Exploring attitudes and knowledge of climate change and sustainability in a dental practice: A feasibility study into resource management

Adult attitudes to sustainable dentistry in Trinidad and Tobago and their willingness to accept alternatives

INTRODUCTION

Attitudes towards and willingness to accept alternatives for sustainable dentistry in Trinidad and Tobago have never been assessed. Market research aids in the understanding of the behaviours of people. Since change can be enacted by public pressure, it is worth engaging the public through research to understand their attitudes and which changes they are willing to accept.

METHOD

A self-administered questionnaire was distributed to private and public dental clinics. The questionnaire assessed attitude towards and willingness to accept alternatives which decrease the effect of dental treatment on the environment.

RESULTS

The study consisted of 1267 participants. Participants were mostly female, older, employed and mainly of African descent. Participants reported a very positive attitude towards sustainable dentistry (Mean = 3.89, SD = 0.8). and were moderately willing to accept alternatives such as a longer appointment time (Mean 3.47, SD = 0.73) and pay more for their dental treatments (Mean=3.00, SD = 0.87). There was a strong positive correlation with attitudes to sustainable dentistry and participants willingness to accept alternatives such as a longer appointment time (r = 0.658, p < 0.05).

CONCLUSION

The adult population had an overall positive attitude towards sustainable dentistry and was willing to accept alternatives so that their dental treatment would have less impact on the environment.

Curriculum Content for Environmental Sustainability in Dentistry

OBJECTIVES

(i) Identify suitable strategies and opportunities to embed Environmental Sustainability (ES) within an existing Oral Health Professional (OHP) curriculum through a series of focus groups with students and academic staff and (ii) Create high-level evidence-based and subject-specific ES content through an approach grounded in evidence and collaboration with key stakeholders in OHP education.

METHODS

Focus groups were used to explore academic staff and student views on appropriate teaching and assessment methods for ES. Content statements were developed from an extensive literature search, mapped to curriculum subjects, and validated through consultation with students, discipline-experts and education-experts.

RESULTS

Five themes were identified from the focus groups: Environmental Sustainability transcends all disciplines of dentistry and oral healthcare; Baseline knowledge transmission with relevant practical application; Viewing and modifying existing teaching and assessment events through a different lens; Normalising the topic of Environmental Sustainability to support attitude and behaviour change and Safeguarding against misinformation and disinformation. Forty-four content statements were developed and mapped to nineteen curriculum subjects.

CONCLUSIONS

This study identifies for the first time a comprehensive strategy for the inclusion and delivery of ES (method and content) in the curriculum. A novel method to define and map curriculum content has been explored and validated using a range of complementary methodologies. A comprehensive and robust list of evidence-based and subject-specific educational content statements have been defined in the field of Environmental Sustainability in dentistry and oral healthcare.

CLINICAL SIGNIFICANCE

Oral healthcare has a significant environmental impact, the key to all mitigation strategies is by educating the profession at all levels.

Disposable and reusable instruments in dental health practice: A comparison of cost factors in a public provider organization in Queensland, Australia

OBJECTIVES

Choosing between reusable instruments (RIs) and disposable instruments (DIs) for dental care provision requires a careful consideration of costs and their contributing factors, alongside other choice criteria. This study aimed to assess the current use of instruments in the West Moreton Oral Health Service (WMOHS) in Queensland, Australia, with a broader goal of informing future practice in this and comparable organizations.

METHODS

A cost model was developed reflecting costs arising from procurement, reprocessing and disposal, depending on the RI and DI composition of instrumentation. The current practice in WMOHS was compared to modular (RI-only and DI-only) strategies by considering four standard instrument sets (examination, simple extraction, surgical extraction, restoration) and the annual use of instruments in the organization at large. The use of resources (water, electricity) and emissions (waste) were quantified for each strategy. The robustness of findings was explored across a range of scenarios that involved varying instrument prices, lifespans, factors impacting on the cost of reprocessing (labour, water, energy), the cost of waste disposal and couriering.

