Dentistry is going Green?
There are a number of eco-friendly disruptions brought on by socially minded groups that are happening in dentistry that are highlighting my dental practice’s competitive vulnerabilities, while at the same time representing opportunities to turn those vulnerabilities into sustainable competitive advantages for many years to come. As of late, there has been a tremendous debate in dentistry in the area of sustainability. This debate has brought together dental professionals from all aspects of the industry, including academia and clinical practice, along with members of public health, regulatory, and government sectors to propagate to the dental world the importance of sustainability. Our dental regulatory college, the Royal College of Dental Surgeons of Ontario, is considering regulatory changes to encourage the adoption of sustainable practices and a push towards development of technology to facilitate these changes. This disruption is also exacerbated by the fact that a younger generation of dentists and millennials are concerned about the environment and global warming, and want to actively pursue more sustainable practices.
Why Green Dentistry?
Dentistry is a very competitive industry and the latest buzz word used by many dentists to promote their clinics and differentiate themselves from other clinics is “Green Dentistry”. Green dentistry helps dentists identify gaps which need to be addressed in the area of sustainability, in order to promote and help dentists make impactful changes. Most of these concepts are foreign to the older generation of dentists. The introduction of green dentistry has also brought on debates of sunk costs involved to move towards this type of practice and perceived ongoing financial burdens. Proponents of green dentistry argue that sustainable practice conserves money and time by reducing waste, conserving energy, and decreasing pollution.
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In healthcare, dentists usually have the tendency to not adopt new technologies or concepts as quickly as other healthcare professionals. This is usually due to the fact that small changes in dentistry can cost a great deal, and given that our fixed and variable expenses are already higher compared to many of the other healthcare professions, change comes about slowly. This, coupled with the fact that climate change, until recently, was never mentioned in dentistry, makes this a foreign concept to many dentists. Green dentistry aims to teach the dental industry how dentists can take better care of the planet while at the same time running a successful business. The main priority for dentists has always been their patients and being green has not been at the forefront of many dentists’ minds. This is because dentists are usually so busy running from one room to another putting quality first, while at the same time paying close attention to the strict sterilization and safety guidelines that we have to adhere to, which were further tightened by new Public Health policies last year. Figuring out how to deal with these regulations in a sustainable way is a big challenge for dentists.
Green dentistry is forcing dentists to take responsibility for meeting the demands of society to reduce their impact on the environment. I believe that the only way for mass adoption of sustainability in dentistry is for dental bodies to develop guidelines and a framework for dentists to implement these concepts on an ongoing basis. If dentists turn a blind eye to the impact that their clinics have on the environment, then we will never identify opportunities to intervene. Sustainability needs to be engraved in every dentist’s mind and should be incorporated in dental school curriculums. National authorities and scholars should encourage research on the environmental impact of dental practices, and integrate the concept of sustainability into their continuing dental education programs. Such sustainable frameworks, specific to dentistry, are not yet available to provide leadership in converting the concept of green dentistry into a daily routine.
Green Dentistry and the Dental Team
I also believe that dentists should take time out of their busy schedules to educate their teams on concepts of green dentistry, in the form of office meetings and training sessions. These meetings should stress to the staff that whenever possible, the goal should be to reduce the consumption of energy, water, any materials which could be harmful to the environment. The reason why I stated “whenever possible” is because we should not forget that as healthcare professionals our ethical and moral standards should always be to the patient, and those lines should never be blurred.
Green Dentistry and Stakeholders
In addition to the oral health team, sustainability in dentistry involves many stakeholders who all have a role to play, including the government, educators, manufacturers, suppliers, dental equipment technicians, and waste removal companies. Green dentistry means rethinking dentistry, starting from processes, administration, all way to the design of our offices. This re-thinking sometimes has to start from the dental supply manufacturers since they are few in number and operate nationally. Such engagement is important as without manufacturers and suppliers seeking to reduce their carbon emissions, it makes mass adoption difficult. Dental product companies should be pressured to offer more sustainable, environmentally friendly, and socially responsible products, which will indirectly lead to dentists having no choice but to use these products, thus reducing the environmental impact.
Barriers to Adopting Green Dentistry
There is limited priority given to sustainability in dentistry due to lack of awareness, few drivers to influence change, and the various perceived barriers. Dentists need to realize that in sustainable businesses, long-term profitability takes precedence over short-term gains. Hence, dentists need to develop office policies and manuals with these concepts in mind. For a lot of practices, these manuals and policies have not been updated since the dentist started practicing, which means that any change will seem like a major change and barrier to their daily routine. These attitudinal issues stem as a barrier from the dentist towards going green since there is little motivation to do so. Barriers to the shift to green dentistry also include perceptions that being sustainable increases costs. Dentistry in Canada is already perceived as expensive to most patients. A lot of dentists feel like these costs will lead to increased expenses and ultimately increased costs to the patients, which can lead to them losing patients. However, in reality, adopting a green mentality for the office lowers expenses, leading to increased profits. As green technologies mature and become more readily accessible, costs for going green will ultimately decrease. I believe that going green will eventually be the only financially advantageous option in the highly saturated dental market.
