If you've ever sat in the dentist’s chair and wondered where all the latex gloves, chemicals and x-ray films end up or stopped to consider how much water and electricity the office uses, you aren't alone. Some dentists are starting to take off their protective eyewear and see the bigger picture.

The realisation of the "Green Dentistry" idea stems back to the 5th EDSA (European Dental Student Association) Congress of Belgrade, Serbia in March 2003, when the Greek delegation set the outline of the initiative and proposed the adoption of the project by the assembly. Currently, the countries which have adopted this project are Croatia, Sweden, the Netherlands, UK and Greece.

 The Eco-Dentistry Association defines green dentistry as practice that:

• Reduces waste and pollution;
• Saves energy, water and money;
• Incorporates high-tech innovations;
• And is wellness based.

Green certainly seems to be a buzzword right now, doesn't it? Whether it's automobiles or apples, seemingly everything has a “green” or “organic” connotation. So you must be asking yourself, “What does it mean to be green?”

A quick run-through the global facts suggests the following:

• We know that 1998 was globally the warmest year on record. The 10 warmest years on record have all occurred since 1990, and the 10 warmest days on record took place within the last 15 years. The warming has resulted in significant melting of the polar icecaps, resulting in a sea level increase of four to eight inches.
• More than 75% of wetlands have been lost.
• It is estimated that every three years, the amount of plastic in the ocean doubles. In a part of the Indian Ocean, there's a bigger mass of plastic than plankton.
• Today, manufacturers make an estimated 2000 million tons of plastic each year worldwide. Less than 3.5 percent is recycled, meaning every year we add 1930 million tons of plastic to the world — permanently.
• It takes approximately 350 years for an aluminium can to decompose.

Currently, the amount of waste generated by dental practices around the world is staggering, from mercury dumped in the wastewater to using large amounts of water and electricity. Eco-dentistry aids in identifying simple measures that we and our patients can take to reduce waste and conserve energy, thereby promoting awareness of the environment.

Current Scenario

In our country Biomedical Waste (Managing and Handling) Rules 1988 lay down clear methods for disposal of biomedical waste. Despite appropriate legislation and regulation, we do not pay heed to the overall picture of comprehensive patient care and treatment. Virtually all materials and medication used in the dental practice are potentially hazardous and require special handling treatment and disposal.

Hence, the dentist has the responsibility to maintain an "environmentally friendly" dental practice towards the patients, Office Staff, Helps, Himself/herself & the natural environment.

The three ‘W’s: What? Why? When?

WHAT?

Green dentistry (also known as eco-dentistry) is an environmentally friendly way of practising dentistry by using techniques and equipment to reduce waste, conserve energy , decrease pollution and reduce our carbon footprint. Aside from helping to protect the environment, going green can also help save money and time.

There is one simple answer to the question "What is green dentistry?" It's the first of the four R's - the one that comes before Reduce, Re-use & Recycle.

It's Re-think.

Rethinking is the most important, and the most fun aspect of a going-green lifestyle. Re-think your way of getting to work; re-think how far your food has to travel to reach your table; re-think your beauty-care products. If you can start this simple practice in your daily life, it will spill into your work habits, making green dentistry natural.

WHY?

Re-think your role. Your value to your patient lies in your technical skill, but also in your role as a health educator, co-therapist and coach.

The regulatory authorities like town corporations, municipal corporations and health authorities have been empowered by the judiciary to monitor and penalize the offenders of waste and garbage disposal. Our clinic normally has sharps, blood soaked cotton and gauze, saliva touched impression material etc. The authorities have defined the specific containers for disposal and if the clinician / hospital are guilty of not abiding by the code of disposal then they have the power of penalizing to the tune of Rs. 25,000 or imprisonment depending on the extent of violation.

Reduce waste & pollution

Re-think infection control and sterilization practices. Notice the waste generated from a single patient! The Eco-Dentistry Association (EDA) estimates 2.7 billion sterilization pouches and 6800 million chair barriers, light handle covers and patient drapes end up in landfill each year from dental offices around the globe. Consider these cost-saving, planet-saving options for reducing waste and pollution.

