Green dentistry: a practical guide


Denplan’s head dental officer, Louis Mackenzie, gives follow groups with an summary of the challenges and alternatives for practising sustainable dentistry within the pandemic period.


Because the pandemic-induced PPE mountain continues to develop, well being staff are more and more recognising the necessity to present care in a sustainable manner, minimising the impact on natural resources (Duane et al, 2019; Duane, Ramasubbu et al, 2019; Mulligan, 2021).

At house, UK follow groups could have made important eco-friendly diversifications over a few years.

Nevertheless, incorporating these adjustments within the work setting presents a variety of challenges, made tougher by Covid-19 situations.

Sustainability normally dental follow

Sustainability is worried with the smart and accountable use of pure sources, to keep away from depletion past the planet’s capability to regenerate/replenish itself.

Sustaining this ecological stability typically makes use of the scale back, reuse, recycle mannequin.

Sustainability may also have a strong affect on affected person decisions. Sixty seven per cent of shoppers make choices primarily based on environmental components (International shopper traits survey 2022). Subsequently, informing sufferers of sustainable follow improvements will construct belief and make dental enterprise manufacturers more and more common.

Whereas sustainability shouldn’t be particularly talked about within the GDC Requirements, many follow groups are already utilizing a wide range of strategies to increase awareness of the environmental impact of dental care amongst employees, patients, other professionals and native communities, together with (Duane et al, 2019; Duane, Ramasubbu et al, 2019; Mulligan, 2021):

  • Growing a follow sustainability coverage
  • Utilizing on-line sources and academic posters to speak the ‘inexperienced’ imaginative and prescient to sufferers and employees
  • Measuring and evaluating sustainability enhancements
  • Incorporating sustainability schooling in employees induction and coaching processes
  • Calculating and disseminating data on the environmental (and monetary) advantages of sustainable follow

Local weather change

The earth’s local weather has modified many instances, going by a number of ice ages and durations when temperatures have been increased than they’re right now.

Traditionally, common temperature adjustments within the earth’s air and oceans occurred over lots of of hundreds of years.

The extra fast latest international warming development is believed to end result from human exercise. There’s concern that the speed of enhance signifies that some organisms might not survive.

The greenhouse impact

The greenhouse impact occurs when sure gases, akin to carbon dioxide, methane, nitrogen oxide, and chlorofluorocarbons (CFCs) acquire within the earth’s environment creating an insulating layer that retains the local weather snug.

The present international common temperature is 15 °C; with out greenhouse gases it will drop to -18 °C, inflicting most life varieties to freeze.

Determine 1

Because the starting of the economic revolution (~1750), human actions have elevated the greenhouse impact.

Emissions of carbon dioxide, crucial greenhouse fuel, have elevated by 80% between 1970 and 2004.

The principle examples of human actions that generate greenhouse gases are:

  • Combustion of fossil fuels, principally coal, petroleum (together with oil) and pure fuel
  • Deforestation (dwelling bushes soak up carbon dioxide)
  • Incineration of waste merchandise.

In 2019, the UK grew to become the world’s first main economic system to legislate a binding internet zero emissions goal by 2050. Britain already incinerates its municipal waste at a decrease fee than the remainder of Europe, averaging 10% in comparison with 17.3%.

Medical waste disposal presents better challenges. Throughout Europe as much as about 25% of medical waste is incinerated. This releases greenhouse gases in addition to poisonous substances akin to dioxin compounds. These are critical and chronic environmental pollution.

Carbon footprint

The time period carbon footprint refers back to the total greenhouse gas emissions caused by a person, occasion, organisation, service, place or product, expressed as a carbon dioxide equal.

The NHS has introduced a imaginative and prescient to be internet zero by 2040. This may embody dentistry, which accounts for 3% of the total health service carbon footprint.

Though tough to measure exactly, the parts making up the carbon footprint for dentistry have been estimated in Table 1.

