Eco-dentistry: benefits, opportunities & examples

Sustainability and climate change are hot topics, with the UK Parliament declaring a climate emergency in 2019.

The Climate Change Act 2008 specifically set targets to reduce CO2 emissions by 80% by 2050, compared to 1990 levels.

In addition to this the NHS Carbon reduction strategy 2009 also outlined the reduction in carbon required by the NHS to comply with the Climate Change Act, and goes on to highlight key areas to help organisations meet the set target

As a dental professional you may now be thinking, how does your practice impact on the environment, and how can they create a working philosophy that reduces this impact?

With dentistry contributing to 3% of the NHS carbon footprint, there is much that can be done to help create a more environmentally friendly dental practice.

Whilst the term “eco-friendly dentistry” is patented and trademarked “Green dentistry” or eco-dentistry has been described as:

‘An approach to dentistry that implements sustainable practices by keeping resource consumption in line with nature’s economy, by safeguarding the external environment by virtue of eliminating or reducing outgoing wastes and by promoting the well-being of all those in the clinical environment by conscious reduction of the chemicals in the breathable air.’ 

In this article, I hope to go into some detail about:

• The size of the impact that dentistry has on the environment.
• The benefits of practicing eco-dentistry.
• How your practice can become more environmentally friendly.
• Specific examples of dental organisations moving towards environmentally friendly dentistry.
• Where to find advice, and frameworks to help make a practice more environmentally friendly.
• Continued Professional Development for dentists and DCPs that is specific to sustainability.

What is the size of the impact that dentistry has on the environment?

The relationship between the environment and dentistry is two way: dentistry has an impact on the environment; environmental change impacts the care provided by dentists. 

Dentistry is a direct threat to the environment because of the resources consumed and waste produced. 

Providing dental care is energy intensive, and requires the use of many materials, each of which have a direct and indirect impact on the environment.

Failure to maintain a sustainable practice, and the environmental effects this has, will directly affect patient overall health and this will then need consideration during treatment.

Climate change will also impact dentistry, for example as patients become more aware of their individual impact and seek ways to reduce this.

Climate change policies will also affect the care we are able to provide, with some materials being phased out.

Sustainable healthcare should use the resources available without compromising the health of current and future generations, whilst also not impeding on the ability to deliver healthcare. 

This means that clinical activity should be balanced with preserving our environment, ensuring resources are available for future generations.

How and why does dentistry have an impact on the environment?

The overall NHS carbon footprint is estimated to be 22.8 million tonnes CO2e (tCO2e) per year. This makes it the largest public sector contributor to carbon emissions.

Dentistry, in common with other healthcare providers, has a distinct impact on the environment, with NHS dental services emissions contributing 3% of the overall carbon footprint of the NHS.

According to Richardson et al  this is because there are relatively large carbon dioxide (CO2) emissions, toxic materials are used, and there is also the production of vast amounts of waste. 

With the Centre for Sustainable Healthcare, Public Health England published a report called “Carbon modelling within dentistry: towards a sustainable future”. This detailed report outlines the major areas of carbon emissions for dentistry.

This carbon footprint includes:

• direct emissions, such as from energy generation heating the dental practice.
• indirect emissions from electricity use, for example powering the dental light and chair.
• indirect emissions from the supply chain, travel and waste disposal. This would include emissions used to make an oxygen cylinder, as an example.

It is evident that changes need to be made to reduce the impact of dentistry and dental practices on the environment, and I will discuss specific areas later on.

What is the impact of climate change on dentistry?

Within dentistry we should take into account how the care we provide impacts both the environment and overall health.

Climate change will impact dentistry:

• By changing policy which can impact the care we provide.
• By impacting patient health – with oral manifestations of disease, and increasing infectious disease becoming more prevalent.
• By shifting focus to overall health of the patient and the need to consider the patient’s beliefs about their carbon footprint.

