Waste management in dentistry

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waste management in dentistry
Photo: racorn – 123RF

Australian dental professionals have a duty of care for the correct management of waste within their practice. So what lengths are clinics going to, to help reduce their carbon footprint? Tracey Porter reports

Most dentists recognise that infection control and ecologically sustainable products do not always make the most convenient of bedfellows. 

Despite this, the team at Caulfield Park Dentists and Dentimed takes seriously its responsibilities to reduce their impact on the environment. 

One of a growing number of Australian practices taking their lead from organisations such as America’s Eco Dentistry Organisation, the Victorian clinic’s efforts extend well beyond favouring digital communication over paper or recommending biodegradable toothbrushes to its patients.

Instead, clinics such as Caulfield’s are always looking to make their practice more sustainable by incorporating everything from natural PH, biodegradable disinfection solutions and toothpaste without triclosan, to BPA-free composite resin filling materials and waterless vacuum systems. 

In Caulfield’s case, the clinic has switched to ozone-based options for many of their disinfection needs. These include ozone generators that purify the environmental air, ozone generators for surface disinfection and pre-operative rinses and personal use ozone generators to replace mouth washes for patients. 

“Ozonated water (when used correctly) is a very safe and proven method of managing infection control and is safe for the environment and the individuals that use it. By making the switch to ozone, we have reduced the number of chemicals used daily to a minimum,” says Lesa Sabey, Caulfield’s practice development and training coordinator.

In addition, the clinic now ensures it only uses digital X-rays which emit much lower levels of radiation while removing the need for film, development chemicals, and lead foil papers—materials that are harmful to people and to the environment. Digital scanning (for dental models) removes the need for plaster models and thus couriers and subsequent landfill, and even barrier gowns are washable as opposed to a “disposable (and not white—so no bleach)” alternative.

Bytes of Northcote owner and practice manager Nadia Boermans is another who is adamant she will not contribute to the sector’s reputation as one of the highest users of single-use plastics. 

Boermans says her clinic was founded six years ago with the specific aim of reducing its carbon footprint.

“This was very important to us as we knew the industry had been terrible with waste in the past and we also knew that with the right set-up and knowledge this could be significantly reduced. We wanted to offer high-end dental whilst being as gentle on the environment as possible. When we started there was only one brand of composite filling material that was BPA-free. Now almost all the companies that make composites have a BPA-free alternative.” 

Boermans says her clinic makes use of autoclaves to do all the steam sterilising but they have also sourced some great brands that have biodegradable barrier sleeves. UV-C LED ozone light disinfection systems are used between patients while vac-stations eliminate aerosol residue in rooms.

In addition, plaster and mercury traps are fitted to all sinks to catch all waste before it runs into the waterways.

We knew the industry had been terrible with waste in the past and we also knew that with the right set-up and knowledge this could be significantly reduced. We wanted to offer high-end dental whilst being as gentle on the environment as possible.

Nadia Boermans, owner and practice manager, Bytes of Northcote

“We [also] take out a lot of amalgam fillings in patients and knowing this toxic mercury is not entering our drains is a game changer.”

In doing so, they are helping eradicate one of the industry’s most toxic products.

In 2009, medical students from the University of Sarajevo undertook a study which looked at the impact of dental waste on public health. Their investigations showed that although individual dentists generate only small amounts of environmentally unfriendly waste, the accumulated waste produced by the profession may have a “significant” environmental impact.

The report, ‘Dental Office Waste – Public Health and Ecological Risk’, identified that one of the biggest threats posed by dental waste in recent years was the impact of heavy metal contamination of water systems by dentists, particularly through the production of dental amalgam waste. 

Although dental amalgam is a durable, cost-effective and long-lasting restorative material, it contains several metals that can enter the environment. Mercury, which makes up to 50 per cent by weight of dental amalgam, is known to have toxic effects in plants, animals and humans. 

In 2013, the Minamata Convention on Mercury was introduced. The multilateral environmental agreement addresses specific human activities which are contributing to widespread mercury pollution. In 2014/15 it is believed Australia’s share of mercury pollution attributed to dental amalgam waste was approximately 1.3 tonnes out of 17.8 tonnes for that year, i.e. seven per cent of total output.

While Australia signed the Minamata Convention in October 2013, indicating it agrees, in principle, to its objectives and obligations, it has not yet been ratified meaning it is not yet legally binding.

In his 2017 submission regarding the National Phase down of Mercury, the Australian Dental Association’s (ADA) then-president Dr Hugo Sachs noted the sector had experienced a “considerable and consistent” natural patient trend away from choosing dental amalgam in fillings. 

The use of mercury aside, the ADA now has clear guidelines on the subject of sustainable practices with its policies advising Australian dental laboratories and surgeries of the need to limit the use of single-use items when possible, except for infection control, utilise re-useable face shields, re-use laboratory and postal boxes, update operating lights to LED and use biodegradable cleaning agents. 

It also suggests that clinics consider using solar hot water and electricity panels, and passive heating/cooling systems as well as use digital imaging of radiographs and clinical photographs, produce eNewsletters and keep digital as opposed to paper records.

But the Caulfield’s team believes there’s still more the ADA and other industry leaders could do to encourage larger numbers of dental practices to follow the green dentistry route. 

Stabey says these include putting together documents or websites outlining the range of different products available with a rating system in terms of their environmental friendliness and user-safety, working with manufacturers to develop eco-friendly PPE, and stopping unsolicited samples.

“When it’s all said and done, the largest reason for a dental practice’s environmental impact is mostly about infection control and this cannot be compromised. Finding the balance between the environment and good infection control is a significant juggle and deserves a lot more discussion.” 

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