Sir, we read with interest the letter The environmental impact of dentistry where the author has rightly raised the awareness of the impact of packaging waste in dentistry.1 There are umpteen ways in which green dentistry can be implemented and it is now no longer a fad.

This does sound exciting but the ground realities in rural areas in developing countries will, disappointingly, paint an entirely different scenario. Economics and lack of familiarity are the major professed impediments for green dentistry in developing countries that outplay the moral and ethical obligation to the environment by dentists.2

Though implementation of green dentistry and its advantages are taught at graduate level, most of the graduates have no practical experience of effective implementation. The situation is further worsened in rural areas where green dentistry is negligible. Regrettably the cost:benefit ratio becomes the principal influencing factor in this decision for sustainability. Research on long-term economic assessment to establish the financially viable benefits of eco-friendly dental practices must be conducted.

Galvanising numerous professional behavioural modifications for eco-dentistry is daunting. Most importantly, how does a professional who is working in a rural setup in a developing country even think about green dentistry? The enormous amount of information can perplex practitioners on the sustainability vs going green model. Some of the recommendations such as implementing digital radiology, digital impression making, motion sensors and carbon-neutral practice can overwhelm general practitioners in the developing world.4 It will be much simpler if importance is placed on only a single point implementation of an inexpensive step (like use of biodegradable cups) across all the clinics. As Lao Tzu aptly stated 'The journey of a thousand miles begins with one step'. Continuing dental education programmes must emphasise that profits can be made even with a green practice.4