As healthcare professionals, dentists should be committed to the Services (Social Value) Act 2012, which states:

“Public authorities have to regard economic, social and environmental well-being in connection with public services contracts and also taking into account wider social and environmental value when they choose suppliers.”

With this we can expect future policy changes to be developed to try and combat climate change, which will also have a direct impact on provision of dental care. 

Recent examples include the phase down of the use of amalgam. In the future, we could see changes to regulation in the use of single use plastics, and the way we recycle our waste.

Within dentistry in the UK, GDC standards remind the team that they must take a holistic and preventative approach to patient care. Specifically, they should take account of patients’ overall health. There is growing evidence that sustainability, or planetary health, has a considerable effect on human health.

The 2015 Lancet Commision on Health and Climate Change maps out the impact of climate change on human health, and shows that climate change directly impacts human health.

As healthcare professionals, we should also be able to see how the spread of infectious diseases, poor nutrition, and respiratory conditions can directly affect oral health itself.

As well as the direct impact on general health, there are indirect consequences as a result of damaging the environment that we rely on for good health. 

The report discusses how tackling climate change can improve public health, stating that tackling climate change could be ‘the greatest health opportunity of the 21st century’. They outline policies that will improve health, enhance resilience, alleviate poverty and address inequality.

As healthcare professionals, we also need to take into account patients’ beliefs when offering treatment options. Climate change will alter a patient’s priorities and so we must expect patient’s to want to know more about how what we are doing will impact the environment. This means that dental professionals will need to stay abreast of developments and understanding about climate change and dentistry.

This may be as simple as discussing sustainable home oral health practices, such as the use of plastic free toothbrushes, up to the patient’s desire to avoid certain materials.

Taking into account policies that change dental practice, the manifestations of disease as a result of climate change, and needing to be able to communicate with patients about the impact of care on the environment, it is clear that sustainable healthcare is not a simple process.

What are the benefits of practising eco-dentistry?

The benefits of environmentally friendly dentistry, or eco-dentistry are many fold. 

Often, when we discuss sustainability, the focus is primarily on reducing carbon footprint. 

However practising sustainable dentistry, and making changes to ensure your practice is eco-friendly should also consider environmental, economic, and social impacts.

This is sometimes referred to as the “triple bottom-line analysis”. By using these three categories the organisation/service performance and impact is measured in its entirety.

The overall aim of practising environmentally friendly dentistry should be to reduce emissions, save money and improve the health of people and communities in line with the triple bottom line.

Environmental benefits

Switching to a more sustainable practice has obvious environmental benefits, and will enable practitioners to look after the planet. 

By prioritising preventative practices, dentists can minimise the environmental impact of service delivery, and reduce the amount of waste produced and recycled.

Environmental benefits can also be achieved by reducing the carbon footprint by encouraging active travel to staff and patients (which also has health benefits!).

Economic benefits

Considering switching to sustainable practice will also have significant economic benefits, with an overall aim of looking after profits.

Sustainable practice is profitable in the long run, and you can find out more about this in the case examples down below.

Acting sustainably also makes good business sense: there are both short term financial savings to be made and there is also the opportunity to make the NHS more financially secure and resilient in the long term (for example considering energy price and availability fluctuations).

Patients may also become loyal to a practice that explicitly engages with an environmental policy.

Social benefits

Finally, eco-dentistry should also be assessed in terms of the social benefits, in that as healthcare professionals dentists are generally interested in looking after people and improving overall health.

Triple bottom line analysis takes a look at how dental practices have farther reaching social impacts, and how paying fair salaries, providing a safe working environment, and giving back to the community, can have social benefits.

Overall, engaging in sustainable dentistry can boost staff morale which can also have a significant impact in the clinic.

How can a practice become more environmentally friendly?

So far I have explained how the environment and dentistry are interlinked, and the proposed benefits of eco-dentistry. 

So now for a more practical discussion about how to reduce the environmental burden and practice more sustainably.

There is the theme of sustainable practice management which includes travel, procurement, water, energy, waste (the largest contributors to the carbon footprint in dentistry.

