Green dentistry: The integration of sustainability

When people speak of a trip to the dentist, the overwhelming majority are undoubtedly thinking of the dental treatment aspect, but it turns out that the actual journey, when undertaken in fossil fuel vehicles, has a significance that stretches far beyond dental care. A report by Public Health England on UK dentistry found that vehicle travel, both by staff and by patients, is by a considerable margin the most carbon-intensive of activities associated with the dental clinic, accounting for 33.4% and 31.1% of total emissions, respectively. This is also confirmed by a project being run by researchers at McGill University in Montreal in Canada. Prof. Christophe Bedos of the Faculty of Dental Medicine and Oral Health Sciences stated: “Everything we do leads to emissions. In dentistry, one of the biggest culprits is transportation. Getting patients to and from the clinic contributes nearly a third of all carbon emissions.”

A wide variety of strategies are available to mitigate against this. The most obvious is the utilisation of teledentistry to reduce travel for staff and patients. Digital technologies are crucial to this shift, according to Prof. Bedos: “Imagine you’ve had a tooth removed. Instead of returning to the clinic for a check-up, we could do it over Zoom or by phone.” Other emerging initiatives include establishing measures for active travel, such as cycling or walking, for both staff and patients wherever possible and promoting the use of public transport and electric vehicles.

The management of waste, including water waste, from the dental practice is also a crucial dimension of sustainable dentistry. As awareness about sustainability has steadily spread across society, the environmental harm generated by the disposal of dental materials such as amalgam has gained not only clinical but also governmental attention. As reported on by Dental Tribune International, the European Parliament last year moved to ban amalgam outright, a measure that took effect on 1 January 2025. In addition to following such regulations, dental clinics are able to minimise their waste production through a range of simple yet effective measures. Digital technologies reduce the need for impression trays and physical moulds, as well as practically eliminate the need for physical copies of patient records, for example. Furthermore, clinics can introduce recycling, properly segregate clinical and non-clinical waste, and manage food waste through actions like composting.

A third core area that dental clinics have seized on as a meaningful and straightforward means of reducing their ecological impacts is energy efficiency. Here, the primary process is that of retrofitting clinics with technologies that are more efficient. A first key step for clinics is to conduct an energy audit, through which the total energy use of the practice is systematically mapped. From here, certain areas may be targeted for improvement. This may initially entail the introduction of new heating, ventilation and air-conditioning systems. Also, practices may consider replacing their existing dental equipment with more energy-efficient options. There is also the possibility of in-house power generation, most notably through solar energy.

A final area to consider is preventive oral care. Such measures are by now well known to the dental industry and include partnerships with regulatory authorities to promote initiatives such as community water fluoridation schemes as well as supervised toothbrushing programmes for young children in those areas where oral disease and the risk factors for poor oral health are greatest.

Each strategy aimed at sustainability has its own inherent time and money commitments, some of which may be perceived as inhibitive or excessive. While an environmentally friendly approach to conducting dentistry may be desirable, for some, it may be seen as an economic trade-off that they are unwilling or unable to implement. Speaking to Dental Tribune International, Dr Nicolas Martin, professor of restorative dentistry at the University of Sheffield in England and a leading researcher in sustainable dentistry, illuminated this tension: “The challenge is that, as individuals, we show a tendency to separate our societal responsibilities of environmental citizenship from our professional, work-related duties. The latter is mostly focused on the need to deliver an outcome in a cost-effective manner, environmental citizenship concerns becoming secondary or redundant. We need to extend our environmental citizenship, from an individual or societal role, such as at home or in the neighbourhood, to our work environment, namely the dental practice.”

Whether or not this entails rebalancing a focus on profitability is for Prof. Martin more of an attitudinal than financial imperative: “The prevention of oral disease is the single most important and effective way of helping the population that we serve and at the same time, as an unintended consequence, achieves the greatest environmental gains. Yet, the different legislative and financial frameworks in which the dental profession operates across the world disregard this approach and focus their efforts on the remuneration of interventive operative treatments. The solution seems so obvious, yet unattainable!” From this perspective then, a clinical emphasis on oral health and meaningful patient care, as opposed to exclusively generating profit, is the most effective means through which to institute a sustainable, ethical and economically robust practice.

A final and important point is the large variation in regulatory frameworks that pertain to sustainable dentistry from country to country. A report from last year by the European Federation of Periodontology noted, “Countries such as Sweden and Germany have strong regulatory frameworks that promote sustainability, making it easier for dental practices to invest in green technologies. In contrast, countries in southern and eastern Europe may still struggle with economic constraints and less-stringent environmental regulations. In such regions, local efforts and initiatives are critical to promoting sustainability in dental care.” This passage highlights a fundamental element of any sustainability initiative, namely the regulatory ease or difficulty with which it may be achieved. In countries with strong policy frameworks, a shift towards environmentally sound practices may not only be encouraged but may also be expedited through incentives and subsidies, whereas in those countries where such guidelines are absent, becoming increasingly sustainable may not only be entirely the responsibility of the practice but also be increasingly restrictive from a financial perspective. The transition to greater sustainability in dentistry is therefore paramount but also accompanied by a range of challenges and obstacles.

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