Save energy, water and money

Re-think your daily habits. Dental offices use a lot of electricity to run compressors, drills, overhead lights, operatory lights and computers. Dental vacuum systems can use as much as 360 gallons of water per day. It doesn't take replacing all the equipment in the practice today to go green. Simple changes in habits can make a big difference for the planet and the practice bottom line.

• Make sure your electronic equipment is turned off every night at the power strip. This will reduce "phantom load" which is estimated to account for 10% of the typical energy bill.
• Reduce the use of disposables and switch to re-usables. You will lower your practice overhead, and attract green dentistry patients who prioritize their health.

WHEN? Now.

Some popular examples of eco-dentistry are the following:

Conserving energy

There is a real need to conserve energy, as frequent electricity blackouts are a testimony of. Switching off unused lights, and having traditional light bulbs replaced with energy-efficient versions where possible is today’s call. Outside lights maybe put on timers, and only switched on at night.

The lighting is low-energy in the communal areas and low-voltage in the treatment rooms; renewable energy powers the practice. The heating and cooling units are the most energy-efficient on the market, the computer screens are energy-star rated

Traditional incandescent lights are incredibly inefficient. For every watt of energy consumed, only 10 percent is used to produce light — that means the remaining 90 percent is released as heat. It's a waste of power and a fire and burn hazard because of the heat generated. For this reason, compact fluorescent light (CFL) bulbs are becoming more and more popular. Essentially mini versions of the large overhead fluorescent lights found in office buildings and schools, most CFL bulbs last 8 to 12 times longer than incandescents, at a quarter the cost per hour. They also produce 70 percent less heat than incandescents while illuminated, so heat waste is a nonissue.

CFLs do cost more, but given their longer life and energy savings, the cost is worth it. It is estimated that replacing just five incandescent lights with CFLs, a standard office could save up to Rs. 5000 per year. Over the span of 10,000 hours, a CFL can cost less than half of an incandescent.

What to do with burned out light bulbs? All types of bulbs contain a small amount of hazardous waste. CFL bulbs contain mercury and incandescent bulbs and LEDs contain lead. For this reason, avoid tossing burned out bulbs into the regular trash; these toxic substances are best kept out of the landfill. Treat burned out bulbs as hazardous waste — dispose them off at your local hazardous waste site or seek out recycling centers that will accept lightbulbs.

A common thought is that the surge of power that happens when lights are turned on and off takes more energy than just leaving the lights on. This is not true. The relatively higher in–rush lasts just 1/120th of a second, according to the Department of Energy. The amount of additional electricity consumed, equals only a few seconds of normal light operation. So unless you plan to leave the room and return in less than five seconds, you'll save more energy by turning off fluorescent lights too.

Motion sensors in rooms keep unnecessary lights off, therefore reducing energy usage.

Conserving water

Dental surgeries waste a lot of water on an annual basis. This is usually the result of leaving taps running while dentists, staff and patients wash their hands. brush their teeth or rinse their mouths. Simply turning the tap off during washing will save a huge amount of water over a period of time. Pouring some water into a cup and using that for rinsing maybe a responsible deed. Dental staff needs to be trained to use predetermined amounts of water for mixing dental materials. This not only reduces monthly bills but contributes positively towards water conservation.

It is important for a dentist and the staff to wash their hands. However, so much water is wasted every single day in many different establishments. Water is wasted by letting it run when doing something instead of turning it off. One would be amazed how many individuals will wash their hands and leave it running while they dry their hands. You would be also amazed to know how much water is going down the drain while the drying is occurring. Because dentists and their staff have to frequently wash their hands, it is important to turn the water off when it is not in use. To remind everyone, it is good to put a sign at each sink in the office.

Another way in which a green dentist conserves water is by not having sinks in the treatment rooms. This is a form of green dentistry that is occurring in a lot of new offices. The dentists do not have sinks installed in their treatment rooms. Instead, they have a sink installed in one location. This conserves on the materials that are used to build and install the sink. This also helps staff members avoid using the many sinks and accidentally wasting water. It is easier to keep tabs on one sink instead of six or seven. More water is going to be used from six or seven sinks versus just one or two.