There are also the four principles of sustainable clinical practice, which provide a framework for areas to improve your clinical decision making and treatment planning.

Finally, I will go through other ways in which your practice can become more environmentally friendly.

Sustainable Practice Management

This largely relates to changes in the way that the practice is run, and the management of the practice. 

Changes in protocol will create systemic change across the practice, being more effective than the acts of one clinician or staff member alone.

Sustainable practice management to enable sustainable dental practice includes considerations for:

• Travel – staff and patients.
• Procurement of materials.
• Use of water.
• Energy consumptions.
• Waste.

Travel

Within dentistry, travel accounts for the largest proportion of CO2 emissions. This includes staff travel to work, patient travel to the practice, and travel whilst in work, for example domiciliary care or lab work deliveries. Reducing travel by staff and patients will have a significant impact.

Staff could be encouraged to decrease their individual (and therefore the practice’s collective) carbon footprint with some simple common sense schemes:

• Walking to work would have the lowest carbon footprint, and should be the first port of call for staff and patients.
• Cycling to work schemes reduce carbon emissions, and also lessens the need for a car park. Provide secure bike storage and have shower facilities available to make this a good option for your staff. 
• Where cycling is not an option, encourage public transport. For example, offer a loan for yearly passes at zero interest, or facilitate flexible working patterns to accomodate for public transport timings.
• Encourage staff to commit to car pooling where possible.

If you provide domiciliary dental care, you could think about moving to an electric powered vehicle as your means of transport.

Where possible, use local labs where the travel distance for lab work is less, and may even be able to be completed on foot. 

The emissions caused by patient travel could be reduced by:

• Booking family appointments together.
• Completing multiple interventions in a single visit, where possible.

Procurement

Dentistry is particularly demanding with regards to supplies required. The production of supplies, whether for dentistry, or otherwise, creates waste. The packaging required for these products also creates a substantial amount of waste (a topic to be discussed in more detail later in the article).

According to CSH within the NHS in England, supply chain emissions make up 57% of the total carbon footprint. 

To reduce the impacts of procuring dental supplies, some recommendations include:

• Buying in bulk will save money by making the most of bulk purchase offers, as long as stock can be used before expiring. This will also consolidate the number of deliveries made, reducing carbon emissions.
• Where possible purchase products that can be decontaminated and reused, rather than single use items (whilst still adhering to HTM01-05 regulations or similar).
• Buy locally where possible to reduce delivery mileage.
• When purchasing equipment use whole life costing to factor in running costs (energy use, consumables) and lifespan. Reduce carbon footprint of deliveries by liaising with suppliers to reduce the number of deliveries.
• Optimise stock inventory to avoid products going out of date and being wasted.
• If items are close to expiry and you don’t think you will be able to use them in time, consider offering to swap with local practices or even donating to dental charities.

Water

Sustainable dental practices should also consider reducing water usage where possible. 

Using a water meter will make you more aware of water consumption, and will allow you to monitor this.

Conserve water use, for example avoid leaving taps running wherever possible, and ensure timely repair of leaking water points.

Energy

Use of energy increases the carbon footprint of a dental practice. Reducing energy consumption will contribute to a more environmentally friendly practice. There are three main ways in which this can be positively changed:

1. Increase efficiency – buildings can be improved with insultation, energy efficient boilers, and using LED lighting and timing sensors. Ensure heating is optimal by using thermometers and thermostats.
2. Decrease usage – aim to try to reduce overall energy consumption, getting buy-in from all staff by explaining the benefits to both the environment as well as financial benefits. Use blinds to reduce overheating in summer.
3. Use low carbon alternatives – if possible, use an environmentally friendly energy supplier. Buy green energy, or produce your own with solar panels.

