P2: Dental Practices Reasons for Change

There are many reasons to change to an environmentally-friendly dental practice. Protection of human health can be a concern when making choices about disinfectants, cleaning supplies, fixers, solvents, paint and building materials, and dental amalgam. Another reason for change is to save money. Practices that lower energy use, water consumption, and waste generation will reduce operating costs.

• Human Health
• Monetary Savings
• Waste Reduction

Human Health

Mercury is a major environmental pollutant affecting water, air and soil. Dental amalgam consists of elemental mercury, which does not degrade. Released into water, some of the mercury may be converted by environmental processes from elemental mercury to its most toxic form: methylmercury. Methylmercury bio-accumulates in the food chain because fish and other waterborne organisms cannot eliminate it from their tissues. Humans, at the top of the food chain, can accumulate the highest levels of mercury and pass it on to nursing children and developing babies.

• There are several ways that dental office mercury can enter the environment:
• Bulk mercury from past practices of mixing amalgam at the practice may have settled in sink traps and can still be leaching into the water years after its use was discontinued.
• Amalgam particles can be rinsed down drains.
• Poorly maintained chair-side traps and vacuum pump filters can release amalgam to water treatment plants, where it is captured in sludge. Mercury from this sludge may re-enter water when it is incinerated or land-applied.
• Dental amalgam placed in medical waste "red" bags is usually incinerated and can be released into the air. Medical waste incinerators are one of the leading sources of airborne mercury emissions.
• When amalgam waste is put in with regular garbage, mercury might leach into groundwater at the landfill.

Monetary Savings

A 2007 economic study commissioned by the Eco Dentistry Association examined ways that dentists can benefit their bottom line and the environment at the same time. Based on a dental office average of 16.5 patients per day and 3.5 operating chairs, the study evaluated the economic benefits of the following:

• Amalgam vs. tooth colored restorations
• Disposable paper cups vs. re-usable ceramic mugs
• Disposable items vs. cloth items
• Chemical sterilizers vs. steam sterilizers
• Paper billing/charting/scheduling vs. digital billing/charting/scheduling
• Traditional x-rays vs. digital x-rays
• Plastic suction tips vs. metal suction tips
• Standard efficiency HVAC vs. high efficiency HVAC
• Typical lighting vs. energy efficient lighting and motion sensors
• Wet dental vacuum pump vs. dry vacuum
• Standard paint vs. no VOC (volatile organic compound) paint
• Dispensing amalgam into water vs. amalgam separator

It found that significant savings can be realized from the implementation of many of these practices. Switching to cloth items yields the greatest annual savings. The quickest return on investment comes from switching to tooth colored restorations.

Members of the Eco Dentistry Association can download a calculator that assists dental clinics in determining how much they can save from various strategies.

Other environmental choices that save money include purchasing ENERGY STAR appliances, turning off equipment at night and installing low-flow faucets and toilets.

Waste Reduction

Dental offices that use disposable products produce a lot of waste. According to the Eco Dentistry Association, "The dental industry would prevent 680 million plastic and paper chair barriers, light handle covers and patient bibs, and 1.7 billion instrument sterilization pouches from ending up in landfills yearly, " if the industry as a whole switched to reusable products.

When using reusable products, as with disposables, it is important to follow guidelines for infectious disease control. For detailed information, see the Guidelines for infection control in dental health care settings from the Journal of the American Dental Association.

Paper billing and patient charting/scheduling is another source of waste produced by dental offices. The Eco Dentistry Association estimates that in one year the average dental office could save over 50,000 sheets of paper by going paperless.

Traditional x-rays also generate a lot of excess waste that could be eliminated by switching to digital x-ray equipment. In a time span of five years, the average dental office can reduce their waste by 200 liters of toxic x-ray fixer and 17,200 lead foils, according to the Eco Dentistry Association.

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