Published: 26/7/22

By Denplan Practice Team

Oral healthcare has an environmental impact that is specific to the profession and currently unsustainable.¹ Clinical dentistry is a highly energy - and resource - intensive field and consequently has a significant environmental impact.²

Oral healthcare professionals are increasingly recognising the need to provide care in a more sustainable manner, minimising the impact on natural resources while promoting and helping optimise oral health.¹

Despite increased professional interest, there are currently no comprehensive standards for sustainable dentistry and no GDC development outcomes relating to sustainability.² Sustainability experts consider that the first step towards green dentistry is to break down mindsets that distinguish domestic environmental actions from those in the workplace.¹

Here are some of the advantages of sustainable dentistry, which is also a marketable commodity in that it has the potential to improve a practice’s reputation.²

Waste

As discussed in Part I, nearly two thirds of dentistry’s greenhouse gas emissions relate to patient and staff travel. To mitigate this alone, 28,048,800 trees would need to be planted.² Waste, in its various forms, is the next most important factor.

Dental practices produce significant amounts of waste, which need to be managed appropriately to reduce carbon emissions and enhance sustainability. The dental team also have legal responsibilities to ensure that waste is managed to eliminate health risks and reduce environmental pollution.³

Paper and nitrile gloves are the most commonly disposed of items in dental practice.³ Most restorative procedures involve a wide range of plastic items, many of which are designed for single patient use. Dentistry is also a considerable net contributor to the global burden of discarded plastic packaging.¹

Food

History will not reflect kindly on an era when one third of the food produced globally is being wasted, while one in nine of the world’s population are suffering from hunger or starvation. Wars and conflicts in over 60 countries and the global pandemic are making the situation significantly worse.

Disposal of food waste also has a major environmental impact due to the release of methane, a potent greenhouse gas. Approximately 15% of waste from primary healthcare facilities is reported to be food waste.^1,3 It is recommended that clearly labelled food waste bins are placed in staff rooms/kitchens/patient areas and disposal is by composting where possible.

Paper

Paper has a surprisingly high carbon footprint. Its production accounts for 7% of global greenhouse gas emissions. It also depletes water, the shortage of which is an emerging planetary crisis. As well as reducing carbon dioxide emissions, significant financial savings can also be made by reducing paper usage.

While practices need to comply with data protection rules, alternative methods of record keeping and communication are now in common use, including electronic patient records, telephone calls, email, text messaging and document scanning. Where paper documentation is necessary, a range of sustainable options are available (Table 5). 

Personal Protective Equipment (PPE) 

The COVID-19 pandemic has forced an unprecedented increase in the use of PPE such as gloves, masks/respirators, plastic aprons, visors and gowns (Table 6).¹

It is estimated that an average dental procedure requires eleven PPE items, resulting in a (conservative) UK total of 396,000,000 items per year. Facemasks worn by the public have contributed an additional 66,000 tonnes of contaminated PPE to household waste in the UK.

Although increased PPE consumption will not decrease until enhanced infection prevention and control measures are reversed, it has been demonstrated that reusable gowns are superior in environmental terms, with a two to three-fold reduction in energy, water and carbon emissions and a seven-fold reduction in waste.³ 

Single-use plastics (SUPs)

Many healthcare professionals are compelled to use single-use devices, the reliance on which has increased during the pandemic. In dentistry, over 20 SUPs are used for the average dental procedure.

Established strategies for plastic waste management (reduce, reuse, recycle) are not readily applicable for SUPs, which are classified as clinical waste and are disposed of through landfill and incineration, with limited energy recovery. 

Disposal of plastic waste is also expensive. The UK healthcare sector generates 590,000 tonnes of waste annually, costing the NHS over £33 million per year.

The combined total of dental SUPs is estimated at 720,000,000 per year. When added to PPE, this results in over one billion items annually (excluding plastic packaging).

Analysing the purchase, usage and wastage of unsustainable items and reducing procurement are integral components of any carbon reduction strategy. They will be discussed in detail in the third Denplan Insight article on green dentistry.