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LEIPZIG, Germany: Sustainability in dentistry is more than a trend. It is a reality that businesses of all sizes have to face and find ways to adapt if we are to sustain a liveable planet for generations to come. At first glance, this may seem like an impossible task, because there is so much to consider. What should one do? Where should one start? How much time and money will it cost? There is much to do. But there are many positive changes towards a greener future that can be put in place almost immediately which are inexpensive and sometimes even free. Besides an initial discussion on the topic, this article provides some easy-to-implement hands-on tips and a focus on practice owners who are already successfully practising environmentally friendly dentistry.
Before considering how dental professionals can take action, let’s take a quick detour into the history of eco-friendly dentistry, figure out what that actually means, and look at some facts and figures. Broadly speaking, the main goal of eco-friendly dentistry (also called environmentally friendly dentistry, green dentistry or sustainable dentistry) is to do the least possible damage to the environment while ensuring infection control and quality of care. FDI World Dental Federation regards sustainability as a core principle of dentistry, which “must be practised ethically, with high levels of quality and safety, in the pursuit of optimal oral health”. It expands on this: “Sustainability integrates a broader commitment of the oral health professional to social and environmental responsibility. The right of future generations to a world with adequate natural resources must be respected”. However, how this should be implemented in the dental office is not regulated—at least not yet.
The environmental movement started in the 1960s and 1970s in the Western world and is a way of living still today. What used to be considered a hippy lifestyle is now more mainstream, as environmental awareness is continually increasing, especially through movements such as Fridays for Future, which was founded by Swedish pupil Greta Thunberg in 2018. Statistics provided by YouGov (an international research data and analytics group) showed that, in the past ten years alone, environmental awareness has more than doubled among young Britons. According to the data, 45% of 18- to 24-year-olds say environmental issues are one of the nation’s most pressing concerns. Moreover, environmental protection and climate change are top public policy priorities for adolescents living in the US, as a recent poll carried out by Statista (a German provider of market and consumer data) confirmed. The trend is similar across the globe and translates to action taking in international politics. Climate change acts, such as the United Nations’ 2030 Agenda for Sustainable Development, force countries to look into greenhouse gas emissions and ways to reduce them.
What role does dentistry play?
Of course, not only one industry sector is to blame for climate change. The collective exploitation of the planet and its resources by our society, especially in the last 50 years, has meant that everyone must now cooperate to stop or reverse the damage. As FDI suggests, dental professionals should accept and act on an ethical responsibility towards their profession’s contribution to climate change.
When looking at figures that concern the dental industry’s carbon footprint, one thing stands out: patient and staff travel to and from practices make up the largest chunk. In England, travel makes up over 60% of the dental carbon footprint, energy consumption ranks second, contributing 14%–21% of the greenhouse gas emissions, and procurement comes in third at 19%. A study conducted in Scotland has found that patient and staff travel to and from dental offices account for 45.1% of carbon dioxide emissions.
One of the co-authors of that study is Dr Brett Duane. He is a specialist in dental public health with a strong passion for healthcare sustainability and has contributed dozens of publications on the topic. Together with his colleagues, he released a series of articles for the British Dental Journal about environmental sustainability in the dental practice. One of the papers particularly concerned travel and recommended the following: reducing appointment times by combining visits for family members or combining operative procedures or reducing appointment frequency based on patient risk; implementing telemedicine and teleconferencing for patients; as well as encouraging cycle to work schemes or car-pooling for staff. However, reducing on staff and patient travel is just one area to consider among other contributing pollutive factors.
What can dental professionals do?
The four Rs—reduce, reuse, recycle and rethink—are essential pillars in guiding environmental responsibility for the dental office.
- Go paperless and switch to digital (e.g. patient records and radiography).
- Make improvements to water and electricity management (e.g. buy green energy or generate your own power).
- Invest in reusable products (like stainless-steel trays).
- Recycle materials (such as paper and aluminium).
- Invest in autoclavable items (e.g. metal air/water suction tips).
- Take control of waste management.
- Switch to biodegradable single-use products (such as refuse bags and washable bibs).
- Educate patients on alternative options (e.g. bamboo toothbrushes and biodegradable floss and picks).
- Encourage patient and staff travel via public transportation or sign up for a cycle to work scheme.
- Employ teledentistry in some form.
This list is already rather extensive for dental practice owners who are just starting out on their sustainability journey. More detailed ideas and inspiration can be found in this guide released by UK non-profit the Centre for Sustainable Healthcare. In addition to that, the FDI Dental Practice Committee, which is currently focused on the issue of sustainability in dentistry, has developed an infographic for dental teams to help illustrate the real and achievable goals that can be implemented in their offices.
These examples are intended to demonstrate that there are many ways to take things into one’s own hands. Changes on a small scale are an important start and the only way for long-term change towards a greener future. But, of course, these measures are only one part of a greater puzzle that needs to be solved.
Associations and industry value sustainability in dentistry
There are no official governing agencies that control or certify an office as meeting eco-friendly standards. The Australian Dental Association’s spokesperson on sustainability, Prof. Neil Hewson, recommended referring to the resources of one’s respective association (like the Australian Dental Association’s policy statement and guidelines on dental amalgam waste management) and to find ways to self-regulate.
