How ‘green’ is your dentist?

The last time you went to see your dentist, you may have noticed fewer magazines in the waiting room. Instead, the receptionist may have handed you an iPad so you could browse through digital copies of your favourite mags. You may have also noticed fewer brochures and business cards. Instead, the receptionist may have suggested that you download the dentist’s own mobile phone app so you never lose their number again.  Paper statements and appointment reminders have long disappeared in favor of email and/or SMS.

Hmm, is your dentist ‘greening’ on you?

You walk into the treatment room and the plastic barriers have ‘biodegradable’ written all over them in green. The cups are paper or glass, the bibs are recycled paper or cloth, the paper towels and tissues are recycled too.

Time for x-ray images? Your tooth shows up in all of its glory on the big computer screen – digital imaging has replaced the chemically processed films. The dentist types their notes instead of writing them – digital record keeping has replaced old card notes.

The health pack you receive is in a brown paper bag, the toothbrush is made of bamboo and the toothpaste is in a biodegradable tube.

OK, so maybe your dentist is not doing ALL of these things, but do you ever stop and think, “How ‘green’ is my dentist?”

How green is dentistry today?

Just like any other business today, dental businesses worldwide are looking to reduce their environmental footprint.

One of the reasons us dentists are more interested in the environment than ever is that we also contribute significant amounts of waste. We contribute plastic waste to landfills through the plastic barriers we use for cross-infection control, which cannot be recycled as they are contaminated. We also contribute amalgam waste – a mercury-containing material from old dental fillings – to our water. In fact, there are reports that the dental industry in the US and Canada contributes between 10% and 80% of total mercury sewer loads, while the dental industry in Australia is the single biggest source of mercury pollution of waste water. Most dentists have almost eliminated use of amalgam fillings in their private practices, but it is not just the creation of the amalgam fillings that creates mercury contamination – it is also the removal of old amalgam fillings.

Dentists all over the world are putting their heads together in an effort to make dentistry and its related industries (such as material and equipment manufacture, and supply chains) more accountable and environmentally responsible. One such effort was the 2009 Dentists for Cleaner Water project, initiated by the Victorian branch of the Australian Dental Association and supported by the Environmental Protection Authority Victoria and the Victorian government. The aim of the project was to eliminate mercury from Victoria’s sewerage systems by encouraging dentists to install amalgam separators. These are special filters which capture silver fillings before they reach waste-water. Containers which store the captured amalgam are collected on a regular basis by amalgam recycling companies and it is in their facilities that old amalgam is turned into new filling material, essentially closing the loop of production and waste disposal. As you can imagine, the cost of installing one such device and entering into waste collection agreements would have added to the already high costs of running a dental practice. Victorian government stepped in offering rebates for installation of amalgam separators and over 700 practices utilised this rebate in the three-year period between 2008 and 2011, when the rebate ended, significantly reducing the amount of mercury released into Victoria’s sewerage.

The Victorian study estimated that if all Australian dental practices were to follow suit, more than 1600kg of mercury would be collected from dental practices each year!

There is now even a way for dentists who truly care about the environment to accredit their dental practice as an eco-friendly practice. The Eco Dentistry Association (EDA), started in the USA in 2010, now has members all over the world, including here in Australia (see here and here).  It provides members with resources and tools to help them convert their practices into ‘greener’ practices. The EDA then awards scores for each of the  practice’s environmentally friendly credentials, such as: practice location (near public transport, within a green-star rated building), use of energy efficient lighting, reduction of plastic and paper waste, elimination of the need for chemicals  (both as cleaners and as developers for x-ray images), use of digital patient records and imaging, use of email or SMS to correspond with patients and other practitioners or suppliers etc.

How green can dentists be today?

All dental practices should be aware of their impact on the environment and an increasing number of practices now have an environmental policy. There are some very simple measures almost every practice can now put in place to become ‘greener’. These include:

• Separating and recycling amalgam
• Using computerised patient records and digital x-ray images (they require lower radiation doses and no chemical processing)
• Recycling paper and non-contaminated plastic
• Using biodegradable plastic barriers and recycled paper items
• Using steam sterilisers only (no chemicals)
• Encouraging their patients to opt out of paper correspondence in favour of email and SMS
• Encouraging patients to opt out of printed account statements and receipts, opting instead for these to be emailed out after each visit or yearly (in time for tax returns)
• Reducing printed material in their waiting rooms and offering access to electronic versions of magazines as well as practice materials
• Using water responsibly and educating patients to turn off the tap while brushing their teeth
• Turning off power every night.

How green can dentists be in the future? 

There is no limit to how green a dental practice can be. However, dental practices are consumers of goods produced by dental materials and equipment companies. A lot of the responsibility rests with these companies to produce more environmentally friendly products and packaging as well as to reduce their carbon footprint during transportation.

Not every dental practice can be custom-built to incorporate the latest sustainable building standards. Dental practices are often located in pre-existing buildings, some of which may be quite old, so this may limit the extent to which some sustainable building ideas can be implemented.

Dental materials still have some way to go to become more ‘organic’. We have come a long way from the amalgam filling and we have improved the durability of composite resin fillings immensely, so fewer fillings should now end up as waste. In fact, we now have extremely tough, durable ceramic materials, which we can turn into any kind of restoration while you wait, but some of our bonding systems still rely on composite resin polymers, which are distant cousins of plastic.

There is plenty of room for innovation in the field of dentistry, to make it more sustainable and gentler on the environment. One thing that is just begging to be improved and reinvented is waste disposal. We currently have very limited options when it comes to disposal of contaminated recyclable plastic as well as biodegradable plastic; there is virtually no instrument recycling program (most dental instruments are stainless steel); and while there is a solution for amalgam capture, no such solution exists for other types of fillings.

Whatever the future may hold for the development of new or improved dental materials or growing, harvesting and implantation of whole new teeth, the most natural, environmentally friendly and ‘organic’ way to practice dentistry is to prevent disease. To do this, dentists, patients and their families need to engage in a more meaningful way. To effect meaningful change in their patient’s lives, dentists need to learn more about their patients, their interests, lifestyle, values and beliefs, and patients need to seek out dentists who share these values and beliefs. For an increasing number of people, ‘green’ dentistry may just be the manifestation of these values that they have been waiting for.

So, green dentistry, yea or nay? How green would you want your dentist to be?

Do you engage with your dentist and make them aware how important environmental preservation is to you? Does your dentist listen to your suggestions? Would you be prepared to vote with your feet and see someone who shares your values?

I would love to hear your comments about this (as I am sure many of my colleagues would, too). Don’t be shy – leave a line or two below.