Climate Change and Oral Health

Impact of climate change on dentistry and oral health: a scoping review

BACKGROUND

Direct effects of climate change on different domains of general health have been well documented with evidence-based literature; however, the implications for oral health and dentistry have been addressed in different forms of research papers and lack a comprehensive evaluation.

OBJECTIVES

We aimed to conduct a scoping review of the existing literature to elucidate the connections between the impact of climate change on oral health and dentistry, exploring how environmental shifts can influence dental diseases and practices and offering insights for future dental care using a systematic search strategy.

METHODS

A systematic search was carried out using keywords in PubMed, Embase, and Scopus databases. Boolean operators were also used to combine the searches and elaborate the search strategy. We did not apply any restriction of time frame or language to the articles. A total of 10 papers were included in the final review. The findings from different papers have reported direct/indirect associations of climate change with oral diseases and conditions such as dental caries, dental erosion, and oral cancer; developmental defects of enamel; early childhood caries; periodontal disease; and dental trauma, skeletal, and dental fluorosis.

DISCUSSION

The findings synthesize a nascent yet significant body of research exploring how environmental changes driven by climate change impact the dental profession and oral health outcomes. Continued research and policy attention are imperative to address the complex and evolving challenges posed by climate change to oral health.

Oral Health and Climate Change: Working Toward Adaptive Strategies to the Changing Environment

Climate change has been acknowledged as one of the current's century most significant global public health challenges. Climate change has resulted in a multifaceted impact on oral health, including the exacerbation of periodontal diseases, enamel erosion, and the increased risk of oral cancers. At the policy level, oral healthcare initiatives should be incorporated into climate adaptation strategies. Key recommendations include promoting climate-resilient dental practices (like mobile clinics and tele-dentistry), integrating sustainable oral healthcare practices, and advocating for water conservation. To summarize, these findings offer a blueprint to mitigate oral health disparities and augment the resilience of dental care systems, emphasizing the linkages between environmental policies and oral health outcomes.

Carbon footprint of private dental clinics in Egypt: a cross-sectional study

BACKGROUND

Climate change is a global challenge, caused by increasing greenhouse gas (GHG) emissions. Dental clinical practice contributes to these emissions through patient and staff travel, waste, energy and water consumption and procurement. Carbon footprinting quantifies GHG emissions. This study assessed the Carbon Footprint (CFP) of private dental clinics in Egypt.

MATERIALS AND METHODS

Data were collected from private dental clinics in Alexandria and Elbeheira, in Northwestern Egypt from July to August 2024 through interview questionnaires. A CFP calculator was used to estimate carbon emissions from patient and staff travel, waste, energy and water consumption, and procurement. To determine the average CFP per clinic and per patient visit, the CFP of all clinics was averaged, both with and without considering the depreciation of dental equipment.

RESULTS

Data from 27 dental clinics were collected. The average CFP of an Egyptian private dental clinic, which, per year, received 3,322 patient visits, and where 5 personnel worked 279 days was 14,426.8 kg CO2e, or 4.3 kg CO2e per patient visit. The largest contributor to the CFP was patient travel (45.6%), followed by staff travel (19.6%), energy consumption (18%), procurement (12.4%), waste (4.2%), and water consumption (0.3%). After considering the yearly depreciation of dental equipment, the CFP per clinic in a year increased by 12.2%.

CONCLUSION

Private dental clinics in Egypt produce substantial carbon emissions. Patient travel was the major contributor to the CFP. While there was a high CFP of electricity consumption, the CFP of gas was zero. The high CFP of waste was likely due to improper segregation and the lack of recycling. Country-specific CFP calculators are needed to accurately measure the carbon emissions of dental clinics in various settings. Preventing oral diseases, raising public awareness to sustainable practices, promoting walking and cycling, improving public transportation, implementing waste recycling, shifting to renewable sources of energy, and local manufacturing of dental products are important to reduce carbon emissions in dental clinics.

Assessing the Impact of Climate Change on Early Childhood Caries Within the Framework of Sustainable Developmental Goal 13: A Scoping Review

Climate change, a significant factor in global health disparities, has been linked to numerous health issues, including oral health disorders such as dental caries and enamel hypoplasia. Sustainable Developmental Goal 13 (SDG 13) accentuates immediate action to battle climatic changes and their complications. This scoping review aimed to explore the existing evidence in the literature linking SDG 13 with Early Childhood Caries (ECC). The review was carried out following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A rigorous search was done during the month of May 2024 using databases PubMed, Web of Science, Scopus, and Google Scholar with search MeSH terms related to climate change, Early Childhood Caries (ECC), and Sustainable Developmental Goal (SDG). Publications or abstracts were included only in English from 2015 onwards, with no restrictions on the type of study. A summary of the eligible studies was compiled, highlighting the countries where the research was conducted, the type of study designs used, the region, study aims, and key findings. Additionally, the study results were analyzed to determine whether SDG 13 was addressed. The initial search provided 74 articles, of which 51 were duplicates, yielding 23 for screening. After applying the eligibility criteria, seven studies were finally reviewed. Two of the seven studies included were from the African continent (Kenya and Nigeria), and one was a multi-centric study involving various continents, Africa (Nigeria & Kenya), Asia (Saudi Arabia, Indonesia), and America (Canada, Brazil). Two other studies were conducted in the UK, China, and India, while one was from the USA and focused on how climate change impacts dental caries. Only three studies were found to be addressing SDG 13. The review established a plausible link between ECC and climate change factors, addressing the need to incorporate sustainable developmental strategies and eco-friendly preventive measures in pediatric dentistry.

