition and are detrimental to one’s health causing too much acid reflux, which can further trigger bacterial growth in the mouth. Dr Bagde explained, “Eating foods that are high in sugar and refined carbs means they will not hold your hunger for more than three-four hours. Foods such as sugar, white flour, pastries, cakes and cookies are to be avoided as they also spike blood sugar levels plus the high sugar triggers acid build up in the mouth cavity.”

Foods high in salt such as processed meats, sauces, salted nuts and chips increase sodium content in the blood and upset the electrolyte balance, triggering dehydration. The more dehydrated one feels, the higher the chances of having a ‘dry’ mouth.

Carbonated Drinks — stay away from drinking soda and carbonated fruit juices as they are very high in sugar and will cause dehydration

Fried Foods — eating greasy or oily foods will trigger indigestion and upset the PH balance of the oral cavity triggering gum infection and bad breath.


• Be diligent with brushing and flossing after Suhour and Iftar.

• Add a 0.2 per cent Chlorhexidine- based rinse to your routine with brushing and flossing, this helps control the plaque biofilm in your mouth.

• Drink plenty of water during the non-fasting hours to help keep your body hydrated during fasting.

• When brushing, spend a little more time on the upper front 6 teeth as these suffer the most from mouth breathing with masks on.

• Consider using miswak during times of fasting as this has antibacterial, anti-fungal, and anti-plaque properties.

• Take breaks from your mask when you are alone and when it is safe to do so.


• Be sure to not overconsume sugary foods when breaking your fast. Have a few dates with plenty of water.

• Avoid drinking too much coffee or caffeinated drinks as these tend to be acidic.

• Don’t overindulge in salty foods especially during Suhour; these can lead to increased dehydration.

• Breath naturally through your nose and be conscious of “mouth-breathing” more than usual.

• Don’t forget about flossing, this is very important for removing food debris and bacteria from in between the teeth.

Source: Megan Murray, Dental studio