Waste 

With a lot of supplies comes a lot of waste. The impact of this waste can be reduced by:

1. Reducing waste production.
2. Improving waste collection and correct waste disposal.

Richardson et al identified the most frequently disposed of items during clinic sessions:

Practical tips for reducing waste production include:

• The use of digital radiographs.
• Switching to digital impressions.
• CAD/CAM and chairside production of restorations to eliminate need for intermediate restorations.
• Use compostable or reusable sundries where possible.
• Reduce paper waste by using paper-free technology for patient medical histories, consent etc.
• Repair and reuse durable goods.

In January 2020, researchers at Harvard School of Dental Medicine drew attention to the importance of waste disposal. They highlighted that plastic, mercury, lead and silver waste are common within dentistry, and that these pollutants can compromise food, water and air quality. Proper disposal of contaminants as well as regular waste could reduce environmental impact.

Correct waste disposal means ensuring waste is appropriately sorted. This avoids unnecessary waste being sent to be incinerated, lessening the financial and environmental cost of waste disposal.

Steps for improving waste collection and disposal include:

• Providing recycle bins for food, paper, and plastics (as well as other household waste produced by staff, such as tin or glass).
• Recycling unusable instruments at the end of their life.
• Improving clinical waste segregation, to include:
  • Use of amalgam separators.
  • Safe disposal of medications.
  • Proper segregation into hazardous and non-hazardous waste.
• Rehome unwanted items (so long as there is no contamination risk).

The four principles of sustainable clinical practice

The overall aim is to reduce our environmental impact, without reducing the quality of healthcare. This can be achieved by reducing activity, and favouring activities with a lower environmental footprint. The Centre for Sustainable Healthcare has identified four principles to make medical care more sustainable:

1. Prevention

Disease prevention and health promotion should be the centre of patient care. By understanding and changing the underlying causes of disease, we can prevent disease occurring. Where possible, interventions should capture environmental benefits of healthy lifestyles.

2. Self care

Patient education and empowerment enables patients to take a greater role in managing their own health. Informing patients how to prevent disease progression will enable them to feel empowered. Clinical teams can also work together, and with the patient, to reduce duplication of care.

3. Lean Pathways

This is the process of improving clinical decision making, avoiding interventions which are not effective or costly, and therefore reducing their environmental impact. Increasing efficiencies, for example with referral pathways, also reduces environmental impact.

4. Low carbon alternatives

Using medical technologies and treatments with a lower environmental impact, where possible.

These four principles can be applied in specific clinical scenarios, each of which I will go into more detail later on, but which includes the use of polluting materials, dental labwork, the use of antimicrobials.

Pollutants in dentistry

There are some dental specific wastes that are particularly harmful to the environment. Like with all waste discussed in the sustainable practice management section, each of these should be considered in terms of:

• Do I have to use it, is there an alternative? Therefore reducing useage where possible.
• Where there is no alternative, ensuring the waste is appropriately disposed of.

One of the main differences with these materials is the fact that it is primarily the dentist who will decide on their usage, as part of the clinical decision making process.

Dental plaster

Used in the production of study models for lab work. Avoid unnecessary impressions and ensure accuracy of impressions to avoid remakes. 

Dental models should be stored for a period of time, and could be reused if appropriate. 

The use of CAD/CAM technology will reduce the need for impressions and models, reducing the production of dental gypsum and plaster waste.

HTM07-01 advises that gypsum/plaster waste should be segregated and appropriately disposed of to avoid production of hydrogen sulphide gas,

Mercury pollution

Putting aside patient concerns about dental amalgam, there is clear evidence on the contamination to the environment caused by mercury pollution. The WHO estimates that about two thirds of mercury from dental amalgam worldwide end up in the atmosphere, soil, surface and groundwater

The International Academy of Oral Medicine and Toxicology (UK) outlines the impact of mercury pollution from dentistry – including its effect on the environment as wastewater, in human waste and as a vapour.

The Scottish Dental Clinical Effectiveness Programme (SDCEP) document Restricting the Use of Dental Amalgam in Specific Patient Groups discusses the impact of the Minimata Convention on Mercury and gives advice about reducing the use of amalgam and safe disposal of mercury.