A green dentist may also opt to turn the water off at existing sinks within treatment rooms. This will force everyone to use the one sink that is designated for employees. Even for bathroom sinks that are used by the general public, a nice sign that states the office is conserving water can be easily understood. A sign such as, "Please turn off the water when not in use" will get the message across. Taking these measures could conserve up to a gallon of water a minute.

Reducing radiation

Using digital radiation techniques rather than conventional radiation techniques reduces the amount of radiation that the patient is exposed to by up to 90%, while at the same time the amount of radiation sent into the universe is reduced. Image quality is not only better (therefore less x-rays are needed to get just the correct image), but our carbon footprint is smaller because we no longer have to use toxic developers and fixers to get the image on a plastic film. By switching to digital X-rays, it is estimated that each dental surgery would prevent the disposal of around 200 litres of toxic dental X-ray fixer and more than 7,200 lead foils (part of the packaging of the conventional x-rays) over a five year period. And our patients will have the added advantage that their x-rays can be sent around through the world wide web. Storage of conventional x-rays usually pose a major problem in the long run.

Reuse / Recycle

Paper can be recycled, even the ads & reminders from companies can be used to print internal office information on the other side or as a mixing pad to manipulate dental materials! Paper or plastic products, magazines, and general waste should be placed in recycle containers. Recycling helps to reduce costs as well as cutting down on waste.

All the water in the practice can go through a filter that diminishes calcium and other deposits, increasing the longevity of the instruments and reducing the need for maintenance.

Many offices use paper cups for various reasons. Those paper cups can be recycled. Employees drink beverages throughout the day in both cans and plastic bottles, so a recycling program amongst the employees can be implemented. There's just so much that can be done within the office of a green dentist and a lot of those things are being done.

Dual-flush-valve toilets and hand sprays may be used to sterilize hands are just some of the other measures designed to keep water use to a minimum.

Just don’t be surprised if you are asked not to flush!

Go paperless

Nowadays, most companies depend on computer technology to do accounts, keep client records, make appointments, communicate with clients and other companies, pay bills, online banking and many other important everyday functions. Dental practices are becoming increasingly reliant on computers but most of us still use paper records, appointment books and paper forms, which means a significant amount of paper is being used. The only printed statement that cannot be digitalised is probably the patient prescription that he/she receives on the day of treatment. In case patients later require another copy or another document, this can be emailed to them as a pdf.

Paper or Plastic? Neither. Ask for cloth.

Use eco-friendly reusable sterilization pouches and cloth barriers, drapes and headrests, instead of paper or plastic. Studies show that using cloth sterilization methods diverts nearly 5000 pieces of paper and 5000 pieces of plastic from the average dental practice in just one year. Using fabric patient drapes instead of 2-ply paper or 1-ply plastic drapes diverts 10000 pieces of paper and 5000 pieces of plastic from landfill annually.

Paper and printing

Since the onset of personal computers, the amount of paper generated has skyrocketed. Not only is paper a waste product, it's expensive and diminishes natural resources. By reducing the amount of paper used in your office, you can reduce the amount of paper needed to be stored and purchased. Come up with milestone goals for the percentage reduction in paper usage. Encourage everyone to think before printing, and make sure everything is accurate before hitting the print button. When making copies, can the document be double–sided? Are handouts really necessary for a staff meeting? A simple rule: Think about the importance of a copy before making or printing it.

Speaking of printing, what about ways to save on the ink you're using in the office? If you must print a document that may not be final, print it in draft mode. The draft mode on your printer uses approximately 50 percent of the ink used in normal print mode.

Some software is also available that will lower the amount of ink used per print. ecoPrint2 Ink and Toner Saver can reduce up to 75% of your ink usage and it can be used with any printer, as well as printers shared over any Local Area Network (LAN). When activated, ecoPrint2 Ink and Toner Saver resides in the system tray and does its work in the background, so there is no need to make adjustments every time you print. New ink saving settings can be activated via one click. Download it at www.zdnetasia.com/downloads.

