Sustainable Dentistry: Making a Difference

Acknowledgements
Contents
List of Figures
List of Tables
List of Boxes
1: Sustainable Dentistry: An Urgent Need for Change
1.1 An Urgent Need for Change
1.2 Healthcare Systems Cause Planetary Health Deterioration
1.3 How to Read This Book
1.3.1 Environmental Impact Categories
1.3.1.1 Climate Change: Climate Change Total
1.3.1.2 Ecosystem Quality: Freshwater Ecotoxicity
1.3.1.3 Ecosystem Quality: Freshwater Eutrophication
1.3.1.4 Resources: Dissipated Water
1.3.1.5 Human Health: Respiratory Effects, Inorganics
1.3.1.6 Resources: Land Use
1.3.1.7 Human Health: Photochemical Ozone Creation (POC)
1.3.1.8 Human Health: Ozone Layer Depletion
1.3.1.9 Human Health: Non-carcinogenic Effects
1.3.1.10 Human Health: Ionising Radiation
1.3.1.11 Resources: Fossils
1.3.1.12 Human Health: Carcinogenic Effects
1.3.1.13 Ecosystem Quality: Marine Eutrophication
1.3.1.14 Ecosystem Quality: Terrestrial Eutrophication
1.3.1.15 Ecosystem Quality: Freshwater and Terrestrial Acidification
1.3.1.16 Resources: Minerals and Metals
1.3.2 DALYs (Disability-Adjusted Life Years)
1.3.3 Normalised Figures
References
2: Building a Sustainable Dental Practice
2.1 Introduction
2.2 Environmental Impact
2.3 To Build or Not to Build (Retrofit)
2.4 New Build Dental Surgery
2.4.1 Energy Efficiency
2.4.2 Energy Production
2.4.3 Heating System
2.4.4 Ventilation
2.4.5 Water Management
2.5 Habitat Level Considerations for Build Options
2.5.1 Greenspace Area for Biodiversity
2.5.2 Greenspace Areas That Facilitate Adaptation to Extreme Weather Events
2.5.3 Non-traditional Greenspace Areas
References
3: Planning the Location, Skills Mix and Method of Delivery of Care, and Reducing Your Travel Emissions for Sustainable Dentistry
3.1 Environmental Sustainability and Travel Within the Dental Practice
3.2 The Contribution of Dentistry to the Travel Footprint
3.3 Improving Sustainable Travel
3.3.1 Combining Appointments
3.3.2 Only Undertaking Evidence-Based Dentistry
3.3.3 Preventative Dentistry
3.3.4 Appropriate Dental Examination Scheduling
3.4 Using Information Technology
3.4.1 The Basics of Teledentistry
3.4.2 Capturing the Data
3.4.3 Store and Forward Teledentistry
3.4.4 Security, Accuracy, and Acceptance
3.4.5 Cost-Effectiveness of Teledentistry
3.5 Mode of Travel
3.5.1 Active Travel
3.5.2 Public Transport or Car Sharing
3.5.3 Rent a Car and Use It only When You Need It
3.5.4 Electric Vehicles
3.5.5 Improving the Sustainability of Conventional Car Travel
3.6 Travel Policies
References
4: Reducing the Energy Needs of Your Dental Practice
4.1 Introduction to Energy and Water
4.2 Quantity of Each Utility Used in the Dental Practice
4.2.1 Quantity of Water Used in a Dental Practice
4.2.2 Environmental Outcomes of Water
4.2.3 Environmental Consequences of Energy Used in a Dental Practice
4.3 How Demand Can Be Minimised
4.3.1 Building Anew or Reconfiguring Existing Building
4.3.2 Space Utilisation
4.3.3 Energy Efficiency Can Be Improved in a Number of Ways in the Dental Practice
4.3.4 Sealing and Draught Proofing
4.3.5 Double Glazing
4.3.6 Blinds and Curtains
4.3.7 Timers and Thermostats
4.3.8 Radiators and Closing Doors
4.3.9 Smart Meters
4.3.10 Boiler Efficiency
4.3.11 Air Conditioning
4.3.12 Water Heating
4.4 Choosing Sustainable Appliances
4.4.1 Energy Use of Different Appliances
4.4.2 High Energy Appliances
4.4.2.1 Computers
4.4.2.2 Water Coolers
4.4.2.3 Televisions
4.4.2.4 Lighting
4.4.2.5 Fridges
4.4.2.6 Dental Suction
4.4.2.7 Autoclaves, Washer Disinfectors, and Ultrasonic Cleaners
4.4.3 Moderate Energy Appliances
4.4.4 Low Energy Appliances
4.4.5 Turning Off Appliances
