Sustainability in dentistry: Urgent call to action

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Dr Les Kalman believes that dental diseases and environmental damage share similar characteristics and that both require urgent intervention. (Image: Les Kalman)

Tue. 10. January 2023

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Our profession deals with issues that rarely improve on their own. In fact, most dental problems will become more challenging unless we intervene with dental treatment. Let us consider a patient with symptoms of a carious lesion that has extended into the dentine. The symptoms will worsen and the caries will progress unless we take surgical action, remove the decay and replace it with a restoration.

Periodontitis will progress, sometimes silently, until a patient presents with signs or symptoms. Action is required to address the problem. This could include simple scaling, root planning or, ultimately, extracting the tooth. Finally, and more seriously, if a patient presents with an abscess, we must act before the infection spreads to other areas, as this could pose a serious threat to the patient.

In all of the examples presented, the oral health problem may have an impact on the overall health and well-being of the patient through complex interactions. Our ethical role in all of these situations is to advise the patient of the problem and explain how to resolve it, obtained through a patient-specific, procedure-specific informed consent. Subsequently, treatment occurs, the dental issue is resolved, and the impact on overall health and well-being has been mitigated. If treatment is not rendered, the outcome can be detrimental to the patient and the consequences possibly irreversible over time.

Let us shift our thoughts to earth. This amazing planet provides the necessities for life, including human life, but the earth continues to be assaulted by our mismanagement of resources. Such is the case with the ongoing use of single-use plastics. Every day, we use them and then discard them. Most do not decompose but rather clog up our landfills and oceans. Some plastics do not break down, and they remain in the environment, which can cause injury or death to aquatic and terrestrial wildlife through ingestion and suffocation. Some plastics break down into smaller particles, which are then recycled back into the environment, resulting in physical and toxicological risks to living organisms. For perspective, consider this on a global level. It is estimated that humans use 1.2 million plastic bottles per minute (91% of which are not recycled) and produce 380 million metric tons of plastic per year. These figures are truly staggering. We are well aware of the detrimental effects of this, and we need to act now.

Dentistry contributes to this problem. Our profession is unfortunately reliant on single-use plastics in our clinical workflow, including barrier protection, air/water syringes, restorative material packaging, instrumentation such as micro brushes, and oral hygiene aids. We need to analyse our workflow and remove as many single-use plastics as possible. We need this to happen now.

Carbon emissions from industrialisation and vehicle exhausts continue to pollute the atmosphere at an unprecedented rate. These pollutants have resulted in a significant change in the atmosphere and the planet, resulting in climate change and altered weather processes. Consequently, irreversible changes have occurred, including glacial melting, flooding, drought, catastrophic storms, changes in ecosystems, farming disruptions and injury to, and death of, organisms, including humans. If we consider the global impact, the figures are extremely depressing. It is estimated that global carbon dioxide emissions from fossil fuels produce 35 billion (yes, billion!) tons. Although some evidence indicates that the damage is now irreversible, urgent action is required to reduce emissions.

“This amazing planet provides the necessities for life, including human life, but the earth continues to be assaulted by our mismanagement of resources

Once again, dentistry is part of the problem. Most of our clinical workflow involves patients commuting to our clinics for in-person dental examinations and treatment. Inaccurate diagnoses, limited patchwork treatment and poor communication may result in repeated vehicle trips—which result in further carbon dioxide emissions—back to the clinic for additional procedures that could have been avoided. Consider these factors in your workflow: improve your information gathering, establish an accurate diagnosis, take time to communicate with your patients and obtain appropriate informed consent, provide definitive treatment options and, finally, explore teledentistry. Do your part in trying to limit or reduce the number of vehicle trips required by your patients. A recent study from the Schulich School of Medicine and Dentistry at Western University in Canada indicated that virtual medical visits during the pandemic resulted in a reduction of 3.2 billion km travelled and between 545–658 million kg of carbon dioxide emissions. Action leads to results, and we must all take action.

Why is it time for an urgent call to action? The short answer is that we should have made changes to our environmental impact decades ago. The scientific evidence existed, and the damage was obviously progressing, but perhaps we took ourselves out of the equation. We are not going to live forever anyway, right?

We now understand from evidence-based scientific research that the planet is a complex web of interactive systems. Damage or disruption to one area will ultimately affect other areas. Ironically, the impact of pollution and climate change is now affecting us. Studies have now confirmed that increased pollution has detrimental health consequences, from respiratory illnesses to neurological disorders. These include a recent study suggesting that traffic-related air pollution may be linked to an increased risk of dementia. We have to act now, not only for the sake of the planet but also for the sake of our health and the health of future generations.

Dental diseases and environmental damage share similar characteristics—both are processes that continue until an intervention occurs. Both are largely irreversible. Both have widespread interactions that have negative impacts. Both require prevention to minimise the problem. Both require action. Let us look at this marvellous planet through the same lens through which we look at patients. Let us limit our carbon footprint, improve the planet and make 2023 the year in which we all live, and practice,  more sustainably.

Dental disease Dental treatment Environment Greenhouse gas emissions Prevention Sustainable dentistry

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