Part 5: Sustainable dentistry in 500 words or more

Dental waste management has been primarily focused on amalgam disposal, but this is no longer the primary issue.¹ Even though it is well known that dental practices generate great amounts of waste, there is limited data available on the effect of this on the environment. Similar to sustainable dentistry, dental waste management lacks a global consensus on how to tackle certain environmental issues that are associated with dentistry.^1, 3

To address dental waste management, it is vital to first understand the classifications of dental waste and how it is handled. It is important to note here that dental waste management can differ from region to region and depends on local policy.

In the day-to-day running of a dental practice, waste is generated from all parts of the business and can be divided into three categories: household waste, hazardous waste and clinical waste. Household waste is similar to what is generated in a residential environment. Hazardous waste, however, is considered harmful to people and/or damaging to the environment. It includes clinical waste, radiographic solutions, amalgam and gypsum, which generates a toxic gas during degradation in landfills. Clinical waste is defined as “any waste which consists wholly or partly of human or animal tissue, blood or other body fluids, excretions, drugs or other pharmaceutical products, swabs or dressings, syringes, needles or other sharp instruments” and is also classified as hazardous. ⁴

“Dental waste management lacks a global consensus on how to tackle certain environmental issues that are associated with dentistry”

Household waste should, if possible, be recycled. Hazardous waste must be disposed of through the appropriate facility. Clinical waste should be incinerated.

The four Rs in dentistry

For dental professionals, waste management aims to protect humans and the environment. If correctly done, it can also reduce costs, since most of the waste produced is clinical waste and this is more expensive to dispose of compared with household waste. A popular way to manage waste has been to employ the four Rs—reduce, reuse, recycle and rethink.

• Reduce in the surgery

Many practices work with preset trays containing certain instruments and disposable material, such as plastic tray liners, gauze, cotton rolls and polishing paste. As soon as the tray has been contaminated, all materials, both used and unused, are classified as clinical waste. Practices should review their set-up routines to minimise the waste of unused material. Reducing also goes hand in hand with sustainable procurement, the topic of Part 3 in the series.

• Reuse in the surgery

Most of the waste in dentistry consists of single-use equipment. Single-use equipment is not used for the sake of convenience but to minimise cross-contamination.^2, 3 There is thus a need for the development of novel solutions allowing sterilisation and reuse. In the case of swapping from single-use to multiple-use items, it is important to make sure that patient safety comes first and to remember that it is not all black or white; for example, not all multiple-use equipment leads to less environmental impact in terms of the manufacturing process, water usage and energy usage. Practices must do their homework before switching and ask the following questions: is the equipment safe for patients and personnel, and do its production and use have a positive impact on the environment?

• Recycle in the surgery

This is the most challenging R, since clinical waste cannot be recycled. The most common materials found in clinical waste are tissues, gloves and sterilisation pouches.¹ It makes sense to discard tissues and gloves in a clinical waste bag, but what about sterilisation pouches? We should be able to establish routines that allow us to open them with clean gloves, separate the plastic from the paper and recycle appropriately. Small actions like this can have a positive impact on the environment and save costs for dental practices.

• Rethink in the surgery

Rethinking is the most important of the four Rs. Even though reducing, reusing and recycling are the most discussed, they do not adequately address the clinical reality of dentistry or medicine.³ To meet the United Nations’ Sustainable Development Goals set out in Agenda 2030, our suppliers must understand the waste management system in order to align their dental products and materials with the most appropriate end-of-life procedure—incineration, landfill or recycling (chemical or mechanical).

Moving forward

All clinical waste is destined for incineration and should, therefore, be bio-based instead of fossil-based to reduce the net emissions. Additionally, a consensus is needed on how to safely minimise single-use equipment, including sterilisation pouches.

The healthcare sector must move from a linear to a circular approach. This could involve recycling; however, recycling has its challenges. To be able to produce raw material, the recycling process requires non-contaminated homogenous material. Otherwise, the material will have different properties and lose quality in each cycle, resulting in downcycling instead of recycling.

There are many different types of plastics used in the healthcare system, and a circular approach will never be accomplished if they are recycled together. Our efforts in the clinical setting will have little impact on sustainability unless there is an alignment of equipment production, waste management and end-of-life procedures. Only then can good oral health and reduced environmental impact be achieved.

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