Sedation in dentistry

Sedation involves the use of nitrous oxide for relation and pain relief, and many dentists refer patients to, or provide such a service. 

However nitrous oxide is the third most important greenhouse gas in the UK, with a global warming potential 310 times that of CO2. Nitrous oxide also damages the ozone layer, thus reducing the protection offered from harmful UV sun rays.

Whilst dentistry produces only a low volume of nitrous oxide – it is associated with a high carbon footprint and therefore should be used with careful consideration. 

The principle of patient prevention to avoid treatment and exploration of all alternative treatment modalities should reduce the impact of sedation.

Dental labwork

Dental labwork uses resources and produces waste. 

For example crowns contain precious metals and non-precious metals, whilst dentures use metals and acrylics. 

With regards to clinical decision making, reduction in the production of non-essential labwork could reduce the impact of this on the environment. 

There is little research in this area at the present time, but nonetheless this is a consideration for the future.

Prescribing and antimicrobial resistance

Medications and prescriptions during care have a considerable carbon footprint. This can be reduced by ensuring appropriate prescribing.

Appropriate antimicrobial prescribing will also lessen the burden of antimicrobial resistance.

Single use products

The nature of the care provided in dentistry, which is often invasive, involving blood and saliva, means that single use products are a requirement. 

In some cases this is unavoidable, and enshrined in law. For example, endo files are single use and require safe disposal after use.

However in some cases the use of single use plastics is more for convenience, or because regulations have been falsely interpreted. For example, the use of single use plastic drinking cups at the chairside.

You could implement simple changes to reduce this impact, such as:

• Swapping plastic cups for autoclavable reusable cups.
• Reduce use of plastic cups by only putting them out when requested by the patient.

In the BBC video below, professor Tony Ryan urges dentists to ditch single-use plastics where possible:

Decontamination

Studies have shown that materials used to support infection control constituted up to 91% of total waste produced in a practice. 

There is clear decontamination guidance available across the four UK countries (HTM 01-05 in England, Minimum standards for dental care and treatment in Northern Ireland, Decontamination into practice in Scotland and WHTM01-05 in Wales). 

Becoming familiar with these will ensure the practice is within health and safety legislation whilst also reducing impact on the environment.

Trays of instruments could be packed instead of individual instruments, where the whole tray will be used in one clinical session and where the open tray is stored away from contamination (for example, in a dedicated cupboard. This could work particularly well for examination kits, where multiple kits are required and used in a clinical session. 

This could be taken one step further. In fact, HTM0105 gives specific advice regarding whether dental instruments must be packaged after sterilisation. Sterilised instruments can remain unwrapped after processing and before being used on a patient. The 2013 edition (paragraph 2.4k) advises that:

• Unwrapped sterilised instruments may be stored in a clinical area for one day (after which they must be reprocessed), so long as they can be stored away from the contaminated area, such as in a cupboard.
• Unwrapped sterilised instruments may be stored in a non clinical area for up to one week.

These changes to decontamination in practice can potentially reduce the amount of time spent packaging sterilised instruments, and the amount of packaging produced as waste.

Oral health products for patients

A key part of dentistry is oral health advice provided to our patients and the general public. This focuses on toothbrushing, fluoride containing toothpaste, and the use of interdental cleaning aids such as floss and interdental brushes.

Whilst good prevention advice is one of the four principles of sustainable practice, and thus overall looking to reduce waste as fewer interventions are required, it is important to recognise the potential environmental impact of such home care products.

The Dental Tribune reported on the history of plastic toothbrushes and how they pollute our planet. 

Fortunately, alternatives are becoming available for those patients interested in sustainable alternatives for oral care at home. Whilst the full range is outside of the scope of this article, there are some key products to make practitioners aware of, including:

• Non-plastic toothbrushes, and closed loop recycling of dental products. Examples include increasingly popular bamboo toothbrushes.
• Package free toothpaste, such as fluoride containing toothpaste tablets.
• Mouthwash powders, tablets and concentrates.
• Natural floss products which are therefore compostable in many cases.