Early childhood caries, climate change and the sustainable development goal 13: a scoping review

BACKGROUND

Sustainable development goal 13 centres on calls for urgent action to combat climate change and its impacts. The aim of this scoping review was to map the published literature for existing evidence on the association between the Sustainable Development Goal (SDG) 13 and early childhood caries (ECC).

METHODS

The scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. In August 2023, a search was conducted in PubMed, Web of Science, and Scopus using search terms related to SDG13 and ECC. Only English language publications were extracted. There was no restriction on the type of publications included in the study. A summary of studies that met the inclusion criteria was conducted highlighting the countries where the studies were conducted, the study designs employed, the journals (dental/non-dental) in which the studies were published, and the findings. In addition, the SDG13 indicators to which the study findings were linked was reported.

RESULTS

The initial search yielded 113 potential publications. After removing 57 duplicated papers, 56 publications underwent title and abstract screening, and two studies went through full paper review. Four additional papers were identified from websites and searching the references of the included studies. Two of the six retrieved articles were from India, and one was China, Japan, the United States, and the United Kingdom respectively. One paper was based on an intervention simulation study, two reported findings from archeologic populations and three papers that were commentaries/opinions. In addition, four studies were linked to SDG 13.1 and they suggested an increased risk for caries with climate change. Two studies were linked to SDG 13.2 and they suggested that the practice of pediatric dentistry contributes negatively to environmental degradation. One study provided evidence on caries prevention management strategies in children that can reduce environmental degradation.

CONCLUSION

The evidence on the links between SDG13 and ECC suggests that climate change may increase the risk for caries, and the management of ECC may increase environmental degradation. However, there are caries prevention strategies that can reduce the negative impact of ECC management on the environment. Context specific and inter-disciplinary research is needed to generate evidence for mitigating the negative bidirectional relationships between SDG13 and ECC.

Determinants and inequality of recurrent aphthous stomatitis in an Indonesian population: a cross sectional study

INTRODUCTION

Recurrent Aphthous Stomatitis (RAS) is the most common type of ulceration in the oral cavity which can occur due to several factors.

AIMS

To determine the factors related to the incidence of RAS and examine the social class inequality in RAS among the Indonesian population using data from the fifth wave of the Indonesian Family Life Survey (IFLS5) in 2014.

METHODS

This study is a descriptive study with a cross-sectional design using secondary data from IFLS5 data in 2014 (n = 28,410). Socio-economic position (SEP) was calculated by Adult Equivalent Scale and categorized into 4 classes. Outcome is RAS. Mediating factors were psychosocial (stress), eating behavioral (food consumption), and systemic diseases. Descriptive analysis, chi-square and a series of logistic regressions were performed to analyze the data. Odds ratio (OR) and 95% confidence interval (CI) were used to report the results.

RESULTS

Only 18.39% of IFLS5 respondents experienced the incidence of recurrent aphthous stomatitis in 2014. The bivariate (chi-square) results showed that there was a relationship between the incidence of RAS and the related independent variables. Logistic regression showed the highest possibility of RAS in respondents aged 18-34 years, female, unmarried, high school education level, living in the city, having frequent stress levels, having food habits that frequently drinking soda, sweet foods, chili sauce, fried food and has systemic diseases such as, asthma, cancer, rheumatism, and digestion. The lowest SEP group had the highest probability of occurrence of RAS over the other groups among the different models.

CONCLUSIONS

There are several factors that determine the incidence of RAS. There was a monotonic gradient of inequality in RAS according to SEP group. This study might be useful to provide information regarding the relationship of determinants factors with the incidence of RAS to prevent it and promote oral health in the future.

Towards planetary oral health

It is time to consider the protection of our environment as a major public health issue in oral medicine. Evidence shows that activities related to dental practice, such as patient transportation, use of rare materials and chemicals, or energy consumption, affect our ecosystems and contribute to the global degradation we are increasingly observing. The degradation of our environment is considered the greatest threat to our health. Exposure of oral tissues to multiple environmental factors can lead to pathological conditions. In addition to these direct effects, there are more complex phenomena, leading to co-deficits in the health of populations. The example of the sugar industry illustrates the systemic failures resulting in the double degradation of the environment and the health of individuals. Face with these dynamically interacting phenomena, human communities must consider systemic responses such as those described in this article. The dental community will need to do its part and consider global oral health as a central issue. This conceptual work will help define the innovations and action needed to ensure equitable practice that respects planetary limits.

The impact of climate change on paediatric dentistry

The effects of global warming and climate change are happening at a faster rate than expected, and they are going to get worse. Global climate change has already started to show the effects on environment-fast melting glaciers, accelerated sea level rise and base shifting of native flora and fauna. There has been an increase in temperature globally with a few countries already showing intense heat waves and extreme cold temperatures. The interrelation between dentistry, environmental impact and human health is still in its nascent stage, but studies in medicine show that the healthcare industry contributes to greenhouse gas emissions and climate change, poor air quality, food and water insecurity, extreme weather events and vector-borne illnesses. The concept of eco-friendly dentistry has evolved in this context for providing environmentally feasible dental solutions. Paediatric dentistry is no exception. The concept of prevention has to be promoted more in paediatric dentistry to provide a positive impact on environment. The prevention of oral diseases will lead to less travel to paediatric dental clinics, less use of dental materials, lesser energy usage, minimal use of single-use plastics and less use of nitrous oxide/general anaesthesia for behaviour management. The greenhouse gases have an effect on teeth of children in relation to early childhood caries (ECC). Here, we discuss the impact of climate change on paediatric dentistry and what changes can be made to provide environment-friendly solutions.

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.