Net zero dentistry
A new initiative is aiming to support the profession in reducing its impact on the environment – helping practices save money and the planet
At the opening of COP26 in October, the activist Brianna Fruean, of Samoa, told delegates: “Two degrees could mean the end. 1.5 degrees could mean a fighting chance”. As Glasgow got back to normal – after hosting 38,000 delegates from 194 counties, including 120 world leaders – Alok Sharma, the president of COP26, reflected on the conference’s achievements.
“By any measure, the Glasgow Climate Pact is a historic agreement,” he said. “It was the result of two years of marathon work, and a two-week sprint of negotiations, but we achieved what we wanted. We can credibly say that we kept the goal of limiting global warming to 1.5 degrees above pre-industrial levels in reach.”
While many, including Sharma himself, were upset at the last-minute intervention by India and China that weakened the effort to end coal power and fossil fuel subsidies (the participating countries agreed to “phase down”, rather than “phase out”, coal), the conference certainly had the effect of putting climate change at the forefront of thinking among the public, organisations, and sectors including dentistry.
As part of COP26, Glasgow University hosted an international conference, Sustainability in Healthcare and Education: Global Challenges and Solutions, which presented new ways of thinking and working to increase sustainability in the delivery of oral and dental care, with a focus on essential medicines, minimal intervention and disease prevention. The Royal College of Physicians and Surgeons of Glasgow also hosted its Sustainability in Dentistry webinar.
But the dental profession is not new to the challenge. The first systematic attempt to quantify the carbon emissions of a national dental service was carried out a decade ago. Taking a bite out of Scotland’s dental carbon emissions in the transition to a low carbon future1, published in 2012, calculated the carbon footprint of the NHS dental service in Fife and extrapolated the findings for Scotland as a whole. It found that travel was the greatest source (45.1 per cent) followed by procurement (35.9 per cent) and building energy (18.3 per cent).
One of the authors, Dr Brett Duane, a former lecturer at Dundee University’s School of Dentistry and currently Associate Professor of Dental Public Health at Dublin Dental University Hospital, went on to co-author, and publish in 2019, a series of papers on environmentally sustainable dentistry2.
The authors said: “The carbon footprint is one proxy of sustainability and is closely related to expenditure. In 2014-2015, the carbon footprint of dentistry [in NHS England] was calculated to be 675 kilo tonnes carbon dioxide equivalents (CO2e) with 64.5 per cent related to travel, 15.3 per cent from energy and 19 per cent from procurement. The GDC [General Dental Council] should consider incorporating sustainability education into the undergraduate framework in line with student demands and similar moves by the General Medical Council.”
They added: “There is a need for a wider research agenda underpinning the development of dentistry as a sustainable health service. Within the UK and Ireland there is some early research being undertaken in waste management and behavioural change, carbon foot-printing, life-cycle analysis and understanding perceptions of the dental workforce. This work, however, needs to be developed in parallel and in collaboration with other healthcare partners.”
Into this mix comes a new initiative, based in Scotland but with a UK-wide – perhaps, even international – reach; Net Zero Dentistry.
It has been established by Mike Gow, of The Berkeley Clinic in Glasgow, and Marcus Macleod, co-founder of the ‘find a dentist’ site, defactodentists.com, and the dental e-commerce site, yourdentistrecommends.com. They had been discussing single-use plastic in dentistry, and how it could be combatted, over the past few years but their thinking crystalised during the early stages of the pandemic, when practise was on hold. Their discussion engaged a wider audience via Mike’s Facebook-based Interdental – Dentistry Discussion Group.
“One of the ideas was an e-commerce site based on environmentally friendly dental products,” said Marcus. “But when you looked at the carbon footprint of bringing those to market it was actually not good. So, our thinking shifted to the need for some kind of lobby group for the profession, a ‘voice’ that could articulate meaningful ambitions and a platform that could facilitate realistic, measurable, and impactful steps the profession can take.”
Mike added: “Dentistry produces a massive amount of waste and pollution. Of particular concern is the volume of single use and plastic waste. With increased cross-infection control, more single use items have led this to become a bigger issue in the last 18 months. Around the world people and businesses are looking for the roadmap to become ‘net zero’.”
He said: “Net Zero Dentistry is working towards solutions for how the dental profession and trade can band together to take responsibility and do our part to make a tangible difference and achieve our goal of net zero dentistry. It sets out to identify, and resolve, environmental and ecological problems within the profession using education, environmental assessments and offset programmes.”
The education modules, and many of the activities, have been designed for team engagement with thought given towards inclusion, physical activities, and mental health. The assessment will consider waste, operational methods, treatment methods, as well as personal and team objectives. Offsetting programmes will adhere to best practice and the highest standards of environmental integrity.
“The Net Zero Dentistry initiative has no political agenda,” said Mike. “Collectively, as a profession, we simply want to bring about small degrees of change that will have massive impacts on our environment. This can be achieved by making small, gradual changes to the way that we dispose of waste, burn energy, consume single-use plastics, and even the procedures we use during treatments.”
Marcus added: “Net Zero Dentistry has tapped into some of the foremost experts in relevant fields in order to create an extensive education programme. We do not align ourselves with any activists or protesters we see on the news. We are the dental profession trying to bring about some behavioural changes that will impact considerably the environment our children will inherit.”
Dublin centre’s sustainable goal
The Association for Dental Education in Europe (ADEE), based in Dublin, has set a goal of embedding environmental sustainability in the curriculum. Over the summer last year, an ADEE Special Interest Group met to discuss next steps after the publication of its initial findings following discussions at its annual meeting in 2019.
Discussions centred on four themes: disease prevention and health promotion, patient education and empowerment, lean service delivery, and preferential use of strategies with lower environmental impact. A spokesperson said: “It is apparent that there is a widespread need for teaching materials relating to environmental sustainability. This includes specific learning outcomes relating to the four educational domains of the Graduating European Dentist curriculum, and methods for teaching and assessing these outcomes.”
Following the meeting this year, the finalised learning outcomes will be entered into a Delphi style consultation process with wide stakeholder representation across Europe The aim is to publish the learning outcomes along with guidance for how these could be implemented and assessed – as a consensus paper.
Meanwhile, the British Dental Association is working with Brett Duane, of the ADEE, to consider how sustainability can be put into practice, while ensuring dentists continue to uphold the highest standards in decontamination and protect patient safety.
Mike and Marcus discuss Net Zero Dentistry on the Protrusive Dental Podcast.