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FDI World Dental Federation

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Iveta Ramonaite, Dental Tribune International

Tue. 10. September 2024

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In recent years, the global dental industry has been increasingly focused on sustainability, recognising the need to reduce its environmental impact while maintaining high-quality patient care. As part of this movement, Ars Salutaris, a dental clinic in Croatia, has become a beacon of eco-friendly innovation, winning the prestigious FDI Sustainability Award in 2023. Dental Tribune International spoke with co-owner Dr Hrvoje Pezo about the clinic’s journey towards sustainability, the challenges and successes encountered along the way and the role of digital technology in shaping the future of green dentistry. 

Dr Hrvoje Pezo is the co-owner of Ars Salutaris dental clinic in Croatia. (Image: Hrvoje Pezo)

Dr Pezo, what prompted you to incorporate sustainability into your dental clinic, and what advantages have you observed as a result?
Through my clinical work over many years, I have been burdened by the fact that we as dental professionals produce a huge amount of waste, which is often not only biological waste but also waste that is difficult to biodegrade or materials such as amalgam that have a significant impact on our environment. Conversely, I am also delighted that the modern digital workflow reduces waste to a certain extent, thus minimising our environmental impact.

When talking about sustainable dentistry, we often first think of waste reduction, rational usage of resources and renewable energy sources. However, the sustainability story is extremely complex and offers many more opportunities to act in an environmentally responsible way.

At Ars Salutaris, we have developed a doctrine that focuses on sustainability by engaging our employees and patients in addressing environmental challenges. While researching existing literature, I found a lack of information on how transportation choices affect the accessibility of dental services. This led us to consider how much impact we could have by encouraging patients to walk, cycle or use public transport when visiting our clinic. Additionally, communication between the dental laboratory and the office, particularly when dealing with multiple prosthetic restorations, significantly contributes to environmental pollution. These are processes that we may assume are beyond our control, but that is not the case.

From an economic and entrepreneurial perspective, incorporating sustainability into a system ensures process optimisation, and each optimisation contributes to progress towards environmental goals. Consequently, designing any organisation with sustainability in mind, including dental practices of all sizes, actively supports eco-friendly initiatives.

What steps have you taken to make your dental clinic more eco-friendly, and which has had the most significant impact?
We have long been committed to implementing eco-friendly processes at Ars Salutaris. We began with fundamental initiatives, such as installing solar panels, introducing water-saving systems and removing calcification without using electricity, chemicals or salt. Additionally, we have upgraded to energy-efficient lighting fixtures with motion sensors and provided specialised education and training for both our employees and our patients.

We relocated the dental laboratory to the same building as the clinic, an expensive step but the benefits have been substantial. This move has improved professional efficiency and significantly reduced the energy used for transporting materials and facilitating communication between the clinic, laboratory and patients.

By rationalising material consumption, we not only achieve economic value but also significantly reduce waste. Unfortunately, our efforts to incorporate green guidelines into our entire supply chain have often not achieved the results we are striving for. Therefore, it can be challenging to choose between suppliers with similar green agendas who contribute positively to our supply chain’s environmental impact. Since Croatia is a small market, finding suppliers that meet our criteria for quality, price and contribution to green dentistry is particularly difficult.

I am deeply concerned that the dental industry does not adequately emphasise sustainable practices that could reduce its environmental impact. During the numerous congresses and exhibitions I have attended, this topic has been rarely addressed and only modestly by a few individuals. This lack of focus is troubling, and I believe our profession is significantly lagging in developing and implementing new, environmentally friendly ideas.

Digital dentistry was once met with scepticism by many dentists, but it is now seen as a key enabler of sustainable practices. What is your opinion on the role of digital technology, including the use of artificial intelligence, in modern dentistry?
I partially agree with ecosceptics. While I support sustainability, I believe that we cannot embrace radical ideas if they compromise quality or endanger our patients. When analysing the actual contributions to sustainability in other industries, I often find that the outcomes do not result in genuine ecological progress and may even threaten our environment. Industries are very skilled at marketing these ideas, and we as consumers are not always able to recognise this.

For this reason, we must exercise caution when implementing modern materials and technologies in our profession. The benefits of digital technologies and artificial intelligence in patient treatment are undeniable. However, we must consider the real costs and justify the price of these systems, as both resources and clinic funds are valuable and must be used wisely. I frequently discuss this topic in the context of the clinic’s policy because the rational management of resources in our supply chain is a critical issue.

Further monitoring of the behaviour of new materials in the environment after use is essential, and I am pleased to see that the world, especially the EU, is taking political action on this issue. The increasing use of acrylates for 3D printers, zirconia instead of metals, new composites, silicones and other chemicals will certainly raise these questions in the future.

“We still have a long way to go in amplifying the eco-friendly impact of our profession on our planet.”

Achieving sustainability requires a team effort. How important is it to train staff and educate patients about sustainable practices?
Teamwork is something that brings success to any endeavour, including green dentistry. In establishing the framework, systems, policies and procedures that shape how the dental practice operates, Ars Salutaris employed tools that are widely recognised in health economics to develop a doctrine incorporating the elements of sustainability. Doctrine and strategy are crucial components of any organisation, representing core values that are implicitly understood rather than debated. Patients quickly recognise and embrace these models, often integrating them into their behaviour patterns to varying degrees.

I often raise questions that seem to have little to do with dentistry, but their inclusion in patient communication tools gives excellent results. Through our clinic and the Red Cross of the city of Zagreb, I am engaging in discussions about food waste, which can be conveniently introduced during conversations about oral hygiene or when discussing a dental treatment plan. People would be surprised how sensitive patients and the public are to unnecessary food waste but also to the impact of diet on our oral and systemic health.

Eco-sustainability is gradually becoming a standard concern in dental practices worldwide. In your opinion, what support is still needed to facilitate the transition to sustainable dentistry?
We still have a long way to go in amplifying the eco-friendly impact of our profession on our planet. As you mentioned earlier, it requires a team effort, not only by health professionals and patients but also by the dental industry, the media, politicians and civil society organisations.

I am very grateful to Dental Tribune International and FDI for covering this topic. The visibility of such ideas and the promotion of individuals seeking to implement change are vital in our society. That support will open up many more opportunities for sustainability that we encounter every day without recognising them. Addressing seemingly simple questions about replacing gloves with biodegradable ones and finding a disposable cup that does not contain any plastic foils or coatings eventually becomes impossible, and we very often give up on them.

How effective is the FDI Sustainability in Dentistry interactive toolkit in providing actionable ideas for implementing sustainable practices in dentistry?
For the last 20 years, I have been regularly attending the FDI World Dental Congress and am impressed by the speed with which priorities and goals within FDI policy are changing. Recognising crucial topics on the periphery of the profession, such as green dentistry, positions FDI as a world leader in driving change and contributing to the public good. Its influence extends beyond health, embracing a wide range of innovative ideas. I believe that FDI’s involvement in sustainability and ecology is crucial because it supports our national organisations, which often do not address these topics. FDI’s tools for implementing these ideas are not only useful but also globally significant.

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