It's been said, stupid

Sir, on reading your timely editorial, It's the environment, stupid,¹ I paused on your comment that 'environmental issues in dentistry, and indeed medicine, have received scant attention...'. I did this as lead author of a paper entitled Dental practice and the environment,² published in 1998. This paper, which summarises the issues considered to be pertinent to the environmental effects of the clinical practice of dentistry in the 1990s, stemmed from a lecture I presented at the Silver Jubilee Meeting of the British Society for Restorative Dentistry, held in 1993. The lecture was entitled Are dentists an environmental hazard? To the best of my knowledge, Professors Mjør and Bellinger (an environmental scientist) and I were on our own at the time in publishing on the subject of dental practice and the environment.

The world has moved on since the publication of that paper but I would suggest that much of its content remains relevant today. Materials and agents used in the clinical practice of dentistry which may pose a hazard to the environment include anaesthetic gases (also gases used in conscious sedation), base metal debris, disinfectants, etchants, monomers (ie initiators, accelerators, inhibitors, stabilisers, primers and conditioners) and associated reagents, clinical waste, X-ray processing solutions and drugs, including antibiotics. With the growing popularity of procedures such as tooth bleaching, which relies on the action of one or more reducing agents, and the increasing use of 'bioactive' materials in dentistry, the list of dentally related hazards to the environment, in my opinion, is no longer complete. As such, much-needed, would be 'champions of green thinking' in dentistry need to think much more widely than indicated in your editorial. Critically, in environmental auditing, it is important to adopt a 'cradle to grave' approach as, only by considering the sourcing of raw materials and the manufacturing, use and eventual disposal of consumables, devices and equipment is it possible to define the 'environmental footprint' of an activity. Such thinking is clearly behind the Minimata Convention which requires dentistry to phase down the use of dental amalgam.

As discussed in my earlier paper² we must not expect individual countries or regions to realise environmental goals and responsibilities by imposing costly additions to existing regulation. The environmental impact of dentistry may be relatively small but this does not exonerate anyone from critically reviewing and reducing the environmental impact of their clinical practice. As with recycling, switching off unnecessary lighting, turning down the heating thermostat and not running water while brushing your teeth, if everyone in the profession did something, the overall effect would be substantial. Needless to say, the safety of patients must never be compromised in making the practice of dentistry more environmentally friendly. As in all matters in clinical practice, the interests of the patient come first.