As oral hygiene is dependent on patient compliance, it is imperative to take patient desires into consideration. With environmental concerns becoming more commonplace, it is likely that patients will present asking for plastic-free alternatives for dental products.

Referrals and communication pathways

Referrals can often involve the use of printed documents and forms, which are then sent via a postal system. One way to decrease waste would be to move towards digital formats for referrals, eliminating paper waste and reducing emissions from delivery services (and additionally benefiting by reducing postage costs!).

Some examples of what others have done

Dental Care at Home 

Dental Care at Home, a Glasgow-based domicillary dental provider, joined a scheme to be able to use an electric car to transport its team to care homes . 

The NHS dental care provider now visits care homes in an electric car which is rented from a social enterprise rather than owned by the practice.

Plaster recycling at Liverpool University Dental Hospital

The SDU highlights the work done at The Royal Liverpool and Broadgreen University Hospitals NHS Trust to recycle plaster casts from orthotics and orthodontics.

Instead of sending models to landfill, the gypsum is recycled

As well as a financial saving, the changes provided a significant reduction in carbon footprint.

More about this can be found out by reading the case study on the SDU website (under the waste section).

Terracycle

Terracycle offers free recycling services for products which are typically hard to recycle. They have teamed up with Colgate and are able to offer The Colgate® Oral Care Recycling Programme.

Members of the public can drop off their oral health products at the locations, where they are then collected and recycled into plastic pellets to be reused. Collectors also benefit from a points scheme that provides financial rewards for charities and schools.

You can search on the website for locations. You can also set up collection points through the website, although at the time of writing this particular scheme was not accepting any new applications. 

There are a number of different schemes through Terracycle, from crisp packet recycling to stationary recycling. It may be beneficial to have a look at the website to find a scheme that you could support in your practice!

Wales e-referral scheme

The NHS within Wales developed an all-Wales online referral scheme, using FDS consultants. 

The e-referral scheme was introduced in 2019 and applies to almost all referrals from dentists to locations offering treatment on referral, including oral surgery and orthodontics.

The scheme has clinical benefits including speedier referral process by avoiding the postal system, as well as environmental benefits by reducing paper usage.

The service is also available to some healthcare services in England by FDS Consultants and Vantage.

Honeycomb Dental Clinic

Honeycomb Dental Clinic is an independent general dental practice who are proud of their environmental policy. They have received the Green Achiever Award (Gold) and show true dedication to reducing their impact on the environment.

They outline their policy and actions in detail on their own website, and are also used by Dental Susnet as a shining example of how dental practices can implement environmentally positive changes, which are outlined in a case study on the Susnet website.

What are some of the barriers to sustainable dental practice?

To move towards a sustainable dental practice, changes are required to the mindset of the industry. 

The focus within the industry is predominantly on patient safety, NHS targets and financial stability. 

Grose et al identified that an individual’s attitudes can affect the success of implementing environmental policy in a practice. The changes required can be seen as costly and time consuming, but hopefully I have explained how even simple changes can be made quickly and cheaply.

The move towards environmentally friendly dentistry is still in its infancy, and practitioners may feel isolated at times. But there has recently been a change in momentum with regards to the environment, which will hopefully soon trickle through to healthcare.

There are barriers in the form of policy, such as decontamination guidelines HTM0105, which require single use products and packaging. 

Policies regarding waste can be confusing and require clarification with regards to contaminated vs hazardous waste, and clarifying what can actually be recycled. And this message needs to be easy to implement on a practice level for practitioners to buy into it.

Policies in general spend years in development and may not yet have caught up with the emphasis on sustainability.

With time, perceived barriers should hopefully fall to enable sustainable changes within dental care that promote a reduction in emissions, that save money and which also improve the health of people and communities.

Support for practices wanting to become more environmentally friendly

Having covered the reasons to move towards a sustainable dental practice, and ideas of how this can be implemented, the next step is gaining support!

