The impact of COVID-19 on sustainability in dentistry

A year on from the Extinction Rebellion protests in London, and following a COVID-19 pandemic, Alkisti Vousvouni discusses sustainability issues in dentistry.

The UK parliament and EU countries declared a climate emergency in 2019 in an effort to prioritise this complex issue.

As the climate emergency threatens our ecosystem and air quality, it is obvious that it is a healthcare emergency.

COVID-19 has been an inconvenience for some, detrimental for others and certainly a shake-up of the world; an irrefutable awareness of our fragility. Predictions and real life examples such as the Syrian war help us realise the huge risk of the imminent societal collapse should we fail to tackle the climate emergency effectively.

And if you think that the Middle East is a bit too far away, our privileged western world will suffer more in the post-COVID generations.

To paraphrase Greta Thunberg: ‘Our house is on fire and according to the IPCC, we have fewer than 11 years to undo our mistakes’.

Increased PPE and plastic use

The need for PPE is real. But can we achieve the safety of dental health staff and at the same time ensure that our practices are sustainable?

We have all seen an increase in PPE, which is now extending wider than just the medical and dental sector. We have all seen those people who put on their nitrile gloves once they leave their home, go shopping, touch pens, papers and everything in their way, then come to your surgery and take their dentures out, and retract their cheeks to show you their complaint, all in the deceptive safety of those gloves.

All jokes aside, we need to have a good look at how our PPE is manufactured and disposed of.

Firstly, the increased demand of plastic for healthcare and as such, its manufacturing, fuels the petrochemical industry. This is notoriously polluting to our ecosystem.

An increase in disposable PPE use is necessary to protect the dental team in a post-COVID world. This has increased the load that is sent for incineration.

Incineration is a polluting practice and an increase in plastic sent for incineration increases its energy demand and therefore pollution. In turn, pollution has an effect in our ecosystems, biodiversity and even our lungs.

Our profession is a huge contributor for incineration practices and waste. Some companies are making an effort to produce alternatives such as compostable PPE. And some organisations are hoping to formally introduce medical composting among other measures.

Existing efforts for sustainability in dentistry

There are a number of organisations worldwide who try to push the sustainability agenda in healthcare. The Doctors for Extinction Rebellion and the Centre for Sustainable Healthcare are examples of this.

It is extremely important to incorporate sustainability in dental policy and regulate it.

Are we certain that the current (and indeed pre-COVID) guidelines relating to cross-infection and PPE are scientifically reasonable? Can we, as a profession, push for policies that take into account the urgent issue of sustainability in professional guidelines and standards?

We have a duty of care and our systems are impeding us from delivering long-term effective healthcare.

It is easy to adopt short-term fixes of a particular problem. But we remain unable to address long-term risks.

We, as a healthcare profession, should know better than this. Ultimately we are able to understand long-term irreversible problems caused by poorly informed decisions in the past.

I remain optimistic. After all, we are a group of highly intelligent people who are able to digest and consider information and act for our patient’s best interests.

What can we do?

  1. We need a push to change in policies. Produce guidelines with sustainable measures in mind. We need to work towards zero-waste practices
  2. Read and talk about it. This article may come across as strongly worded. However, we have no time for niceties around the topic. We have to act now, firmly and together
  3. Be kind and respectful to others and help them through this terrible situation we have inherited and created. Extinction Rebellion’s principles and values are a very good guide.

Practical changes to your practice

  • Use re-usable PPE where possible. Adopt policies for its disinfection and decontamination to ensure it’s safe
  • Inform your patients and educate them regarding PPE
  • Minimise plastic and recycle plastic and paper where possible
  • Bamboo toothbrushes, compostable interdental aids and floss
  • Plastic-free toilet roll
  • Push for digital communication and records to minimise handling. This will significantly reduce waste.

Much like perio for the uninitiated…

I am hoping that our profession can address this serious issue with integrity and avoid any personal or financial gains from companies and sectors whose interests are conflicting with humanitarian interests.

There has obviously been an increase on plastic use in dentistry from the impact of COVID-19. However, the problem remains the same. The climate and ecological emergency is not going to go away unless we adopt sustainable and regenerative practices.

We need reasonable policies to implement and enforce those changes. And we should not pretend the responsibility is down to the individual.

In the meantime, sustainable dental practices remain a USP and not a standard. A little like periodontal disease, the patient may choose to ignore its subtle manifestations, carry on with their habits and not realise the detriment of the disease or seek help until it’s too late.

The use of plastic and short-term gain policies is much like the standard response of some of my perio patients: ‘But is there something else like antibiotics or a mouthwash I can use?’ as they seek an easy fix in the hope to remove all responsibility from the anguish and effort that is toothbrushing.

Yes, there is a bit of hassle. But not putting the work in at the beginning means an imminent and irreversible full clearance.


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