| Abstract|| |
For many people, dentistry is not the first word that springs to mind when one hears the word "eco-friendly." Dentistry has an impact on the environment, and there are moves toward "eco-friendly dentistry." Eco-friendly dentistry uses a sustainable approach to encourage dentists to implement new strategies to try and reduce the energy being consumed and the large amount of wastes being produced by the industry. However, with eco-consciousness becoming a new trend, everyone is looking for ways to create and market "green" products. Green dentistry is a high-tech approach that reduces the environmental impact of dental practices and encompasses a service model for dentistry that supports and maintains wellness. Together, green dental practices, green dental patients, and companies offering green dental products are transforming the dental industry through adoption of the EDA's (Eco-Friendly Dental Association) green dentistry model.
Keywords: Community health, eco-friendly dental association, eco-friendly environment, green dentistry
|How to cite this article:|
Passi S, Bhalla S. Go green dentistry. J Educ Ethics Dent 2012;2:10-2
| Introduction|| |
Dentistry is defined as the "evaluation, diagnosis, prevention and/or treatment (non-surgical, surgical or related procedures) of diseases, disorders and/or conditions of the oral cavity, maxillofacial area and/or the adjacent and associated structures and their impact on the human body."  People who practice dentistry are known as dentists. They practice in according to the ethics of the profession and to the law.  Dentistry, among other fields in the medical industry contributes to climate change and increasing the pollution of our environment. Though individual dentists generate only small amounts of environmentally "unfriendly waste," the accumulated waste produced by the profession may have significant environmental impact. 
According to a 2007 article by the Canadian Dental Association, "eco-friendly dentistry" attempts to reduce the industry's detrimental impact on the environment and promote environmental awareness and sustainability to patients.  It is an approach of dentistry that encourages sustainable practices by reducing resource consumption and waste. Eco-friendly dentistry also tries to increase the health of patients by reducing chemical use in the clinics and using low volatile products. Eco-friendly dentist offices take into consideration patient volume, consumption of dental resources, electricity, energy, chemical and water usage, and waste and try to implement environmentally friendly alternatives. 
The Eco-Dentistry Association (EDA), and educational and membership association for green dental professionals, (www.ecodentistry.org) has developed a model for eco-friendly dentistry that is environmentally conscious and wellness-based, helping dentists to protect the environment although integrating dental practices that advance preventive dentistry and serving the needs of green dentistry consumers. ,
Dentistry is responsible in contributing to pollution by the following:
- X-rays: Traditional radiography uses various chemical and generates waste fixer containing silver that must be managed as hazardous waste or the silver be reclaimed and recycled properly, because of the high silver content used, fixer is readily recyclable. The lead foil contained in each film packet may be hazardous unless it is recycled for its scrap metal content. Waste developer may be flushed down the drain or sent for recycle, but it should not be mixed with fixer. The lead foil inside each X-ray packet is a leachable toxin and can contaminate the soil and groundwater in landfill sites. Lead foil packets should never be thrown in the regular garbage. This material must be hazardous unless it is recycled for its scrap lead content. 
- Silver amalgam: Amalgams are typically 50% mercury with silver, tin, and other metals. The detrimental effects of mercury are widely known; therefore, it is crucial to prevent the release of mercury to the environment. Once in the environment, changes in pH, oxygen availability, temperature, can allow the mercury in amalgam to be used by bacteria, which are able to convert it to the more toxic "organic methyl mercury" and becomes a major source of mercury in the fish people eat. The mercury in amalgam is a neurotoxin. Vulnerable populations such as children, the fetuses of pregnant women, hypersensitive individuals, and people with kidney impairments are known to be particularly susceptible to the neurotoxic effects of dental mercury. 
- Mix only as much amalgam as is immediately required by using amalgam capsules. If mixed amalgam remains, after a restoration this can be recycled. Amalgam shavings and bits of amalgam from the drilling or restoration shaping operations should be intercepted by drain traps or screens. The drain traps and screens should be cleaned daily to retain good water flow and to collect amalgam waste for recycling. 
- Toxic chemicals: Any chemical is a hazardous waste. Most used disinfectants may be discharged into the sewerage directly. Straight alcohols and ethers are considered ignitable.
- Usage of disposables items: Different kinds of disposables used in dentistry are latex gloves, disposable patient bibs, head rest covers, syringes, plastic pouches, plastic suction tips.  Office waste is usually non-hazardous waste e.g., paper, cardboard, aluminum, plastics etc., The use of these should be minimized. Office paper material may be recycled.