RESULTS

At the organization level, the current mix of instruments (A$1.28 m per year) was 4% more costly than the lower cost, RI-only alternative (A$1.23 m). However, with lower DI prices or higher labour costs current practice would become the lowest cost option. Results for specific instrument sets varied by service type. DI-only offered the lowest cost option for oral examinations (A$6.29), and the current practice of mixed instrumentation for simple extractions (A$16.56). RI-only sets were less costly in more resource intensive procedures such as surgical extractions (A$40.19) and restorations (A$43.83). In terms of environmental impacts, the use of instruments based on current practice required 37% of water and energy use of an RI-only alternative and generated 36% waste of the DI-only alternative.

CONCLUSIONS

Reusable instruments are generally less costly than DIs, but for specific instrument sets the outcome depends on the type of procedure. In some circumstances, mixed instrumentation can provide the lowest cost alternative. While the WMOHS instrument mix used in current practice does not minimize cost for the provider, it may be justified in light of operational risks, logistics and uncertainty regarding cost factors.

Aspects Regarding Sustainability among Private Dental Practitioners from Bucharest, Romania: A Pilot Study

Oral health professionals' knowledge of sustainability is essential for promoting environmental protection in dental healthcare. This pilot study involved an online survey addressed to 70 dental private practitioners from Bucharest, Romania, to evaluate their awareness of the concept of sustainability in dentistry. The performed statistical analysis revealed that 41.4% of the participants were well aware of sustainability in dentistry, with older participants demonstrating significantly higher levels of such awareness (p = 0.001). Sustainability awareness among participants correlates positively with their knowledge of the negative environmental impacts of dental activity (p < 0.001) and with the concern for sustainable dentistry implementation in their workplace (p = 0.037). Improper biohazardous waste disposal was identified as the primary cause of negative environmental impact of dental practices by 87.1% of participants. Installing high energy-efficient dental equipment was selected as the most important action to implement sustainability in participants' dental practices (64.3%). Overall, 51.4% of the participants reported that the COVID-19 pandemic had a medium impact on their dental activity in terms of sustainability. Our study found that participants have a moderate level of awareness regarding sustainability in dentistry, highlighting the need for education on sustainability for oral health professionals.

Facilitators and Barriers to Implementing Sustainability in Oral Health Care

OBJECTIVE

The aim of this research was to study the facilitators and barriers to implementation of sustainable oral health care in Dutch dental practices using a qualitative research design.

METHODS

A conceptual framework was developed and based on 2 theories for implementation in dental practices. The framework covered 4 levels: structural, dental practice, oral health care practitioner, and method and product level. Semi-structured interviews were conducted to collect guided and in-depth data. Fourteen key stakeholders were interviewed: dentists, dental hygienists, dental assistants, managers and owners of dental practices, and suppliers of dental goods. Data were analysed using both a thematic analysis approach and open coding.

RESULTS

Participants were aware of the compromised planetary health and, in part, of their contribution to it. However, turning this awareness into action proved to be challenging. Barriers that were identified included limited knowledge and awareness of the largest sources of planetary burden in oral health care. Also, information and availability of sustainable products and methods cannot yet meet the requirements of current performance standards, costs, and infection control guidelines. Facilitators that were observed included a growing awareness to contribute to planetary health and to implement sustainability outside oral health care, especially in women and younger people. Overviews and guides of existing sustainable methods are available, but additional methods and products should be developed as well.

CONCLUSIONS

Many participants considered infection control guidelines as the most prominent barrier to sustainable oral health care. Women felt more involved with planetary health compared to men, which is in line with the concept of ecofeminism. It is essential for stakeholders to collaborate to reach the next levels of implementation. Action is required on all levels to secure both oral and planetary health. Now is the time to act.

Drivers, opportunities and best practice for sustainability in dentistry: A scoping review

OBJECTIVE

To undertake a comprehensive scoping review of the literature to address the research question 'What is the current state of environmental sustainability in general dental practice?' To provide an effective baseline of data that will consider the drivers, opportunities and recommendations for the implementation of sustainable practice.