As mentioned above, redevelopment of a mindset to incorporate green policies requires a shift in thinking that our responsibility as healthcare professionals to our patients is matched by our responsibilities as citizens to the world that we live in. Since there is a lack of appropriate guidance by our regulatory bodies towards sustainable dentistry, dentists have to take their own initiatives and ownership. This means that it is a matter of choice for dentists to choose green products and practices, and to realize that change is not always easy, but that even one practice can make a difference. The impact can be made greater as more dentists join the green dentistry movement and help make the world a cleaner place.
Dental Practice Waste
Four main processes are responsible for most dental practice waste:
- Sterilization and cleaning methods (disposable barriers and toxic chemicals).
- Conventional x-rays create toxic chemicals and waste. Even though digital x-rays have been around for a few years, older generation dentists don’t see the “benefits” since it comes with a higher price tag compared to conventional x-rays.
- Conventional suction systems use a tremendous amount of water. Dry suction systems use no water but usually cost more than double the conventional systems.
- Major mercury release to the environment comes from use of amalgam in dental restorations. For the older generation dentists, amalgam restorations were the only direct restoration material they were thought to use.
Green Dentistry and Marketing Benefits
A green dentistry approach can help reduce waste and save water, energy, and time. As these benefits become more publicized, more dental practices will ultimately have no choice but to move towards a sustainable approach to cater towards consumers who care about the planet. Sustainability is a priority for modern patients, particularly the millennials. This means that a green dental practice is a marketable dental practice which can actually be good for your bottom line. These types of patients tend to be loyal to the practice and the great cause, and are likely to share their positive experiences with other patients, increasing word-of-mouth referrals. Hence, green dental policies will eventually lead to a booming practice that is not easy to replicate, giving the dentist a sustainable competitive advantage.
Green Dentistry and the Role of Technology
Almost every high-technology innovation in dentistry seems to also have environmental benefits, thus amplifying the opportunities in this disruption by using high-tech innovations to differentiate a practice from the rest. These new technologies can be profitable and boost the financial success of a dental practice. For example, an important innovation in dentistry was the introduction of computer-aided technology/computer-aided manufacturing (CAD/CAM) technology. Over the years, improvements in digital impressions have made it more practical for day-to-day use. CAD/CAM technology is very convenient as it helps in completion of restorations that would normally take a two week span in a single appointment, lowering carbon emissions because of reduced patient travel to the office. CAD/CAM systems also eliminate the need for disposable impression materials, packaging, storage, and shipping of these impressions back and forth between the dental lab and the office, while significantly increasing accuracy and productivity. In addition to CAD/CAM technology, the following high-tech innovations are also part of green dentistry that should be adopted by all dentists:
- Digital X-rays.
- Steam sterilizers that eliminate use of toxic chemicals.
- Digital patient charts, reducing paper waste.
- Digital marketing, reducing paper flyers and the shipping carbon emissions.
Internal Hurdles to High-Tech Green Dentistry
A barrier to this technology and an internal hurdle that I face when wanting to implement this technology in my offices is cost. New technologies in dentistry are typically expensive and there has to be a financial justification for upgrading a procedure or machine that in my teams’ staff eyes is already working well. Staff are also not fund of the learning curve that a new technology needs in order to be adopted efficiently. For example, a typical CAD/CAM machine (called a CEREC machine) for a single practice has a price tag of $150,000, meaning that the patients in that clinic must not only have a high dental IQ, they must also have a green mindset to not mind paying a little more for something that is better for the environment and saves them time. To stay ahead of the competition, I purchased a CEREC for one of my clinics two years ago and the productivity improvements and patient “wow” factor has been outstanding, not to mention the environmental benefits. However, I have also had to deal with the mindset by my staff that if the office can afford a new machine for $150,000, then the office can afford to increase their salaries. They also had to go through two weeks of training which meant breaking the routines that they were used to. These internal hurdles mean that until technologies like this become more mainstream and mass adoption does not happen, the “don’t fix it if it isn’t broke” mentality in dentistry seems to be prevailing. For me to get over this hurdle, I have had to invest time, money, and resources to educate my staff in the benefits of the technology, not only for them but also for their patients and the planet.
Conclusion
As a practicing dentist, my leadership for my clinics has always been geared towards optimal and quality dental care for our patients. Yet unbeknownst to myself, and most dentists, our practices contribute significantly to global pollution and warming. So now, as a healthcare professional, I believe it is our duty to do something by our own will, not because we are forced to, to make the world a better place for the next generations to come. Building a green dental office is not just an investment in a clean future , it is also an excellent, ethical, business decision.
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