4.5 The Environmental Impact of Energy Sources: Buying Appropriate Sustainable Energy and/or Generating Energy In-House
4.5.1 Transmission of Energy and Embodied Environmental Impact
4.5.1.1 Wood Pellets
4.5.1.2 Energy from Incineration
4.5.1.3 Solar Power
4.5.1.4 Wind Energy
4.5.2 Comparison of Fuel Types, Cost, and Carbon Dioxide Emissions (CO2e)
4.5.2.1 Heating the Practice with Non-renewable Energy
4.5.2.2 Heat Pumps
4.5.2.3 Solar Thermal Systems
4.5.2.4 Recycling of Hot Water Systems
References
5: Prevention: The Sustainable Practice Initiative
5.1 Introduction
5.2 Caries
5.2.1 Public Health Measures to Prevent Caries
5.2.2 Diet Advice
5.2.3 Toothbrushing with a Fluoride Toothpaste
5.2.4 Fluoride Mouth Rinse
5.2.5 Fluoride Varnish Application
5.2.6 Fissure Sealants
5.3 Periodontal Disease
5.3.1 Toothbrushes
5.3.2 Interdental Cleaning Aids
5.3.3 Systemic Disease and Periodontal Disease
5.4 Non-carious Tooth Tissue Loss
5.4.1 Erosion
5.4.2 Attrition
5.4.3 Abrasion
5.5 Oral Cancer
5.5.1 Tobacco
5.5.2 Alcohol
5.5.3 HPV Infection
5.6 Conclusion
References
6: A Guide to How to Reduce the Impact of PPE in Your Dental Practice
6.1 PPE in the Dental Setting
6.2 Environmental Impact of PPE
6.3 Opportunities to Mitigate Environmental Impact of PPE
6.3.1 Reduce
6.3.2 Reusables
6.3.3 Recycling and Alternative Waste Processing
6.3.4 Low Carbon Manufacture and Distribution
6.4 Challenges and Opportunities for Sustainable PPE
References
Untitled
7: Responsible Decontamination
7.1 Introduction
7.2 Recommendations for Instrument Decontamination and Autoclaving
7.2.1 Washer Disinfector
7.2.2 Autoclave
7.2.3 Recommendations for Cleaning Waterlines
7.2.4 Recommendations for Suction System Cleaning
7.2.5 Recommendations for Surface Disinfection
7.2.6 Recommendations for Cleaning Prosthesis
7.3 An LCA of Hypothetical Products
7.3.1 Surface Wipe 1
7.3.2 Surface Wipe 2
7.3.3 Surface Wipe 3
7.3.4 Sustainable Wipes
7.3.5 Cleaning Prosthesis
7.3.6 Washer Disinfectant Using Chemicals Part A and B
7.3.7 Washer Disinfectant Using the Chemical Methyl Pentane
7.3.8 Sterilisation Using an Autoclave
7.4 Considerations About Chemicals
7.5 Conclusion
References
Untitled
8: Supporting People and Their Behaviour in the Dental Setting as Sustainably as Reasonably Achievable
8.1 Introduction
8.1.1 Dental Behaviour Support
8.1.2 Populations Covered
8.2 Choices for Behaviour Support in Dentistry
8.2.1 Communication-Mediated Dental Behaviour Support Techniques
8.2.2 Inhalation Sedation
8.2.3 Intravenous Sedation
8.2.4 General Anaesthesia
8.3 Factors Influencing Selection and Application of Behaviour Supports
8.3.1 Sustainability of Different Techniques
8.3.2 Communication-Mediated DBS
8.3.3 Inhalation Sedation
8.3.4 Intravenous Sedation
8.3.5 General Anaesthesia
8.4 Comparing Sustainability of Alternative Modalities
8.5 Sustainability of Dental Behaviour Support (DBS): As Sustainable as Reasonably Acceptable (ASARA)
8.6 Policy
8.7 Leadership
8.8 Research and Education
8.8.1 Dental Education Should
8.9 Clinical Practice
8.10 Conclusion
References
9: Buying Sustainably and Ethically for the Dental Practice (Procurement)
9.1 Sustainable Procurement
9.2 Type of Product
9.3 Buy Less
9.3.1 Stock Control
9.4 Buy Better
9.4.1 Safe for the Patient and the Dental Team
9.4.2 Fit for Purpose
9.4.3 Not Fossil Fuel Based
9.4.4 Grown: But Able to Be Reused Repeatedly, or Able to Be Reused with Local Processing
9.4.5 Supplied in Sustainable Packaging
9.4.5.1 Recycling and Packaging
9.4.6 Biodegradable into Harmless Natural Environmental Elements
9.4.7 Easy to Clean and Reuse, Where Possible Without Causing More Harm Than Good
9.4.8 Simple, i.e. Not a Complex Product That’s Difficult to Recycle