Incorporate High-Tech

There is a 1:1 correlation between high-tech dentistry and eco-friendly dentistry.

• Learn to use diode lasers for periodontal therapy.
• Use digital imaging. If your practice hasn't made the switch, become familiar with how to operate the various digital imaging systems on the market so you're green-office ready.

Miscellaneous

Wooden floors are made from sustainable wood which are fully biodegradable and naturally inhibit bacterial growth. Use of steam-based instrument sterilization, which contains no harmful chemicals, prevention of pollution of the water system through a special filtration system to allow environmentally sound disposal of old mercury fillings, equipping of the office with all energy conserving appliances, installing only energy efficient  lighting, using natural cooling via ventilation instead of energy consuming air conditioners, printing of business cards and pamphlets with soy ink etc may contribute towards our green destination.

In addition to efforts towards a paperless office, eliminating the use of plastic bottles and cans, and printing business cards and pamphlets with vegetable-based ink, sustainable architectural panels made from eco-resins, with organic acoustic insulation constructed from recycled denim jeans go a long way justifying green dentistry. Every surface from the floors to the cabinetry should be thoughtfully procured for zero PVC and formaldehyde content, as well as being chlorine-free.

Electronics in the office

Should computers sleep or shut down? When you're not using your computer, you have a few power–down options for saving energy. The most efficient one is turning off the computer. It's true that a surge of energy is released when you turn it back on, but that surge is not large enough to outbalance the amount of energy saved by turning the computer off. Going into sleep or stand–by mode causes the computer to consume 70 % less electricity. Screen savers can actually use as much energy as an active screen.

So does this really matter? The Green Electronics Council has evaluated the environmental effects of six months of computer ecology. The results show that, by going green, in six months' time, global computer users saved 13.7 billion kilowatt hours of electricity and prevented more than a million tons of greenhouse gases from escaping into the atmosphere.

The office television is another energy guzzler. Be sure to unplug it when not in use. Some models may consume more electricity in 20 hours of being off than they do in four hours of being on. Off isn't really off. Most TVs remain in low–energy standby mode when turned off so they can instantly respond to remote controls. If you have a VCR or DVD with the TV, consider using a power strip that can turn them all on and off with one click, saving energy on multiple items.

How can the patient help?

Patients can also do their bit to help save the environment. Ideas to help out include turning off the taps when washing your hands, sharing lifts to or from the dentist or using public transport (where possible) and recycling waste. The drive for greener dentistry is still in its infancy so there is no doubt that more improvement is needed & we alongwith our patients & office staff need to be a part of the movement.

Let your patients know that you are “going Green!” & ask them to contribute to your movement. School & College-going kids would respond more enthusiastically to you.

Share the "Save 90 A Day!" campaign with your patients, encouraging them to turn off the water while they brush their teeth, saving as much as 90 glasses of water per day.

The ladder towards a ‘green’ dental practice

Green dentistry is a whole-earth approach to tooth care that reduces the environmental impact of dentistry and creates a caring environment for clients.

• Office may be designed to maximize energy efficiency and reduce our carbon footprint.
• We may use state-of-the-art dental technology to minimize toxic pollution and water waste.
• Our patients should not be exposed radiation which can be done by means of digital imaging technology instead of x-rays for tooth imaging. This also eliminates the need for toxic x-ray development chemicals.
• Use of steam-based, surgical-grade instrument sterilization, contains no harmful chemicals and reduces water use.
• Installation of a special water filtration system allows for the environmentally sound disposal of old mercury fillings, to prevent pollution of our local water ways.
• Biodegradable sterilization solutions may be used to clean examination areas.

Universal Recommendations

• The introduction of this concept as a standalone domain in dental education can be a first step forward in order to shape environmentally conscious future dentists.
• Development of adequate information for proper disposal and treatment of dental waste.
• Also our dental schools should dedicate adequate curriculum time and emphasis on environment awareness of dental students during their training.
• All our efforts should converge so that an environmentally friendly dental practice is the one in which the practitioners choices for "Green Practice" are easy ones.
• Low voltage and the heating and cooling units used are energy efficient.
• Indoor plants, air filtration system and a commitment to reduce office waste (recycle) are simple changes that do not cost much and are a good place to start.

