Dental News - Building a sustainable dental practice

Dr Sanjay Haryana

Mon. 17. October 2022

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Sustainable dentistry’s two major outcomes, namely good oral health and reduced environmental impact, could be achieved by focusing on preventive care and quality operative care. However, the large amount of waste produced by the dental office daily is a problem that needs immediate attention.

Reducing emissions—a complex task

Dental caries and periodontitis are two of the most common diseases globally. Thus, the primary aim of sustainable dentistry is to improve the quality of life through preventive care and quality operative care. In order to be able to offer this to the underprivileged part of the global population, increased emissions are inevitable.

However, from an environmental perspective, we want the population to have immediate access to dental care, but we do not want patients to visit the dental practice too often. After the manufacturing of dental supplies and the dental waste generated in daily practice, patient and staff travel are the largest emitters of greenhouse gases within dentistry. Since dental appointments accumulate over a patient’s lifetime, total emissions end up being extremely high compared with those resulting from other healthcare treatments.

In order to decrease emissions, FDI World Dental Federation promotes source reduction through good oral health or prevention. This is because preventive dentistry results in fewer appointments, fewer recall visits, a reduction in materials and, consequently, less clinical waste. Dental diseases that are preventable or are in the early stages of progression should be targeted using individualised maintenance plans where home care should be the centre of attention.

Sustainable procurement

Dr Sanjay Haryana. (Image: Sanjay Haryana)

Why should dental professionals strive towards sustainable dentistry? Firstly, it is the right thing to do ethically; secondly, it is a great marketing tool; and finally, it creates an attractive workplace for new colleagues. Before taking steps towards creating a green dental practice and practising green dentistry, the practitioner should understand that sustainability minimises pitfalls and simplifies the process.

To build a sustainable dental practice, it is essential to establish the coming change with management and take advantage of the trickle-down effect—the spreading of attitudes and behaviours through the core of the organisation. The team members must understand why the change is necessary, feel responsible for their roles and be inspired to take part in the sustainability journey.

For example, switching to green energy leads to a great impact, requires little effort and minimises interruption to day-to-day practice. To make sustainable procurement more manageable, it can be divided into buying less, wasting less and switching to products and services with a lower carbon footprint.

Healthcare waste—a major problem

Medical and dental care generate substantial waste. The healthcare sector is responsible for 5% of all the greenhouse gas emissions in the EU. Dental waste management has been primarily focused on amalgam disposal, but this is no longer the main issue. Even though it is well known that dental practices generate great amounts of waste, there is limited data available on the effect of this on the environment. Similarly to sustainable dentistry, dental waste management lacks a global consensus on how to tackle certain environmental issues that are associated with dentistry.

In the day-to-day running of a dental practice, waste is generated from all parts of the business and can be divided into three categories: household waste, hazardous waste and clinical waste. Household waste is similar to that which is generated in a residential environment and should, if possible, be recycled. Hazardous waste is considered harmful to people and/or damaging to the environment and must be disposed of through the appropriate facility. It includes clinical waste, radiographic solutions, amalgam and gypsum, which generates a toxic gas during degradation in landfills.

“The primary aim of sustainable dentistry is to improve the quality of life through preventive care and quality operative care.”

Clinical waste is defined as “any waste which consists wholly or partly of human or animal tissue, blood or other body fluids, excretions, drugs or other pharmaceutical products, swabs or dressings, syringes, needles or other sharp instruments”. It is also classified as hazardous and should be incinerated.

The four Rs in dentistry

Waste management aims to protect humans and the environment. If correctly done, it can also reduce costs since most of the waste produced is clinical waste and is more expensive to dispose of than household waste. A popular way to manage waste has been to employ the four Rs—reduce, reuse, recycle and rethink.

Reduce in the surgery

Many practices work with preset trays containing certain instruments and disposable material, such as plastic tray liners, gauze, cotton rolls and polishing paste. As soon as the tray has been contaminated, all materials, both used and unused, are classified as clinical waste. Practices should review their set-up routines to minimise the waste of unused material.

Reuse in the surgery

Most of the waste in dentistry consists of single-use equipment designed to minimise cross-contamination. There is a need for the development of novel solutions allowing sterilisation and reuse. However, practices must consider whether the equipment is safe for patients and personnel and whether its production and use have a positive impact on the environment.

Recycle in the surgery

This is the most challenging area since clinical waste cannot be recycled. The most common materials found in clinical waste are tissues, gloves and sterilisation pouches. We should be able to establish routines that allow us to open the pouches with clean gloves, separate the plastic from the paper and recycle appropriately. Small actions like this can have a positive impact on the environment and save costs for dental practices.

Rethink in the surgery

Rethinking is the most important of the four Rs. Even though reducing, reusing and recycling are the most discussed, they do not adequately address the clinical reality of dentistry or medicine. In order to meet the Sustainable Development Goals of the United Nations as set out in Agenda 2030, our suppliers must understand the waste management system and align their dental products and materials with the most appropriate end-of-life procedure—incineration, landfill or recycling (chemical or mechanical).

Moving forward

All clinical waste is destined for incineration and should, therefore, be bio-based instead of fossil-based to reduce net emissions. Additionally, a consensus is needed on how to safely minimise single-use equipment. There are many different types of plastics used in the healthcare system, and a circular approach will never be accomplished if they are recycled together. Our efforts in the clinical setting will have little impact on sustainability unless there is an alignment of equipment production, waste management and end-of-life procedures. Only then can good oral health and reduced environmental impact be achieved.