Sustainability and the protection of the environment are topical in all aspects of life and living and very much play a significant role in dentistry. Dentistry must also consider its impact on planetary health. For example, the practice of modern dentistry and the protection of patients from infection and cross-infection results in an unfortunate, but essential and significant generation of single-use products.
For several decades, single-use instruments and materials have been the norm. Single use instruments ensure patient safety, the reduction of cross-contamination risk, and save both time and costs associated with cleaning, decontaminating, sterilising, and reprocessing instruments. Regrettably, the use of single use instruments results in the generation of substantial amounts of packaging and instruments for disposal. That said, the practice of sterilisation also has a toll on the global environment. Measures to mitigate the high energy usage, voluminous consumption of water, rapid generation of waste matter including hazardous chemicals and pollutants, must be to the fore. This impact on the environment is now an area of growing research interest, examining opportunities to protect populations, and the planet. As the burden of climate change has become better acknowledged and understood, populations in
developed countries are demanding change, the medical and dental professions are making an effort to embrace sustainability with practices that in addition to being ethical, of high quality and safe, endeavour to be environmentally sustainable. There is an optimism in thescope in which efforts can be made to move towards sustainability in dentistry, from small scale practices like reduce-reuse-recycle and in considering public transport for commuting to
the dental clinic, to more significant actions such as how dental materials are created, used and disposed of. Change at every level is necessary. Addressing the burden of climate change and promoting sustainable practices will require collaboration and innovation – not only in knowledge but also in education, research, and care systems. In dentistry, environmental sustainability can be broadly considered under the headings of Prevention, Travel, Energy, Procurement (purchasing and acquisitions), Waste Management and Decontamination (infection prevention and control in the dental clinic).
Prevention
The prevention of oral diseases, including tooth decay, gum diseases and oral cancer, is more sustainable than their treatment , emphasising once again the importance of the ‘Common Risk Factor Approach’ and ‘Making Every Contact Count’.
Travel
Patient and staff travel contribute to the carbon footprint of dentistry and may also negatively impact health, through particulate matter
inhalation. The ‘Cycle to Work’ scheme which is available across Ireland could be an adoption to be considered. The use of virtual meeting tools for consultations, staff training or meetings are opportunities to reduce travel. Further research is needed to increase the ability to monitor patient’s oral health virtually.
Energy
When aiming to reduce energy footprint it is important to measure current consumption (e.g. using energy monitoring devices) and
develop minimisation strategies. This may include using insulation, double/triple glazing, installing timers and thermostats and investigating alternatives to air conditioning. When purchasing new equipment, the energy use should be evaluated as should the use of renewable energy from solar panels or wind
energy. Whilst some of these changes require investment, many can result in both environmental and financial savings.
Procurement
The products and equipment used daily in the delivery of dental care contribute to the environmental impact of dentistry and sustainable strategies include buying less, buying better, patient education and collaboration with suppliers and industry. Buying less may involve the use of less single use items, and improved stock control with expiry dates checked regularly. Buying better could involve identifying suppliers with sustainable policies and practices, consideration of suppliers packaging, and purchasing products made with renewed energy. The way that goods are procured, and the emissions associated
with their transportation should be prioritised, as should using local dental suppliers and laboratories.
Decontamination
To ensure patient safety, infection prevention and control is paramount in dentistry, and involves cleaning, disinfection, and sterilisation. However, it is important to balance the safety of patients within the healthcare setting, whilst minimising the environmental impact. To facilitate this a common-sense approach is needed, with appropriate research to ensure activities being undertaken are maximised and efficient.
The United Nations Sustainable Development Goals (UN SDG)
The 2030 Agenda for Sustainable Development, adopted by all United Nations Member States in 2015, provides a shared blueprint for peace and prosperity for people and the planet, now and into the future. At its heart are 17 Sustainable Development Goals (SDGs). These goals with their associated targets
are an urgent call for action by all countries – developed and developing through global partnership. The UN SDGs recognise that ending poverty and other deprivations must go together with strategies that improve health and education, reduce inequality, and spur economic growth, while also tackling climate change and working to preserve the oceans and forests. Of the 17 goals identified, seven can be applied within dentistry, namely: 3. Good health and well-being, 4. Quality education, 6. Clean Water and Sanitation, 9. Industry, innovation, and infrastructure, 10. Reduced inequalities, 12. Responsible consumption
and production, 13. Climate action, and 17. Partnerships for the goals. The World Dental Federation (FDI) has also outlined its ambitions for sustainability in the dental industry with three goals: increased awareness on the importance of sustainability in dentistry, creation of a guide for dental professionals on actions that can be taken, and a review process to assess current directives and any gaps in progress. Documents such as Standard Practice for Managing Sustainability in Practice are available to support the Dental Industry. One eco-conscious shift which is evident in the dental surgery is the significant reduction in usage of dental amalgam as a material in the last number of years. Historically, dental amalgam was used by dentists for over one hundred years as the material of choice for dental fillings in back teeth and in the preparation of a core to hold a dental crown. The durability, ease of use, and bacteriostatic properties made it a popular choice globally. Following the 2013 establishment of the Minamata Convention on Mercury, there is recognition of its detrimental effects on the environment. There are now 137 member states which have committed to a phase down in usage of mercury a constituent
of dental amalgam.Studies have been conducted on alternative materials which can be used in place of amalgam, and while some show less success with respect to longevity than dental amalgam, further progress is underway. The European Union (Mercury) Regulations 33, were adopted, by Ireland to uphold the goals of the Convention, and it provides an ambitious roadmap towards the phase-out of industrial mercury. Article 10 of the Regulations sets out the rules relating to dental amalgam and includes an obligation to produce a National Plan by 1 July 2019, on the phase down of dental amalgam. In Ireland, 71% of the population receive community water fluoridation (CWF) as a caries preventive effect. This has been demonstrated as not only cost-effective,
it has also performed well in a Life Cycle Analysis (LCA) study in all measures of environmental sustainability when compared with other community-level interventions for the prevention of dental caries in children (such as fluoride varnish in schools, supervised toothbrushing in schools, the provision of
toothbrushes and toothpaste). Sustainability is increasingly important in Dentistry and as the agenda moves forward so too should all aspects of Dentistry to ensure that achieving optimal oral health for all is aligned with protecting the planet and its people and activities identified against the UNSDG and targets.