| Definition|| |
The EDA defines green dentistry as: Reducing waste and pollution-saving energy, water, and money-incorporating high-tech-wellness-based. EDA offers standards and best practices for green dental offices including infection control procedures. Various procedures, which can be used in the dentistry to practice an eco-friendly dentistry are: 
- To convert high-energy consuming office lights to energy-efficient
- To install a central vacuum that uses no water and has an amalgam trap
- Recycle the big five: Aluminum, glass, plastic, paper, and steel
- Use paint that does not include volatile organic compounds (VOCs)
- Use office furniture made from recycled or reclaimed wood
- If traditional X-rays are taken, recycle fixer, and developer solutions
- Use less harmful surface disinfectants to clean and sterilize
- Implement an environmentally-friendly sterilization program
- Use reusable stainless steel high- and low-volume, surgical/endodontic suction tips as an alternative to disposable plastic
- Use biodegradable disposable cups instead of regular paper cups
- Use chlorine-free, high post-consumer recycled paper products instead of traditional paper products
- Use disposable, plastic or paper barriers only when necessary
- Turn off your computer when you leave the office for the day
- Turn off your lights when you leave the room
- Consider using stainless steel suction tips and saliva ejectors
Eco-friendly dentistry uses a sustainable approach to encourage dentists to implement new strategies to try and reduce the energy being consumed and the large amount of waste being produced by the industry. Four R's is a strategy implemented by dental professionals to help make an easier transition to a more sustainable practice.
Every decision is made with a certain mindset and redeveloping a mindset is a strategy for change. Environmentalism and sustainability are both considered states of mind. Rethinking the way that dentist offices are run is the initial step in trying to change the modern practice. Implementing simple changes like things you can add or change, and decrease energy and water consumption are the initial strategies to consider. 
In order to decrease the pressure on the earth's resources, people must decrease or reduce their consumption of them. For example to prevent deforestation of forests, and slow down global warming we must reduce our consumption of paper and production of waste respectively.
This strategy encourages the prolonged use of an item; to prevent the item from contributing to waste being put in landfills. Finding a new purpose for an item extends its life and decreases contributions to landfills. By reusing items, we take the pressure off of natural resources by decreasing the demand for extractions. By reusing products, it also reduces the amount of energy needed to produce new products.
Much of the waste that is found in landfills can be reprocessed and recycled into a new product. To reduce the waste of useful products, reduce the waste of raw materials and energy needed to extract the materials, reduce water pollution and air pollution from landfills and incinerators respectively, recycling products is a viable way to reduce overall contamination of the environment. 
| Elements of Eco-Friendly Dentistry|| |
Specific elements in office and building construction, office operations, and patient practices distinguish the practice of eco-friendly dentistry in comparison to traditional dentistry.
Building and office construction
- Careful planning and construction of a green building in accordance with benchmarks for constructing green buildings
- Utilizing green interior design finishes, and textiles, including interior elements that are free of persistent bioaccumulative toxins and VOCs and that are made from post-industrial or post-consumer waste or come from sustainable resources.
- Paperless patient charting and registration, electronic claims, electronic patient recall, and reminders
- Digital radiography eliminating film manufacturing, toxic chemical processors and fixatives, and reducing patient exposure to radiation
- Environmentally conscious purchasing of products and services
- Significant decreases in solid waste production and high ratios of recycling. Paper goods and products only from Forest Stewardship Council certified sources
- Utilizing the authoritative benchmarks set forth by the Green Guide for Health Care and the EDA
- Utilizing 100% sustainable energy to power any facility
- Offsetting Carbon dioxide with certified carbon offsets and investment into reforestation campaigns
- Formulating a green team with designated responsibilities and goals
- Recording and publishing metrics in relation to bio-hazardous waste, solid waste, recyclables, water consumption and energy consumption in order to set annual goals, implement improvements and to compare to national benchmarks
- Incorporation of a formal Corporate Social Responsibility program within the cooperate structure.
- Elimination or diversion of bio-hazardous waste through Demolizer II units and/or Pella-DRX (Discontinuously Reinforced material)
- (The Demolizer® II is a smart system, constantly self-monitoring and controlling all regulatory system requirements as waste is processed. Pella-DRX is the end-product of a new, patented and first-of-its-kind process called the Sharps Compliance Waste Conversion Process [WCP]. The WCP processes medical waste that is traditionally incinerated or autoclaved and sent to landfills and repurposes it into an industrial resource).
- Use of amalgam separator or mercury eliminator to prevent mercury from entering and contaminating municipal water system
- Use of dry vacuum systems and bulk instrument sterilization systems, in addition to automated low-flow faucets, and toilets for water conservation
- Formal environmental purchasing of products and services
- Creating formal mission statement and adhering to the pre-cautionary principle.
| Patient Practices|| |
- Practicing metal-free, mercury-free dentistry with no amalgam
- Use of non-toxic, green cleaning and sterilization products and supplies
- Use of only green seal approved products and materials
- Certification with EDA green DOC (Dental Office Certification) Program (The DOC program provides a road map for implementing eco-friendly initiatives)
- Use of dry-heat or steam sterilization versus chemical sterilization
- Recycling of broken or non-usable instruments in a program like Hu-Friedy's environment program
- Utilizing bis (2-ethylhexyl) phthalate-free phthalate, polyvinyl chloride-free surgical tubing and Intravenous fluid bags
- Use of lead-free patient X-ray aprons and shielding
- BPA BisphenolA-free composite resins and oral appliances.
| Conclusion|| |
Although in some cases it may take a little extra effort or money, dentists throughout the world are doing their best to reduce the environment al impact of dental practice. And although the commitment of one small dental office cannot save the planet, certainly the collective efforts of many small offices can ensure that dentists, at least, will not be responsible for destroying it.
| References|| |
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