Sustainability in dentistry

DOI: 10.3238/dzz-int.2020.0203-0205



Translation from German: Cristian Miron

Citation: Hlawa I, Lang H: Sustainability in dentistry Dtsch Zahnärztl Z Int 2020; 2: 203–205–0205


In many areas of life, sustainability, environmental protection and resource conservation are part of social and political discussions. It has been known for nearly 20 years that healthcare systems may also have a negative impact on the environment [10]. Likewise, dental healthcare has contributed to climate change and environmental pollution over time due to the required use of large amounts of electricity, water and plastic. However, dentists around the world are searching for ways to design processes of dental practices that are more resource-efficient and sustainable. In the following article, the current state of academic literature will be examined in detail.


In scientific databases, the number of publications pertaining to the relatively young field of “sustainability science” has increased noticeably over the last 10 years in both medicine and dentistry. However, to date, as far as comprehensive systematic reviews and meta-analyses are concerned, only a few publications can be found; this is due to the fact that the environmental impact of dental practice is very diverse and uniform quantifications are difficult to obtain. The lack of standardized study designs thus leads to publications with a broad spectrum.

There are a variety of articles in specialist journals which discuss strategies for environmentally friendly or “green dentistry” [2, 4, 8]. Furthermore, scientific studies have explored the environmental impact of disposable or reusable materials, as well as the quantity and quality of dental waste [5, 18, 19]. Moreover, through questionnaire-based interviews, the level of understanding and the prevailing attitudes towards the concept of “green dentistry” have been investigated [1, 16].


The first recorded reference to the term “eco-friendly dentistry” goes back to a Canadian study which was published in 2007. The authors defined it as “an approach to dentistry that implements sustainable practices by keeping the consumption of resources in harmony with nature, protecting the external environment by eliminating or reducing waste, and promoting the well-being of all persons in the clinical environment by consciously reducing the chemicals in the air we breathe” [9].

Ten years later, in a secondary data analysis that is still unique to this day, Duane et al. determined the estimated ecological impact of dentistry in terms of emissions. The results show that the emissions for the National Health Service in England amounted to 675 kilotons of carbon dioxide equivalents in one year. Interestingly, within the spectrum of dental treatment, “dental check ups” contributed to the largest share of emissions (27.1 %). Although the least amount of CO2 is produced per individual appointment, this dental procedure is by far the most frequently performed. With regard to dentistry as a whole, almost two-thirds (64.5 %) of emissions stem from employee and patient commutes, 19 % are caused by the purchasing of dental products and 15.3 % by the energy consumption of buildings and equipment in dental offices [6].

Only few industrialized countries have publically disclosed the share of emissions arising from their general health care system in proportion to the country’s total yearly emissions. For instance, emissions amount to about 10 % for the USA, 7 % for Australia and 3 % for the National Health Service in England [6, 7, 11].

Although research suggests that the (dental) medical sector has a detrimental impact on the environment, the understanding for increased sustainability must continue to grow. In a prospective questionnaire study implemented in Romania in 2015, Popa et al. showed that dental professionals and students were interested in environmentally friendly alternatives. However, the concept of “green dentistry” was not well understood, shown for example by their lack of understanding of the environmental risks of incorrect waste disposal [15]. In two other studies conducted among Indian dentists, a positive attitude towards adopting “green dentistry” measures was determined. From the pool of 800 dentists which were surveyed, 91.9 % of dentists claimed to be open towards implementing new strategies [1].

Concept of “green dentistry”

“Green dentistry”, first mentioned by Pockrass in 2008 [14], is a multidisciplinary approach and a concept that has been adopted across numerous academic articles that focus on the efficient use of resources in the dental practice. The concept can easily be summarized by the four R‘s: Reduce, Reuse, Recycle and Rethink.

Reduce: This requirement emphasizes the reduction of energy and resource consumption. The use of energy-efficient light sources, the switching off of devices as well as the use of digital documentation systems instead of paper or lead foil are environmentally friendlier and can additionally reduce the costs for electricity consumption in dental offices [17].

Reuse: The use of reusable and autoclavable instruments, suction tips, patient bibs, chair covers and water cups could significantly reduce the enormous amount of plastic waste. Petroleum-based plastics are only recyclable to a limited extent and they result in environmental pollution that lasts for several centuries [13]. In cases where disposables are absolutely necessary, alternatives such as plant-based and biodegradable plastics for disposables in the dental industry should be considered.

Recycle: A study conducted in Iran by Momeni et al. in 2017 showed that most of the waste generated in a dental clinic was semi-household waste which could easily be recycled. They also found that more than half of the dental clinics that which participated in the study had not implemented waste reduction or recycling programs [12].

Rethink: Rethinking already established processes can reduce their negative environmental impact and promote sustainable development. Besides waste disposal and sepa­ration, this includes optimizing office processes, rethinking the use of reusable materials and consumption of renewable energy [3].


The scientific interest with respect to the possible influence of dental or medical technologies on the environment has grown since the beginning of the 21st century. Regardless of the indispensable and positive impact of these technologies, topics such as environmental protection and sustainability are very likely to play an increasingly important role in this existential field in the future. This requires not only the development of strategies for applying “sustainability” in the dental office, but also the realization of studies on implementation and effectiveness of such strategies. In order to increase the accep­tance of novel concepts, it is inevitable that obstacles must be consid­ered and analyzed. The fact that a sustainable approach to medicine is not always impartial is often reflected in the frequently cited concerns about the quality of treatment and hygiene regulations. However, these concerns fail to notice that a large part of the potential measures to protect the environment and make dentistry more sustainable, can be implemented outside the immediate treatment room. Frankly, decades after the development of the concept of “green dentistry”, there is still a clear need for research into the knowledge and practices of environmentally friendly dentistry in order to thoroughly establish this concept in the future and make it accessible to as many dentists as possible.

Conflicts of interest

The authors declares that there is no conflict of interest within the meaning of the guidelines of the International Committee of Medical Journal Editors.


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Imke Hlawa

University Medicine Rostock

Polyclinic for Dental Preservation

and Periodontology

Strempelstr. 13, 18057 Rostock

(Photo: Imke Hlawa)

Prof. Dr. Hermann Lang

University Medicine Rostock

Polyclinic for Dental Preservation

and Periodontology

Strempelstr. 13, 18057 Rostock

(Photo: Herrmann Lang)

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