There is a wealth of guidance and support available to help with the process of developing eco-friendly dentistry.

The Dental Sustainability Guide

The Dental Sustainability Guide contains a wealth of knowledge and practical advice for developing environmentally friendly and sustainable practice. It was developed by the Centre for Sustainable Healthcare, who describe themselves as:

“The Centre for Sustainable Healthcare (formerly known as The Campaign for Greener Healthcare) is a registered charity.  Set up in 2008 by Rachel Stancliffe and Muir Gray, it works to help the NHS fulfil its commitment to reduce its carbon footprint by 80% by 2050.  It is now the foremost institution in the world working on sustainable healthcare in research and practice.”

Dentistry is one of their sustainable specialities, and in 2018 the charity produced CSH’s dental sustainability guide. This is available to download in full, for free, or when you visit the website individual topics can be viewed, including:

• Travel
• Equipment and supplies
• Energy
• Waste
• Biodiversity and green space
• Measuring and embedding sustainability

Dental Susnet

Dental Susnet is a part of the Centre for Sustainable Healthcare. 

Dental Susnet brings together staff, patients and others from dentistry to share ideas and resources for the transformation to a truly sustainable health service. 

It contains a wealth of knowledge, including the most up to date news.

Sustainable Action Planning

The Centre for Sustainable Healthcare has joined forces with an independent consultant to create and pilot a scheme to help teams plan their sustainable actions.

The process is known as Sustainable Action Planning, or SAP. The programme aims to support clinical teams in taking action for sustainability. 

The SAP website outlines two facilitated workshops, so that front-line staff can learn about sustainable healthcare, focus in on their priorities and put together a green action plan. 

You can use these tools in practice to develop your own plan to make your dental practice more eco-friendly and sustainable.

British Dental Association 

The British Dental Association, BDA, produced a 2017 statement on sustainability, which is a call to action for all dental associations to take a lead on sustainability.

Since 2018, the BDA has been part of the Dental Sustainability Advisory Group (DSAG), originally set up by Health Education England, and run by the Centre for Sustainable Healthcare (CSH).

The BDA good practice self-assessment, encourages sustainable working environments. “Where possible the practice considers how it can be more sustainable and environmentally friendly.”

The British Dental Journal, a publication of the BDA, has put together a collection of articles in 2019, entitled Sustainable dentistry. These articles cover many aspects of dentistry, and how changes can be made to make dentistry more sustainable.

Sustainable Development Unit

The Sustainable Development Unit, SDU, was developed in 2008 and is accountable to the NHS England and Public Health England. 

They support health and social care in England to develop and embed the three principles of sustainable development – the triple-bottom line discussed previously.

The SDU explains how they work:

“We provide expert advice, support and practical help in meeting carbon reduction targets and also engaging with individuals and organisations to change attitudes and behaviours to embrace a more sustainable lifestyle.”

Awards for environmentally friendly practices 

Driving towards an environmentally practice can be challenging. But patients are looking out for these practices. As such, it can be beneficial to work toward recognition for your practice. There are a few recognized general and dental-specific awards.

NUS Green Impact Scheme

The Green Impact Dentistry scheme was launched by the National Union of Students (NUS) in partnership with Public Health England East of England. The programme and toolkit is being trialled in Anglia and Essex, although it is available to all.

The programme follows their tried and tested format for Green Impact, which has previously been implemented across universities, hospitals, museums, and even GP practices.

The full scheme (not yet available to all) involves an annual audit by an appropriately trained student. Even if you do not fall within the catchment for the full scheme, you can still apply.

NUS explains the proposed benefits of joining the scheme in their FAQ sheet, which includes:

• Increased environmental sustainability
• Cost savings
• Improved staff morale
• Demonstrable commitment to improving sustainability practices
• Efficiency through the model – enabling practices to learn from others
• CPD opportunities for staff
• In addition, there may be benefits for patients: fairer access, benefitting a larger proportion of the population, better oral health and equitable, sustainable care.