DATA & SOURCES

The scoping review was conducted for all published literature in the English language that addresses this topic up to the 31st April 2021. The method of the PRISMA-ScR (PRISMA extension for Scoping Reviews was followed. 128 papers included in this scoping review consisted of: Commentary [Letters, editorials, communication and opinion] (n=39); Research (n=60); Literature reviews (n=25); Reports [Policy and legislation] (n=4). Each included record was analysed for emerging themes that were further classified according to their general relevance. The scoping review is considered over two manuscripts, with this second paper focusing on the opportunities, recommendations and best practice to develop and engage with sustainable practice.

CONCLUSIONS

Drivers, opportunities and recommendations for best practice to achieve environmentally sustainable goals in oral health care: The lack of public and professional awareness is the greatest driver to engage with a positive change of behaviour and attitudes. Awareness through education is key at all levels and this should be the bedrock of future strategies. Reduction in staff and patient commuter travel through a reduction of the incidence of preventable oral diseases, improved patient care logistics and IT. Reducing waste and increase recycling opportunities, especially for SUPs. Engagement with legislation and policy makers. Engagement with key stakeholders across the dental materials/products supply chain for the management of manufacturing, distribution, procurement, clinical use and waste management.

Awareness and barriers to sustainability in dentistry: A scoping review

OBJECTIVES

(i) To undertake a comprehensive scoping review of the literature that addresses the research question 'What is the current state of environmental sustainability in general dental practice?' (ii) To provide an effective baseline of data that will consider general awareness, barriers and challenges for the implementation of sustainable practice.

DATA & SOURCES

The scoping review was conducted for all published literature in the English language that addresses this topic up to the 31st April 2021. The method of the PRISMA-ScR (PRISMA extension for Scoping Reviews) was followed. 128 papers included in this scoping review consisted of: Commentary [Letters, editorials, communication and opinion] (n = 39); Research (n = 60); Literature reviews (n = 25); Reports [Policy and legislation] (n = 4). Each included record was analysed for emerging themes that were further classified according to their general relevance. The scoping review is considered over two manuscripts, with this first paper focusing on awareness of the problem and barriers or challenges to the implementation of sustainable care.

CONCLUSIONS

Eight diverse but closely interlinked themes that influence the sustainability of oral health provision were identified: Environmental impacts (CO₂e, air and water); Reduce, reuse, recycle and rethink; Policy and guidelines; Biomedical waste management; Plastics (SUPs); Procurement; Research & Education; Materials. Barriers to implementation were identified as: Lack of professional and public awareness; carbon emissions arising from patient and staff commute; challenges associated with the recovery and recycling of biomedical waste with a focus on SUPs; lack of knowledge and education into sustainable healthcare provision and; the challenges from the manufacturing, use and disposal of dental materials.

Environmentally sustainable dentistry: a brief introduction to sustainable concepts within the dental practice

This paper introduces clinicians to sustainability as it relates to dentistry. There are seven papers in the series. These include this introduction, followed by papers on energy, procurement, travel, waste, biodiversity and engagement and embedding sustainability into current dental practice. A sustainable world aims to ensure the basic needs and quality of life of everyone are met, now and for future generations. The current delivery of healthcare in the modern world is not sustainable due to rising financial costs, increasing demands and a high environmental burden. Dentists, like their medical counterparts, need to consider the General Dental Council (GDC) standards and the relationship between planetary health and human health within their practice. There is increasing awareness of the problems associated with global warming but a lack of knowledge on how to become more environmentally sustainable. There are also financial and reputational benefits to becoming more sustainable for practices. The carbon footprint is one proxy of sustainability and is closely related to expenditure. In 2014-2015, the carbon footprint of dentistry was calculated to be 675 kilotonnes carbon dioxide equivalents (CO2e) with 64.5% related to travel, 15.3% from energy and 19% from procurement. The GDC should consider incorporating sustainability education into the undergraduate framework in line with student demands and similar moves by the General Medical Council.