In an interview with Dental Tribune International (DTI), Dr James Zenk, chair of the FDI Dental Practice Committee, said: “In Minnesota [where he practises], we are regulated by federal, state and local government agencies on how to be more sustainable and energy-efficient to help reduce our carbon footprint. […] The latest example of this concerns a voluntary programme to install amalgam separators in our offices to reduce the amount of mercury released into wastewater systems.” Zenk explained that he is in favour of voluntary programmes because, in his experience, “dentists respond much better to voluntary programmes rather than heavy-handed regulatory bodies”.
This means that dentists and associations voluntarily working together and supporting each other is a key factor for positive change. But what about the wider industry? Manufacturers and other companies dictate what is available on the market and what kind of sustainable options are produced. DTI spoke to the managing director of British company Trigiene Dental, Matthew Evershed, which launched a new range of eco-friendly products in March 2020. These include biodegradable nitrile gloves, paper cups with a waterproof natural starch lining and a range of paper hygiene products made from recycled Tetra Pack cartons. Evershed explained that “Trigiene Dental is very conscious of the usual amount of single-use plastics and unsustainable consumables in daily use in dental practices.” This inspired the company to think of ways that it could reduce or mitigate this, because “we all have a responsibility to implement waste reduction measures wherever possible”.
According to Evershed, there has been a great deal of interest in and a positive response to the use of reusable and sustainable products; however, there are two main considerations that hinder change. One is prohibitive pricing. “If people can make a change to more environmentally friendly products without it hurting their wallets, they will give it serious consideration,” he said. The second one is concern of compromise regarding decontamination or sterilisation protocols.
This is a valid point and a rather problematic one, since sustainability is about more than swapping plastic for bamboo or other materials; it is mostly about using less resources in general. Dr Sanjay Haryana is responsible for the internal and external education programme at TePe Nordic–a company that has taken on the challenge of achieving carbon neutrality in its products and packaging by 2022–and for quality control at the Nordic subsidiary and gives lectures on topics connected to oral hygiene, sales psychology and sustainability. He does not believe that a drastic reduction in plastic is possible today, nor does he believe that this is the answer.
Instead, Haryana says that there are two vital factors: moving from linear to circular consumption (recycling) and using plant-based raw materials to produce plastics. He explained: “Recycling is challenging today because most medical waste is considered hazardous, but chemical recycling is taking impressive steps forward. Chemical recycling is a process through which you can restore plastic to its original state, clean and with its initial properties. Of course, green energy must be used throughout this process.” The result of combining these measures is “a huge reduction in the carbon dioxide footprint” while still being able “to use the best materials for medical and dental practice”, according to the expert.
Practice owners succeeding at green dentistry
In an article from summer 2020, DTI interviewed Dr Robert Panjkov, the founder of an award-winning dental practice based in Melbourne in Australia. His business, Beaconsfield Dental, “uses biodegradable barriers and plastics as well as environmentally friendly chemicals for dental treatments that involve suction, cleaning and washing. The oral hygiene products used in the practice are sustainable, and the staff undergo regular training on waste minimisation. They also take part in plogging, an activity that combines jogging and picking up litter, in order to clean up the nearby park and surrounding streets,” reported editor Iveta Ramonaite.
Sustainability is also a priority in the practice run by Drs Stefan Dietsche and Reiner Wichary in Cologne in Germany. A blog post reported how the dentists are implementing environmentally friendly dentistry in their office: cornflour cups have replaced plastic cups, paper tape is used instead of the usual material, and the practice’s electricity has been generated by regional hydroelectric and wind power plants for years. Just because something has always been done a certain way does not mean it is the right way, Wichary wrote.
Dr Ali Farahani from Stratford in Ontario in Canada has been practising eco-friendly dentistry in his office since 2007. He and his team state that the absence of toxic odours in the air and a holistic approach are reasons to choose their sustainable clinic, which aims to protect water and landfill resources in the long run. Farahani’s contribution goes beyond his everyday work. For many years, he has been involved in the Eco Dentistry Association and is an accredited member of the International Academy of Oral Medicine and Toxicology—an organisation of dental and medical professionals and scientists who research the biocompatibility of dental products.
The greater picture
These three dental offices are just a few of many examples of those around the world that encourage, inspire and practise environmental consciousness in dentistry. Sustainable dentistry is not necessarily about investing in expensive equipment or transforming the office into a self-sufficient building that produces no waste, generates its own electricity and treats wastewater from one day to the next. It is more about making conscious decisions that meet the needs of the present without compromising the ability of future generations to meet their needs. Running a successful business is difficult enough as it is, and making some better choices here and there should not take away from the main tasks at hand, nor should they be daunting or demotivating. One can start small—even minor improvements can have a positive impact on the environment over time—and work one’s way up to more complex changes.
The fact is that there is no time to be wasted in waiting for national governments to implement legal sustainability requirements that a dental office has to meet in order to continue practising. Climate change is a very real threat to the world we live in. For the sake of our future, it is crucial that dentists, associations and the wider industry keep tackling these issues in a joint effort.