9.4.9 Transported with Clean Vehicles or Locally
9.4.10 Produced with Renewable Energy
9.4.11 Manufactured in Ways That Do Not Involve Abuse of Labour
9.4.12 Involving Suppliers and Supply Chains That Espouse Good Environmental Management Protection
9.4.13 Inexpensive
9.5 Collaborating to Accelerate the Pace of Change
9.5.1 Sustainability and Ethical Procurement Questionnaire
References
10: Responsible Waste Management: Using Resources Efficiently
10.1 Introduction
10.2 Types of Dental Waste
10.3 Costs and Environmental Emissions
10.4 Environmental Comparison of Different Waste Streams
10.5 Improving Waste Management Using the Waste Hierarchy
10.5.1 Preventing the Generation of Waste
10.5.1.1 Influencing Manufacturers and Suppliers to Produce Less Waste
10.5.1.2 Reducing Paper Use
10.5.1.3 Reducing Medicines Waste
10.5.2 Preparing for Reuse
10.5.2.1 Use of Reusable Instruments
10.5.2.2 Durable Equipment
10.5.2.3 Reuse and Up-Cycle
10.5.3 Recycling
10.5.3.1 Recyclable Waste
10.5.3.2 Food Waste
10.5.4 Recovering Energy from Waste (Waste to Energy)
10.5.5 Clinical Waste and Landfill
10.5.5.1 Location, Availability, and Type of Bins
10.6 Performing a Waste Audit
10.7 The Impact on Human Health of a Single Dental Appointment
10.8 Changing Waste Disposal Behaviours in the Dental Setting
10.8.1 Barriers to pro-environmental behaviour
10.8.1.1 Lack of Understanding
10.8.1.2 Too Much Trouble
10.8.1.3 Lack of Commitment/Accountability
10.8.2 Enablers of pro-environmental behaviour
10.8.2.1 Discussions with Industry
10.8.2.2 Incentives and Disincentives
10.8.2.3 Legislation
References
11: The Future of Dentistry Products: How Can We Redesign the Products We Create
11.1 Innovating to Improve Sustainability
11.1.1 Starting with Something Simple
11.1.2 Simplifying Forms, Materials, and Processes
11.1.3 Copying Nature: Biomimicry [3]
11.1.4 Industrial Ecology
11.1.5 Develop Sustainable Product-Service Systems (SPSS)
11.2 Case Studies in Innovative Sustainability
11.2.1 Case Study 1: A Company Makes Small or Rapid Changes
11.2.2 Simplification, Reduction, and Maximising the Lifespan of the Toothbrush
11.2.3 Case Study 2: Producing an Alternative to Non-recyclable Gloves
11.2.4 Case Study 3
11.2.5 Case Studies: Summary
References
12: Sustainability: The Need to Transform Oral Health Systems
12.1 Introduction
12.2 Six Health Systems Framework Building Blocks
12.3 Building Block: Service Delivery
12.3.1 Integrated Service Delivery Models and Packages
12.3.2 Consumer Engagement Influencing Demand for Care
12.3.3 Infrastructure and Logistics
12.3.4 Patient Safety and Quality of Care
12.3.5 Leadership and Management
12.4 Building Block: Health Workforce
12.4.1 Knowledge
12.4.2 Skills
12.4.2.1 Scope of Practice
12.4.2.2 Oral Health Care Integrated into Allied Health Training
12.4.3 Workforce Planning
12.4.4 Research Capacity
12.5 Building Block: Health Information Systems
12.5.1 Health Determinants, Health System Performance, and Health Status
12.5.2 Environmental Measures
12.5.3 Quality Improvement
12.5.4 Big Data
12.5.5 Travel Metrics
12.6 Building Block: Access to Essential Medicines and Technologies
12.6.1 Essential Medical Products
12.6.2 Access to Fluorides and Toothbrush
12.6.3 Access to Prevention
12.6.4 Access to Fluoride Varnish
12.6.5 Considering the Environmental Risk/Benefit of Dental Care
12.7 Building Block: Financing
12.7.1 Revenue Collection
12.7.2 Pooling
12.7.3 Purchasing
12.8 Leadership/Governance
12.8.1 Governance
12.8.2 Coalition Building
12.8.3 Inclusion of Public in Decision-Making
12.8.4 Appropriate Sustainability Informed Guidelines
12.8.5 Monitoring
12.9 How Do We Influence Dentistry?
References
13: Conclusion
Reference