Does Fasting During Ramadan Increase the Risk of the Development of Sialadenitis?

Michael V. Joachim; Yasmine Ghantous; Suleiman Zaaroura; Kutaiba Alkeesh; Tameem Zoabi; Imad Abu el-Na'aj


BMC Oral Health. 2020;20(156) 

In This Article


Ramadan is the ninth month within the Islamic lunar calendar, and during Ramadan, Muslims are required to fast (abstain from food and drink) during the daytime (from sunrise to sunset) for the whole month.[1] Ramadan fasting represents a specific form of fasting, consisting of alternating fasting and feasting (re-feeding) periods.[2] Being based on the lunar calendar, the daily fasting duration varies depending on the period of the year and the latitude of the location.[3]

There are several previous reports about metabolic changes related to fasting, such as weight loss and dehydration.[4,5] Those changes may primarily affect individuals with diabetes,[6] but there are also reports that Ramadan fasting may cause hypertension[7] and increase the incidence of ischaemic stroke.[8] However, for healthy individuals, the metabolic changes that occur are unlikely to have significant harmful consequences.[9,10] Infirm individuals are waived from this religious duty; however, patients with various health issues might choose to share this event with peers and family members.[11]

Acute sialadenitis is an inflammation of the salivary glands as a response to bacterial infection. The stasis of salivary flow and secretion as a consequence of dehydration or decreased oral water intake allows retrograde bacterial migration into the gland parenchyma.[12] In most cases, acute sialadenitis affects one major salivary gland, with the parotid being the most prevalent.[13–15] Previous reports found that the incidence of acute sialadenitis is 27.5 cases per million individuals.[16]

The affected gland is swollen and painful, and the overlying skin may be warm and erythematous. An associated low-grade fever and trismus may be present. A purulent discharge is often observed from the duct orifice when the gland is massaged.[12–14]

Dehydration can be assessed through blood hydration status markers on blood tests, especially the blood urea nitrogen (BUN)/creatinine ratio.[17,18]

Given the connection between dehydration and acute sialadenitis, we hypothesized that there is a higher frequency of sialadenitis among the Muslim population during Ramadan than during other months of the year. This study, to the best of our knowledge, is the first study investigating the connection between Ramadan and the incidence of acute sialadenitis, and its objective is to bring this phenomenon to public awareness as a by-product of the religious obligation.