Part 6: Sustainable dentistry in 500 words or more

The consensus is aimed at the oral healthcare community and has a cradle-to-grave methodology that includes the entire supply chain, that is, manufacturers, suppliers, dental professionals and waste management. Even though the consensus is relevant for everyone within the oral health industry, some sections can be perceived as irrelevant to those who are not devoted to sustainability.

The aim of this article is to provide a brief overview of the consensus, particularly the parts that are pertinent to the dental profession, and to discuss how to put the preventive aspects covered in the report into practice. It also offers steps to achieve patient compliance, which is both most challenging and rewarding from a dental professional’s point of view.

A Joint Stakeholder Statement

Through this statement, we recognise that the oral healthcare sector—as a whole supply chain—has a responsibility to undertake its activities in a manner that seeks to improve the sustainability of oral healthcare products and interventions. 

Through our collective ambition to reduce the environmental impact of oral healthcare, we recognise that there is a substantial opportunity and desire to work collaboratively across the sector, to engage in sustainable practices with all stakeholders for the benefit of society. We recognise the need to establish a strategy to achieve meaningful and measurable environmental outcomes throughout the oral healthcare supply chain.

The consensus starts with this joint stakeholder statement, which recognises the complexity of sustainability in the oral healthcare industry, involving not just our clinical setting but rather the whole cycle, from the sourcing and manufacturing to the disposal of dental products. To foster a sustainable industry, dental professionals need to work together to decrease the negative impact of dentistry on the environment and to create a circular economy without compromising the quality of our care.

The consensus is based on scientific publications. To be able to shift the oral care industry towards a sustainable future, the FDI panel sets out six routes to sustainability in the consensus. These include the four Rs (reduce, reuse, recycle and rethink); legislation, policy and guidelines; waste management; procurement and logistics; research and education; and materials for clinical use. A three-step process was suggested to address each of these.

Step 1: Create awareness in the oral care community and identify the challenges it involves

Dentistry’s impact on the environment is not clearly documented. However, it has been established that patient and staff travel account for two-thirds of the total emissions. This is valuable knowledge for the dental profession, since it demonstrates that our impact on the environment starts outside the dental practice.

Water usage is also highlighted in the consensus. Dental treatments are heavily dependent on water, from treatment to sterilisation. We should take this into account when choosing between single-use and multi-use products, since every sterilisation cycle requires water and energy, and multi-use products are not always the best solution. Bio-based single-use products might be a better and safer option for our patients, but this needs further investigation. Home care also requires water, and there is a substantial waste of water during toothbrushing and other oral home care routines.

A third challenge that is mentioned is the dental profession’s “set behaviours and attitudes”, but there is no further in-depth explanation regarding the issue in the consensus. Being a dental professional myself, I can identify with set behaviours and particular attitudes. We work in a high-stress environment, and much of the operative success depends on paying attention to detail, choosing the appropriate material and following a rigid workflow. For dental professionals, changing set behaviours could affect treatment outcomes, which we are not willing to risk.

Step 2: Identify drivers and opportunities

Drivers are motivators for change. One of the drivers for the dental profession is the desire to be portrayed as a positive influence when it comes to sustainability, that is, to be a part of the solution instead of being a waste management problem. Our commitment to preventive dentistry will eventually lower emissions by reducing operative treatment in our patients and thereby decreasing travel and material usage. Additionally, the dental profession improves the quality of life for billions of people through bringing pain relief, creating beautiful smiles and regaining function for our patients. Sustainable workspace is also high on the list for the younger generation and is a great attraction factor for recruiting valued members of staff and marketing a dental practice.

Step 3: Create a strategic action framework for specific recommendations and identify best practices

Towards the end of the consensus report, there is a strategic action framework for each of the six routes to sustainability in oral healthcare. For dental professionals, the route of the four Rs is the most relevant one, especially reduce and recycle. Reduction through prevention focuses on reducing carbon emissions through fewer appointments, which results in fewer patient journeys and thus lower environmental impact, and on reducing material, since there will be less intervention if we keep our patients healthy.

“The only side effect of preventive dentistry is its positive impact on the environment”

The consensus covers the complexity of sustainability from all possible angles. However, how should we employ it in the dental practice, and where should we start? I believe that we should go back to the basics and focus on oral home care, which is the bedrock of all dental treatment and disease control. After all, all success stories are dependent on plaque control. Oral hygiene information and instruction are a very small portion of our daily work, but can greatly impact our decisions and interventions. Therefore, there is a strong need to refresh our knowledge, starting from professional training, including ways to achieve compliance, which is considered one of the most complicated tasks in dentistry.

Reduction through prevention using compliance: Tips and tricks

1. Use a dental model to explain oral disease, the maintenance of a new dental construction and the impact of dental plaque on teeth. There are several such models available at dental dealers that are well worth the investment, such as caries, periodontal disease, fixed orthodontic appliance and implant models.
2. Select a suitable toothbrush (regular or compact size; soft or extra-soft, flat-trimmed or multilevel bristle design) for use on the dental model and pay special attention to the brushing technique. The most recommended one is the modified Bass technique, but there are several techniques to choose from, including the Fones technique, scrub technique and Stillman technique.³
3. Select a suitable interdental cleaning device (floss, soft picks or interdental brushes) to show on the dental model, and pay special attention to the cleaning technique. Oral hygiene tools that are easier to use can be a good starting point for patients. For floss beginners, a preloaded floss stick or dental tape is a good start. For patients who require interdental brushes, a soft pick can be a great start. After teaching them the correct technique, upgrade to interdental brushes at the next appointment. Interdental brushes are essential for managing periodontitis.
4. Demonstrate best oral hygiene practices in the patient’s mouth and the areas that need extra attention while the patient observes in the mirror. Visuals are important, but the main advantage of the demonstration is the sensation and feel of the proper brushing technique, how the floss slides through the contact and continues along the tooth and under the gingival margin, and how much pressure to apply with an interdental brush. It is also important to instruct the patient to work the interdental brush on each tooth surface three to five times.
5. Let the patient repeat the oral hygiene practice in his or her mouth with the help of a mirror.
6. Write down the instructions on an oral hygiene prescription pad, including information on what products to buy and where in the mouth to use them. This is especially important for interdental brushes. Since many patients forget to buy the products, dental practices that can directly supply patients with oral care products as part of the service can maximise patients’ chance of performing home care.

It might seem like a time-consuming exercise, but the demonstration only requires 5–10 minutes, depending on disease severity and patient motivation. Incorporating these steps into the routine and following them systematically will improve patients’ oral health and offer cleaner mouths for us to work in. Less bleeding and better visibility can only lead to better operative dentistry. Good home care facilitates the minimisation of failures and redo’s of our work. The only side effect of preventive dentistry is its positive impact on the environment.

To make the oral care industry sustainable, we must reduce emissions and waste and strive towards a circular approach. It requires a change in global legislation to get manufacturers, suppliers, dental professionals and waste management companies to work in the same direction and towards the same goal. Meanwhile, the dental profession should focus on what we do best, which is practising preventive and quality operative dentistry, and remember that reduction through prevention starts with plaque control.