Dental News - Part 3: Sustainable dentistry in 500 words or more

Dr Sanjay Haryana

Tue. 2. November 2021

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SINGAPORE: In this third article on sustainable dentistry, sustainable procurement will be covered. The definition of procurement is obtaining goods and services, not the actual transaction, more the plan or the strategy surrounding the process of buying goods and services. Adding sustainability to procurement aims to minimise any harm to environment, economy and society during the full life cycle of the product, from cradle to grave.

According to the United Nations Development Programme, sustainable procurement can be described as “making sure that the products and services we buy are as sustainable as possible, with the lowest environmental impact and most positive social results”.¹ A more complete description by Duane et al. is “a process whereby organisations meet their needs for goods, services, works, and utilities in a way that achieves value for money on a whole life basis in terms of generating benefits not only to the organisation, but also to society and the economy, while minimising damage to the environment”,² which is in line with the three legs of sustainable development—environment, economy and society—described by the United Nations in its Report of the World Commission on Environment and Development: Our Common Future.³

To be 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. Even though we often speak about teamwork and team dentistry, remember that dentistry is a hierarchical profession and not having the dentists on board will result in an uphill struggle. A crucial part of this change is creating a sense of urgency within the dental team. The team members must understand why the change is necessary, feel responsible regarding their role and feel inspired to take part in this sustainability journey. Allocate the responsibility to a member of staff who has a passion for sustainability, who feels ready to tackle the challenge and can stand his or her ground internally and externally, as not everyone accepts change easily. Taking full advantage of and capitalising on this task requires time, education and top-level support. A recommended read is “Environmental sustainability: Measuring and embedding sustainable practice into the dental practice”, which applies Harvard Business School Professor of Leadership John Kotter’s eight steps in the context of a dental practice.⁴

To make sustainable procurement more manageable, divide it into buying less, wasting less, and switching to products and services with a lower carbon footprint. Start with a big and easy win, a task that leads to a great impact, requires little effort and minimises interruption to the day-to-day practice, for example switching to green energy. According to Duane et al., 15.3% of all greenhouse gas emissions in the UK’s dental National Health Service came from energy usage, heating and cooling being responsible for the majority of the emissions. Going green is an important step towards a sustainable dental practice, in combination with reviewing energy efficiency, such as insulation, double glazing and other energy waste considerations.² These actions will lower emission as well as the cost for the overall business.⁵

Stock management is a key element for a dental practice and is a skill that involves balancing cash flow, storage space and access to necessary material. The aim is to buy just as much as you need at the best price possible, but there is a temptation to buy through promotions, for instance buy four, but pay for three. In many cases, these products have an expiry date and the reality becomes buy four, pay for three and use two. Bulk buying products with expiry dates should be avoided, but if this is done, make sure what to expect in terms of the expiry dates. Is it a year, a month or a week?

Creating a comprehensive digital workflow, from checking in patients, covering digital aid for clinicians, to cashing out, has a large impact on emissions and waste reduction. A staggering 65%–75% of all dental waste is related to analogue radiographs, such as lead foil and solutions required in the developing process⁸. Another culprit in restorative dentistry is impressions, especially silicone impression. Silicone impressions are fossil-based and can be recycled or downcycled today, which means that the silicone loses its properties each time. Usually, it is melted down to oil to be used in different industries as a lubricant. However, investing in a digital scanner can eliminate most silicone used in the dental practice, resulting in a large environmental impact, less postage and transport, and no need for storage space for models.

How do we decide on what products and services to procure in terms of sustainability? There are different methods of measuring the environmental impact, but a life cycle assessment (LCA) is commonly used.⁷ It measures a product’s emission from sourcing of the raw material throughout the whole life cycle until incineration and can be used to compare products’ environmental impact within the same category. An LCA does not have to take working conditions or ethical values into consideration, which is an important part of sustainable procurement—caring for people’s well-being throughout the whole life cycle of a product. A word of advice is to always consult the clinicians who will be affected by decision. They should be involved in the process; if they are not, there is the risk of ending up with material that will be unused, which defeats the purpose.

What complicates procurement is that dental professionals use hundreds, if not thousands, of different products in a dental practice. Instead of reviewing every manufacturer, shift the responsibility to the suppliers, like dental wholesalers. Make sure that they only offer products that are ethically sourced and offer data for comparing the environmental impact, like LCA or similar methods. The dental suppliers in turn must demand the same thing from their suppliers and so on. By working in these incremental steps, dental professionals can have a positive impact on the world by making demands and subsequently make informed choices.

To summarise, whatever the procurement strategy, it should never harm the patient or clinical staff or lower the quality of treatment and should always be produced in an ethical manner. As a dental professional, you can always fall back on the principle of “first, do no harm” to environment, economy or society.

Sustainable procurement tips and advice:

Assign a non-clinical team member the responsibility.
Respect the hierarchy and get clinicians on board before switching material.
Use green energy and let your patients, suppliers and local community know.
Create a clear policy regarding material with an expiry date; do not overbuy.
Create a digital workflow.
Let the dental wholesaler work for you. Create a set of green requirements that the wholesaler needs to fulfil. Remember you have the buying power.
Do not be shy; brag. Get and display certificates of your green achievements.

Editorial note: In this six-part series, Dr Sanjay Haryana will give an overview of different aspects of sustainability in dentistry. A list of references is available from the publisher.