A students initiative for an environmentally responsible Dental Practice

During the last decades, public awareness and professional accountability on environmental issues has been increasing steadily, as human activities have already resulted in irreversible global changes. “Green” recommendations, regulations and products are now common in many domains of everyday life, whereas their actual contribution is not always supported by hard evidence.

There has been an obvious lack of appropriate legislation and regulations for managing dental waste, whereas the infrastracture for proper disposal and treatment of dental waste needs to be developed. Also, most dental schools do not dedicate adequate curriculum time and emphasis on enviromental awareness of dental students during their training. The main goal of this movement is to inform the dental community, especially students, about the contemporary literature on dental waste production and disposal, but most of all to sensitize all those involved in dental education for a set of actions that will lead to an environmentally responsible dental practice.

The initiative “Green Dentistry—Environmentally responsible dental practice” is a project that operates under the auspices of the European Dental Students Association (EDSA, www.edsa-net.org), through the “Youth” program.

Also, many local dental associations are taking the initiative to spread the word. It is appreciable for dental students to find out & be part of such initiatives. One such global project taskforce is consisted of eleven individuals who have graduated or are studying at the Schools of Dentistry, Chemical Engineering and Political Sciences of Athens University. The taskforce has the scientific support of Assoc. Professor John Tzoutzas, Ass. Professor Argy Polychronopoulou, and Dr. Aristomenis Syngelakis, all from Athens Dental School.

5 ways to go green!

You don’t have to be “San Diego’s Green Dentist” to make a difference in the environment. Follow these five simple steps and you’ll help save our natural resources every time you brush! Turn It Off! Don’t leave the water running while you’re brushing. Turn it only to rinse your mouth and your brush (you don’t even need to use water before you brush!) Go Natural. Next time you buy toothpaste, pick a natural option like Tom’s rather than your normal choice. Natural toothpaste breaks down easier and helps protect our water ways. Compost! Yup… Compost. Buy a composting (or biodegradable) toothbrush. Typically made of corn starch, these brushes won’t clog our landfill (and some can even help your garden grow!) Soft as a baby’s... Don’t brush so hard, slow down and be gentle on your gums. Not only will it save your gums, it will also make your toothbrush last a lot longer, saving you money and reducing waste. Floss! You hear it all the time: “Flossing is the most important thing you can do for your teeth.” But did you know flossing can also help the environment? By flossing regularly you’ll help prevent major dental work, saving you money and reducing amount of chemicals most traditional dentists use when filling cavities.

DOMAINS OF GREEN DENTISTRY
1.	Increase “environmental awareness” and sensitivity among the dental professionals.
2.	Encouragement of procedures, regulations and policies compatible with the EU strategy for “sustainable development”.
3.	Production of electronic and printed informative material to address and communicate the information to the dental society, particularly towards dental students and young dentists.
4.	Establishment of a network of cooperation, exchange of information and opinions, proposals and innovations concerning the “Environmentally responsible dental practice” in Europe and internationally.

Conclusion

During the last decades, public awareness and professional accountability on environmental issues has been increasing steadily as human activities have already resulted in irreversible global changes.

"Green" recommendation regulations and products are now common in many domains of everyday life. The main goal of this project is to inform the dental community especially students on contemporary literature on dental waste production and disposal. But most of all it is important to sensitize all those involved in dental education for a set of actions that will lead to an environmentally responsible dental practice.

It is easy for people to be sceptical and wonder what kind of difference simply turning off a few light bulbs and recycling some paper will do. However, research has shown that making simple changes can make a huge difference to the environment in a very short space of time. As well as helping to protect the environment, deciding to go green can also reduce costs and lower bills.

With every green dentist, a great impact is made. However, that impact can be made greater as more dentists join the green dentistry movement and help make the world a cleaner and healthier place.