Dental Tribune International

Interview on environmental sustainability in endodontics

By Monique Mehler, Dental Tribune International
January 19, 2021

Over the years, researchers have investigated the total annual carbon footprint of dental services in various countries. Now, a life cycle assessment (LCA) was conducted at the Faculty of Dentistry at Malmö University in Sweden in order to investigate and evaluate the environmental impact of a routine two-visit root canal treatment. In an interview with Dental Tribune International, the three main authors Linnea Borglin, Drs Hal Duncan and Brett Duane shared some insights into the findings.

What inspired your research team to analyse the global resource use and environmental output of the endodontic procedure?
LB: This study originated from a master’s thesis at Malmö University.

BD: Stephanie Pekarsi, our co-author, Linnea and I tried to think of three fairly resource-intensive elements of dentistry that we should study and decided on periodontal treatment, an examination and an endodontic procedure. This paper came from the third study.

Were there any challenges you had to face during the LCA? If so, what were they?
BD: It was a challenge measuring all the elements. Also trying to find specific energy use of equipment, for example the autoclave and the washing detergent used to wash dental clothing!

Why did you decide not to include travel to and from the dental clinic in your assessment methodology? Research suggests that staff and patient travel make up the most significant percentage of carbon dioxide emissions.
BD: Travel was central to earlier English and Scottish studies. In this study, we wanted to concentrate on the materials and processes over which we have a greater degree of control; hence we excluded travel.

LB: In this way, we could focus on identifying other environmentally harmful processes more specific to an endodontic procedure.

I have been conducting some research regarding eco-friendly dentistry, and my feeling is that sustainability is not a top priority for the average dental professional. Do you agree with this conclusion? And if so, what do you think are the main reasons that hold dentists back from reducing their carbon footprint?
BD: Many dentists are trying to survive financially and juggling all the additional protections needed for patients so when you mention sustainability, you can get blank looks. I think it wasn’t a priority at all say 5 years ago, but there is a growing number of dentists, especially in the younger generation which realise the importance and relevance of this area of dentistry. There are so many barriers to dentists being involved in sustainability and there are few facilitators. We need a comprehensive programme of education, an incentivisation programme; basically, sustainability needs to be normalised and embedded in everything we do.

Do you have any tips for the endodontic team on how they can reduce the environmental burden of endodontic care?
HD: As modern root canal therapy uses a large number of instruments such as files, which in many jurisdictions are considered to be of single use only, the drive towards more sustainable endodontics should firstly be aimed at reducing the number of patient visits. Single visit treatment will reduce factors such as the number of files, sterilisation costs, and patient and operator time. A second way to improve sustainability would be to limit exposure and to consider vital pulp treatment for cases exhibiting symptoms of pulpitis. The employment of minimally invasive techniques where possible reduces treatment times, cost and instrument use and, in doing so, the environmental burden. Finally, if local rules allow, and if compliance with cross-infection regulations can be ensured, instruments should be reused.

Editorial note: The study, titled “Environmental sustainability in endodontics. A life cycle assessment (LCA) of a root canal treatment procedure”, was published on 1 December 2020 in BMC Oral Health.

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