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SINGAPORE: Sustainable dentistry has two major outcomes, namely good oral health and reduced environmental impact. Good oral health can be achieved through preventive dentistry and quality operative dentistry, which reduce dental visits and dental waste and drastically cut travel time, a major contributor to greenhouse gas emissions. In this fourth part of the series, we will discuss the importance of preventive and operative dentistry in achieving sustainability and reducing emissions within dental care.
Dental caries and periodontitis are two of the most common diseases globally1 and are classified as non-communicable, chronic manifestations that “tend to be of long duration and are the result of a combination of genetic, physiological, environmental and behavioural factors”, according to the World Health Organization.
Community water fluoridation was introduced in 1945 and has become common practice in close to 25 countries to date.2 In 2017, despite the introduction of fluoride, the caries prevalence in permanent dentition was estimated to affect approximately 25% of the global population.1 Fluoride toothpaste, which became widespread in the late 1970s, has decreased caries prevalence dramatically, but use and access to fluoride are still limited to developed countries.3
Nowadays, half of the global population suffer from periodontitis, whereas 10–15% have severe periodontitis. This has not changed in the last 20 years, although awareness of periodontal disease has increased. There are various reasons for this lack of change. Firstly, periodontitis is a silent disease that progresses slowly and has mild symptoms, such as bleeding, that are neglected by patients. Secondly, there is still little awareness of periodontitis within the dental profession, and signs of the disease are often ignored. Therefore, periodontitis may often progress to a stage where tooth loss is inevitable.
“We want the population to have immediate access to dental care, but we do not want patients to visit a dental practice too often”
Finally, not everyone has access to the necessary facilities in order to get diagnosed and treated properly. Seeking to facilitate access to early diagnosis and treatment, the United Nation’s Sustainable Development Goal 3—Good Health and Well-being—aims to reach out to the global population with essential health services.
From an environmental perspective, we want the population to have immediate access to dental care, but we do not want patients to visit a dental practice too often. As previously discussed in this series, patient and staff travel are the largest emitters of greenhouse gases within dentistry.4 The other two culprits are the manufacturing of dental supplies and the dental waste generated in daily practice.5 Since dental appointments are rather short, and a single treatment can lead to multiple sessions, dentistry is responsible for higher emissions than other healthcare services. Additionally, since dental appointments accumulate over a patient’s lifetime, total emissions end up being extremely high compared with other healthcare treatments.6
FDI World Dental Federation promotes source reduction through good oral health or via prevention in order to decrease emissions,6 meaning that preventive dentistry results in fewer appointments, fewer recall visits, a reduction in materials and, consequently, in 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.5 Some preventive interventions have higher emissions because they require several brief appointments, such as fluoride varnish application on high-risk caries patients. In these cases, dental professionals should adopt a cost-benefit approach and consider the net reduction of emissions over a lifetime of dentistry.6
High-quality operative dentistry
Quality operative care is something we should all strive towards since it gives practitioners a sense of pride. Additionally, regarding emissions, it helps to reduce repairs, remakes and early replacements of dental constructions.
Every dental specialty shares the same core beliefs. To perform high-quality operative dentistry, it is essential to constantly update your knowledge, undergo continuous training and promote teamwork within the dental team and with external consultants.5 The common denominator of preventive care is that everyone needs a maintenance plan that focuses on home care in order to ensure the long-term success of the operative treatment.
Even though reducing emissions is a priority, the primary aim of sustainable dentistry is to improve the quality of life through preventive care and quality operative care. And in order to be able to offer this to the underprivileged part of the global population, increased emissions are inevitable.
The list of references can be obtained from the publisher upon request.
Mon. 30 May 2022
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