Quantification of Single Use Plastics Waste Generated in Clinical Dental Practice and Hospital Settings

Curriculum content for Environmental Sustainability in Dentistry

OBJECTIVES

(i) To identify suitable strategies and opportunities to embed Environmental Sustainability (ES) within an existing Oral Health Professional (OHP) curriculum through a series of focus groups with students and academic staff and (ii) To create high-level evidence-based and subject-specific ES content through an approach grounded in evidence and collaboration with key stakeholders in OHP education.

METHODS

Focus groups were used to explore academic staff and student views on appropriate teaching and assessment methods for ES. Content statements were developed from an extensive literature search, mapped to curriculum subjects, and validated through consultation with students, discipline-experts and education-experts.

RESULTS

Five themes were identified from the focus groups: ES transcends all disciplines of dentistry and oral healthcare; baseline knowledge transmission with relevant practical application; viewing and modifying existing teaching and assessment events through a different lens; normalising the topic of ES to support attitude and behaviour change and safeguarding against misinformation and disinformation. Forty-four content statements were developed and mapped to nineteen curriculum subjects.

CONCLUSIONS

This study identifies for the first time a comprehensive strategy for the inclusion and delivery of ES (method and content) in the curriculum. A novel method to define and map curriculum content has been explored and validated using a range of complementary methodologies. A comprehensive and robust list of evidence-based and subject-specific educational content statements have been defined in the field of Environmental Sustainability in dentistry and oral healthcare.

CLINICAL SIGNIFICANCE

Oral healthcare has a significant environmental impact, the key to all mitigation strategies is educating the profession at all levels.

Enhanced personal protective equipment and dental students' experience and quality of a restorative procedure in a simulated clinical setting

OBJECTIVES

To evaluate the effects of enhanced personal protective equipment (Enhanced_PPE) on student-operator's experience and restorative procedure.

METHODS

Student-operators (N = 29 Year 3 dental students) performed Class II composite restorations (SimpliShade, Kerr) in typodont upper molars (OneDental) equipped with N95 respirators, full-face shields, disposable headwear and gowns (Enhanced_PPE) or surgical masks, protective glasses/goggles and non-disposable gowns (Standard_PPE) 2 weeks later. Cavity dimensions were measured on cone beam computed tomography images. The quality of composite restorations was assessed using selected FDI criteria and Vickers hardness. A questionnaire assessed the operators' discomfort, anxiety, confidence, ability to perform, and procedure outcome. Data were analyzed using paired t-test and McNemar test (alpha = 0.05).

RESULTS

Student-operators experienced greater discomfort and anxiety, reduced confidence and ability to perform, and rated the procedure as less satisfactory with Enhanced_PPE (p < 0.05). Differences in proximal box width were marginally significant (Enhanced_PPE 1.8 ± 0.4 mm, Standard_PPE 1.6 ± 0.3 mm) (p = 0.047). Other cavity dimensions were similar between groups (p > 0.05) as were restorations regarding surface luster, anatomical form, marginal adaptation, proximal contour, and contact (p > 0.05). There were no differences in the hardness of composite restorations (top p = 0.349, bottom p = 0.334).

CONCLUSIONS

Enhanced_PPE led to student-operator discomfort, anxiety, and reduced confidence, but did not impact the quality of Class II preparation and composite restorations versus Standard_PPE.

The environmental consequences of oral healthcare provision by the dental team

OBJECTIVES

To undertake a comparative ecological impact (Total lifetime carbon footprint and single use plastics (SUP) waste generation) derived from the provision of professional oral healthcare (Dentists and hygienist) to five different patient categories up to the age of 50 years, representative of different levels of progressive dental disease and treatment experience.

METHOD

CO2e and SUP waste generated was calculated for five patient categories with common preventable diseases; that are representative of different levels of progressive dental disease and treatment experience. The assessment is based on the average restorative care levels for 50-year-olds in the UK. The number of appointments for each procedure was calculated using current evidence-based guidelines. The total lifetime carbon and the SUP waste analysis was calculated using published peer-reviewed data.

RESULTS

The total carbon footprint follows a progression with low impacts for individual persons with very low disease and treatment experience (285 KgCO2e), escalating to very high impacts (approximately 2,170 KgCO2e) for people with high levels of disease and treatment experience. SUP waste follows a similar linear rise across the different cohorts of dental experience over a lifetime (6-50 years), from 1,382 items and 4.6 Kg for patients in a the very low dental experience, to 12,200 items and 33.8 Kg for patients in the cohort of very high dental experience.

CONCLUSIONS

The provision of all oral healthcare carries an environmental impact in the form of carbon footprint and SUP waste. The cumulative lifetime environmental impact of oral healthcare is proportional to the disease and treatment experience of the individual person for these preventable diseases; with a x8 difference between the two extremes of experience.

CLINICAL SIGNIFICANCE

All forms of oral healthcare have an environmental impact. The most effective way to mitigate these impacts is through the promotion and provision of effective evidence-based preventive oral healthcare.

A comparative life cycle assessment of dental restorative materials

OBJECTIVES

Different types of direct-placement dental materials are used for the restoration of structure, function and aesthetics of teeth. The aim of this research investigation is to determine, through a comparative cradle-to-gate life cycle assessment, the environmental impacts of three direct-placement dental restorative materials (DRMs) and their associated packaging.

METHODS

Three direct-placement dental materials; dental amalgam, resin-based composite (RBC) and glass polyalkenoate cements (GIC) are assessed using primary data from a manufacturer (SDI Limited, Australia). The functional unit consisted of 'one dental restoration' of each restorative system under investigation: 1.14 g of dental amalgam; 0.25 g of RBC (plus the adhesive = 0.10 g); and 0.54 g of GIC. The system boundary per restoration included the raw materials and their associated packaging materials for each DRM together with the processing steps for both the materials and packaging. The environmental impacts were assessed using an Egalitarian approach under the ReCiPe method using Umberto software and the Ecoinvent database. Nine different impact categories were used to compare the environmental performance of these materials.

RESULTS

Dental amalgam had the highest impact across most of the categories, but RBC had the highest Global Warming Potential. The highest sources of the environmental impacts for each restorative material were: Amalgam, derived from material use; RBC, derived from energy use in processing material and packaging material; GIC, derived from material and energy use for packaging.

SIGNIFICANCE

Less intensive energy sources or more sustainable packaging materials can potentially reduce the impacts associated with RBC and GIC thus making them suitable alternatives to dental amalgam.