Interview with Dr Davinder Raju on sustainable dentistry

Iveta Ramonaite, Dental Tribune International

Wed. 23. March 2022

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Dr Davinder Raju is the lead dentist at Dove Holistic Dental Centre in Bognor Regis in the UK and the founder of Green Dentistry, an online platform that helps dental practices become more environmentally conscious and reduce their carbon footprint. In this interview with Dental Tribune International, Dr Raju, an ardent advocate of sustainability, explains why he thinks apathy and the fear of litigation are the greatest enemies of sustainable dentistry and how dental professionals often have false beliefs about sustainability. He also discusses why having an environmentally aware team with a can-do attitude is essential in order to promote sustainable practice and describes why the dental industry should be transparent about the environmental impact of its products.

Dr Raju, what does sustainability mean to you personally, and how would you define sustainable dentistry?
I’m continually amazed at the abundance of life that our planet has to offer, and it is something that future generations should have the opportunity to enjoy. To me, sustainability is about being a good custodian of the environment and ensuring the well-being of future generations. It’s about making decisions that reduce environmental impact. I’m deeply concerned about the fact that underprivileged children will suffer disproportionately more in light of the consequences of unchecked climate change.

As for sustainable dentistry, I would define it by combining Gro Harlem Brundtland’s famous definition of sustainability with minimally invasive dentistry. Sustainable dentistry involves delivering optimal oral and dental healthcare, with a focus on prevention, early diagnosis and management, using minimally invasive operative procedures and having the best long-term interests of patients at heart, while at the same time mitigating negative impacts on the planet so that we do not undermine prospects for future generations.

Using a minimal intervention approach to dentistry means that patients are less likely to enter the restorative downward spiral, thus reducing the need to provide resources such as dental restorative materials.

You believe that great leaders should know not only why they are running a practice but also how they are running it. Could you elaborate on that?
We know that greenhouse gases emitted by human activities cause climate change and that the effects of climate change, some of which are already apparent, pose a global health threat.

Now, “to do no harm” is one of the pillars of medical ethics, yet globally, the health sector emits more carbon dioxide than Japan, which is currently ranked as the fifth highest emitter of all countries. Given its mission to protect and promote health, the health sector, including dentistry, has a responsibility to reduce its own climate footprint. This can only be accomplished by examining how we are providing services. Only by scrutinising how we operate can we consider the possibility of delivering the same service, but by employing an approach that has a lower environmental impact.

Climate change will become an increasing concern for consumers, and the dental profession must take action to reduce the harm that healthcare is causing.

Dr Davinder Raju. (Image: Davinder Raju)

To follow up on the previous question, what motivated you to found Green Dentistry, and how do you promote sustainable development in your business?
I first need to explain why I set up an eco-friendly dental practice. The catalyst came about when I was studying for my master’s degree in advanced minimum intervention dentistry. I was struck by the ecological plaque hypothesis. Inside a healthy mouth, there is a stable and healthy community of cells—microbial homeostasis—where a mutually beneficial equilibrium exists between the microflora and the host. If this balance is upset, disease ensues. Consequently, I started thinking about the effects of my business on our host, namely the environment, and how I could mitigate that impact.

When I wanted to set up an eco-friendly dental practice, information about sustainable dentistry wasn’t readily available. Since there seemed to be a lack of practical advice, I had to piece information together from other industries. Green Dentistry came about when I was approached by other dentists who wanted to make their practices greener but didn’t quite know where to start.

There has to be clear leadership and a desire to embrace sustainability in order to promote sustainable dentistry, and having an environmentally aware team with a can-do attitude is essential. As a practice owner, I’m busy running the practice, and I don’t have the time to manage day-to-day activities. Good ideas and strategies aren’t worth anything if you can’t implement them, so I delegate the role of maintaining the changes to a sustainability champion. However, we need the entire team to be on the same page for both coherence and creativity. The team needs to be willing to suggest ideas to the sustainability champion and to ensure that they are discussed at practice meetings.