Desk 1

Breakdown of the annual carbon footprint for dental providers (England)

Affected person journey 31.1%
Employees commuting 30.3%
Procurement 19%
Electrical energy 7.7%
Fuel 7.6%
Work journey (Employees) 3.1%
Nitrous oxide launch 0.9%
Waste 0.2%
Water 0.1%


Greater than 20% of world carbon dioxide is generated by transportation. Automobile exhausts additionally trigger air air pollution eg carbon monoxide and sulphur dioxide. That is reported to lead to 40,000 UK deaths yearly.

As the vast majority of dental appointments are quick and have comparatively few materials/gear prices, affected person and employees journey accounts for an enormous 61.4% of dentistry’s complete carbon footprint (Table 2).

The relative carbon footprints of the commonest dental procedures have been estimated and are listed in Table 3.

Determine 2

Desk 2

UK dental care statistics

Common dental affected person return journey 7.57 miles
Common employees return journey 7.26 miles
Examinations/scale & polish/fluoride varnish and radiographs as a proportion of all procedures (adults & kids) 73%
Examinations as a proportion of all procedures (adults & kids) 41%
Alternative restorations as a proportion of all operative remedies >50%
Common dental appointment period quarter-hour
Annual variety of radiographs 14 million

Desk 3

Relative carbon footprint of the commonest dental procedures

Examination 27.1%
Scale and polish 13.4%
Amalgam filling 9.7%
Composite filling 9.5%
Acrylic dentures 8.6%
Radiographs 6.4%
Extractions 3.5%
Non-precious metallic crowns (the sort most continuously prescribed) 3.3%
Endodontics 2.9%
Examine fashions 1.6%

As transport is the first contributor to dentistry’s greenhouse fuel emissions, a range of methods have been proposed to restrict affected person and employees journey.

The principle proposals match properly with the preventive, minimally invasive focus of up to date dental practices, the place sufferers are empowered to take an lively position in managing their very own well being and wellbeing (Desk 4).

Desk 4: Strategies of lowering the environmental affect of affected person and employees journey

Oral healthcare

  • Oral well being promotion/illness prevention
  • Minimal intervention dentistry (scale back the quantity of dental remedy)
  • Minimally invasive dentistry preserves wholesome pure tissues and smaller interventions last more
  • Specializing in renovation and restore will increase the practical longevity of dental restorations
  • Excessive-quality restorations have better longevity
  • Lowered recall frequency (primarily based on danger evaluation)
  • Identification and elimination of co-morbidity components eg dietary evaluation, smoking cessation
  • Holistic affected person care promotes the early detection and analysis of systemic illnesses, lowering the longer term burden on wider healthcare providers

Appointment scheduling

  • Environment friendly screening/use of digital consultations
  • Maximise chair occupancy (enterprise effectivity in addition to power eg heating)
  • Full a number of remedies at one appointment the place doable
  • Mix dentist and hygienist appointments
  • E-book household appointments collectively
  • Minimise failed appointments eg utilizing textual content alerts
  • Optimising employees work patterns will maximise productiveness and scale back the chance of work-related stress issues eg ≤ 4 scientific days/week.


  • Show strolling/cycle/bus routes on follow web sites
  • Automobile sharing/public transport for employees
  • Encourage lively journey eg pedometers for strolling to work
  • Set up safe cycle parking
  • Register for the federal government’s cycle to work scheme (permits tax-free bicycle buy)
  • Set up bathe/locker amenities
  • Set up electrical car charging factors
  • Digital impressions and in-practice milling or technicians remove the necessity for transport to and from laboratories
  • On-site specialists will additional scale back the necessity for affected person journey.

Sustainable healthcare is a well-researched topic. There’s a vary of evidence-based publications that focus particularly on dentistry.

Key publications on sustainability in dentistry

Duane B, Harford S, Steinbach I and Ramasubbu D (2019) Environmental sustainability and waste throughout the dental follow. BDJ Group 6(6): 21-9

Duane B, Ramasubbu D, Harford S, Steinbach I, Stancliffe R, Croasdale Okay and Pasdeki-Clewer E (2019) Environmental sustainability and procurement: buying merchandise for the dental setting. BDJ 226(6): 453-8

Mulligan S (2021) Sustainable oral healthcare and the setting: Challenges. Dental Replace 48: 493-501

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