Sir, I write to share a recent experience that encouraged me to consider the environmental impact of oral hygiene products.

While concluding a check-up appointment for a healthy and articulate patient, the well-rehearsed oral hygiene instruction that I am used to delivering was interrupted. My patient declared that she will no longer use plastic toothbrushes or nylon dental floss because they are not recyclable. She asked if I was aware that unless incinerated, every plastic toothbrush that has ever been made still exists somewhere on earth, and that because they are non-biodegradable they may continue to do so for 700 years. Furthermore, she enquired, which type of natural toothbrush, (bamboo bristle, or pig hair) was best, and did we stock either hemp or 100% woven silk dental floss in the practice.

I had to concede that I had little knowledge as to the efficacy, or even the existence of some of the products she described. And although I have every confidence in the oral health benefits of the evidence-based products I am used to promoting, I had never considered their environmental impact when multiplied by the millions of people who use and dispose of them on a daily basis.

Recently, programmes like the BBC's Blue Planet, and campaigns run by The One Show have been extremely effective in demonstrating the environmental damage caused by non-recyclable plastics. Consequently, I believe we are likely to encounter an increasingly environmentally-aware public, who may expect the dental profession to give advice and to offer safe, biodegradable alternatives. Whilst we have all seen patients refuse radiographs, fluoride, or 'mercury fillings' – I would hazard that most of us will be as unprepared as I was to field questions about all-natural oral hygiene products.

Practitioners may feel uncomfortable recommending contemporary natural products that a patient has found in a health food store, or online. Indeed, when reviewing the literature there is little to support these products that could be considered evidence based. Perhaps it is time for the profession to urge the major oral health manufacturers to provide safe, plastic-free alternatives, which may help improve both the health of our patients, and our planet.