Green Achiever Award

The Green Achiever award is put together by professional environmental experts, and is tailored to be able to showcase your business’s good environmental practices.

There are many different types of companies working towards Green Achiever awards, including dental practices, and they claim that doing so will provide you with an edge on your competitors.

They claim to support you setting specific goals and to encourage staff and other stakeholders to get on board.

You are able to search through their directory for dental related businesses who are on the scheme.

Continued Professional Development

I have aimed to round up the available information about environmentally friendly dentistry. I have provided an introduction to providing eco-dentistry, including the proposed benefits and barriers, as well as discussing practical ways to start a more sustainable practice.

You may want to develop your knowledge further, in which case I can highlight a few sources for CPD for sustainability in dentistry.

CSH Webinars and courses

The Centre for Sustainable Healthcare in partnership with Health Education England webinar series – currently 3 webinars, each webinar is worth one hour of verifiable CPD. These free resources introduce sustainability in healthcare and dentistry. 

One of the topics is in association with the Green Impact scheme, and you can follow this link to complete the quiz and gain your certificate.

The CSH also runs courses, most of which carry a fee. These cover a range of topics relating to sustainability and healthcare.

E-learning for Health

E-learning for health is a Health Education for England programme that provide CPD on a variety of topics. Their course An Introduction to Sustainable Dentistry and Measuring Carbon in Healthcare is specific to dentistry.

Logins for the e-den section of the site are available to all practitioners who provide an element of NHS care, and information about how to sign up can be accessed here.

This session provides an introduction to sustainability in healthcare and guidance on the practical application of sustainability principles in the dental setting.

The estimated time for completion is 30 minutes, but the certificate records the actual time taken.

Sustainability in Dentistry

The Sustainability in Dentistry group are based in New Zealand and Australia, but their advice can apply elsewhere too. They provide access to CPD such as: 

• Rubbish Basics – a video and multi choice quiz, equivalent to 1 hour.
• NZDA Column Reading – Articles and quiz, updated regularly and provide 1 hour.

Minimata Convention on Mercurcy

With regards to the use of Mercury, the United nations e-learning site InforMEA has produced the course Introductory Course to the Minamata Convention on Mercury. You can register for this one hour course for free. 

Whilst the course does not state that it is GDC CPD approved, the GDC provides guidance to assess whether you believe this CPD is relevant to your role and therefore verifiable.

FAQ

What is the difference between eco-friendly dentistry, eco-dentistry, sustainability?

These terms may be used interchangeably, and refer to practicing dentistry with a lower impact on the environment.

Why does dentistry have an impact on the environment?

Dentistry has an impact on the environment because of the materials required, the energy required to run a practice, the waste produced by a practice. The greatest negative environmental impact comes from travel by patients and staff to a dental practice.

How does environmental change have an impact on dentistry?

Environmental change will affect people’s health, which will impact the care dentists’ provide. Legislation put into place to manage climate change will also affect dental practice.

What are the benefits of practising sustainable dentistry?

Practising sustainable dentistry can positively affect the environment, can provide financial benefits, and also has a positive social impact.

What role does a practice manager have in creating a sustainable dental practice?

A practice manager can implement sustainable practice policies, for example relating to travel, procurement, water usage, energy consumption, and waste disposal.

What role does a dental nurse have in creating a sustainable dental practice?

A nurse can follow sustainable practices implemented at the practice, and aid clinicians make clinical decisions which can have a positive effect on the environment.

What role do dentists have in creating a sustainable dental practice?

Dentists can follow the four principles of sustainable clinical dental practice, as well as supporting other team members implement change and driving positive changes within a practice.

Do you need to bag instruments after every cycle?

No, HTM01-05 explains that instruments do not need to be packaged after every cycle.

Unwrapped sterilised instruments may be stored in a clinical area for one day (after which they must be reprocessed), so long as they can be stored away from the contaminated area, such as in a cupboard.

Unwrapped sterilised instruments may be stored in a non clinical area for up to one week.