Running a sustainable practice is about creating a culture that consistently seeks new opportunities to improve efficiency and environmental performance. The right team is essential, and its members need to unite and collectively participate. We’ve taken many steps in the right direction, but we never assume that we’ve done enough. I want the team to be forward-thinking and future-oriented, almost as if the team members are carrying out mini eco-audits as they’re walking through the practice, carrying out their regular procedures while thinking to themselves: “Is there a better way of doing this? Is there another product we could be using?”

Sustainability is gaining increasing awareness in dental practices worldwide. How would you explain this trend?
Programmes like David Attenborough’s television series The Blue Planet and professional magazines such as the British Dental Journal have all helped raise awareness of sustainability. Still, there is possibly a disconnect between what we do at home and in our working environments. During the COVID-19 pandemic, many dental professionals were alarmed by the large amounts of extra personal protective equipment that they had to use. This may have produced a cognitive tipping point and made dental professionals realise how much the dental sector negatively impacts the environment.

I believe that sustainable dentistry is currently being introduced to the dental curriculum at King’s College London and hopefully at other dental teaching hospitals. I hope that sustainable dentistry will soon reach critical mass and become the norm.

Why is it crucial that the dental industry is transparent about its supply chains and environmental policies?
The lion’s share of carbon dioxide emissions produced by the provision of healthcare are generated upstream and are attributable to the supply chain through the extraction of raw materials and the production, transport and distribution of goods and services. If the dental industry is transparent about the environmental impact of its products, we, as end users of dental products and materials, can make greener procurement choices. In addition, industry-wide environmental policies that promote responsibility and accountability will help those working in the dental profession to determine with which companies they wish to align themselves and do business.

“There has to be clear leadership and a desire to embrace sustainability in order to promote sustainable dentistry”

What would you say is the greatest enemy of sustainable dentistry, and what are some of the barriers to sustainability in dentistry?
The greatest enemy of sustainable dentistry is apathy. It is the feeling that, since dentistry’s overall impact is relatively small compared with, for example, coal-fired power stations, there’s no point in making the necessary changes towards a more environmentally sustainable future within the dental environment. However, we can’t be passive bystanders. We can’t stand back and be spectators knowing that conditions that humans have created, and are continuing to create, are a threat to humanity and other life forms.

We are facing a climate crisis, ever-shrinking biodiversity and acidification of the oceans. We can vote for policymakers who prioritise the environment and make a move towards delivering sustainable dentistry now. Regulatory change will come eventually, but we shouldn’t wait for the government to take action. It’s immensely satisfying to do the right thing.

The fear of litigation is also a barrier to embracing sustainability. In the UK, Health Technical Memorandum 01-05: Decontamination in primary care dental practices has resulted in a significant increase in the use of single-use plastics and increased costs for dental practices. Although aware of the importance of infection prevention, we seem to have tipped too far on the side of caution. If used appropriately and recycled when possible, plastic is a valuable material. However, single-use plastics are now ubiquitous in the dental environment.

There is also a common perception that the changes necessary to achieve a more sustainable approach are expensive to implement. Yes, you can spend a great deal of money on capital expenditure by purchasing solar panels, ground source technology or heat pumps, but this isn’t the only way to achieve a more sustainable approach to delivering dentistry. For example, if a practice wants to help reduce carbon dioxide emissions, it can simply switch to a renewable energy provider. As demand grows, renewable energy will increasingly be sourced for the grid, thus reducing the supply generated from fossil fuels.

It’s picking the low-hanging fruit that hopefully will spark a change in behaviour towards sustainable practice.

What measures do you take outside of work to minimise your impact on the planet?
We obtain our energy from a renewable energy provider at home, don’t eat meat (for ethical and environmental reasons) and buy organically grown food. Last year, we started growing our own vegetables fed with homemade fertiliser made from comfrey and nettles. We also compost.

We have a wild flower garden at the front of our house, which has never been mowed in order to help increase biodiversity. It looks a mess for a few months of the year, but it is delightful when the flowers appear. We also recycle, of course, but more importantly, we’re not big consumers. If we buy goods, we try to buy sustainably sourced goods whenever possible.

Editorial note:

More information about Green Dentistry can be found here.