ENVIRONMENTAL SUSTAINABILITY IN DENTISTRY

define environmental sustainability

environmental sustainability: meeting the needs of the present without compromising the ability of future generations to meet their own needs

list some environmental threats

• climate change

• pollution

• biodiversity loss

what has the IPCC said about the temperature of the earth

• IPCC = The Intergovernmental Panel on Climate Change 

• warned that the earth is at a tipping point 

• currently we are 1.1°C warmer than pre-industrial levels and reaching 2°C will significantly impact health and livelihoods

what was the 2015 Paris Agreement 

• legally binding agreement amongst 196 parties 

• overarching goal is to hold “the increase in the global average temperature to well below 2°C above pre-industrial levels”

• “limit the temperature increase to 1.5°C above pre-industrial levels”

how will the Paris Agreement of 2015 be achieved

through reducing emissions and eventually reaching ‘net zero’

image of UN Sustainable Development Goals (SDGs)

sustainability venn diagram

state the health effects of climate change

• increase in cardiovascular and pulmonary disease

• rise in infectious diseases

• loss of life due to extreme weather events

• increase in mental illness

• reduction in oral health

how does climate change increase inequality

• lower socioeconomic groups typically live in places more susceptible to extreme climate events

• therefore lower socioeconomic populations will feel the greatest impact

what percentage of global net emissions does global healthcare make up 

global healthcare = approx. 4.4% of global net emissions

• equivalent to the emissions produced by the 5th largest country in the world

pie chart showing environmental impact of dentistry

what are the 3 most significant contributors of dentistry to the environment and why

1. travel - patient, staff (∵ oral healthcare is typically provided in small, geographically dispersed practices)

2. procurement - instruments, materials, clinical items (∵ uses a lot of instruments, materials and energy)

3. energy use (∵ produces significant amounts of waste)

what dental clinical material is one of the most wasteful

single use plastics (SUPs)

what is the average number of SUP items used per procedure 

35 SUP items per procedure - more if the additional PPE requirements during COVID-19 is accounted for 

• 2 billion items of SUP waste per yr = 14.4 tonnes

1st, 2nd and 3rd dental materials with the greatest environmental impact and why

1. amalgam: metals that go into amalgam esp. mercury are harmful to the environment

2. resin based composite: uses a lot of energy in processing material and lots of packaging (also concerned about microplastic pollution associated with composite)

3. glass-ionomer cement: least environmental impact, much less energy and packaging used compared to composite 

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NEED TO CONSIDER MATERIAL LONGEVITY THOUGH (GIC does not last as long as composite/ amalgam)

what kind of dental procedures have the lowest environmental impact

simple, short procedures

• assessments, preventive items of care

what kind of dental procedures have a moderate environmental impact

• direct restorations

• simple endodontic procedures

what kind of dental procedures have the highest environmental impact

• treatments that require multiple visits thereby increasing travel, material and energy use

• fixed and removable prosthodontics

• complex endodontic treatment

• orthodontics

• those involving nitrous oxide

outline the Joint Stakeholder Statement made in 2022

• wide range of stakeholders from academia, healthcare providers, industry and NGOs agreed to a consensus on environmentally sustainable oral healthcare

  • Colgate

  • Dentsply Sirona

  • HALEON

  • Tepe

• strategy to achieve meaningful and measurable environmental outcomes across the oral healthcare supply chain

list characteristics of patients that would have a low environmental impact

• good oral health

• no active disease

• no restorative interventions

• low disease risk 

—

low dental treatment needs

list characteristics of patients that would have a high environmental impact

• poor oral health

• failing dentition

• active disease

• extensive restorative history

• high disease risk factors

—

high dental treatment needs therefore imperative to promote and maintain good oral health + preventive regime

outline the pillars/ types of care in the FDI sustainability toolkit

• preventive care

• operative care

• integrated care

• ownership of care 

FDI sustainability toolkit: preventive care

FDI sustainability toolkit: operative care

high quality operative care reduces repair, replacement and waste

FDI sustainability toolkit: integrated care

integrated healthcare services with patients as co-managers of their care mitigates environmental impacts

FDI sustainability toolkit: ownership of care

outline strategies to reduce the environmental impact of travel

• promote and encourage active travel or public transport/ car sharing

• reduce appointments by performing multiple procedures in one visit

• engage with remote clinical consultations and digital dentistry

• centralised care delivery where possible

• optimise practice logistics - family appointments, effective scheduling and transport between laboratories

what parts of the supply chain contribute to the environmental impact of procured goods

1. sourcing of raw materials

2. manufacturing

3. packaging

4. distribution

5. procurement

6. waste management

» linear economy, need to move to a circular one

outline strategies to reduce the environmental impact of procurement

• purchase durable equipment that will last and are easy to maintain

• effective stock management - only order what is necessary, avoid waste

• engage with suppliers to assess their sustainability practices

• select fit for purpose dental materials, clinical items and equipments

outline strategies to reduce the environmental impact of energy and water consumption

• use energy efficient appliance e.g. LED lights, washer disinfectors

• turn off tap when brushing

• use appliances when fully loaded

• consider renewable energy sources

outline strategies to reduce the environmental impact of waste management

• 4R’s: reduce, reuse, recycle, RETHINK

• segregate waste accordingly

• follow waste disposal regulations for hazardous materials

• reduce medicinal waste through evidence-based prescribing

• reduce plastic waste where possible

energy and waste hierarchy diagrams

outline strategies to reduce the environmental impact from dental materials

• minimise amalgam use in line with the Minamata Convention

• reduce nitrous oxide use for relative analgesia/ inhalation sedation

• reduce gypsum use for dental casts (gypsum can be recycled)

• recover and recycle dental materials where possible

• use digital radiography 

mindset and arithmetic

environmental sustainability should form a part of…

your clinical thinking alongside:

• delivering high-quality care

• patient safety

• ethics

• finances

what should environmental sustainability be considered alongside

clinical effectiveness (of a therapy)

what methods of caries prevention are (not) environmentally sustainable

• water fluoridation

• supervised toothbrushing

• fluoride varnish

what renowned document should be taken into account from an environmentally sustainable perspective 

HTM 01-05