Skip to main content

Thank you for visiting You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Combining evidence-based healthcare with environmental sustainability: using the toothbrush as a model


Introduction Healthcare professionals should consider environmental sustainability when recommending medical devices to patients, although there is currently little quantitative data available. The toothbrush is a widely recommended healthcare device worldwide. The aim of this study was to compare the sustainability of different types of toothbrush.

Materials and methods Four types of toothbrush were studied: a traditional plastic and electric toothbrush, as well as a plastic manual toothbrush with replaceable heads and a bamboo manual toothbrush. Life cycle assessment (LCA) methodology was applied to quantify the environmental impact of these toothbrushes over five years.

Results The electric toothbrush performed consistently poorly compared to the three manual toothbrush types and had the greatest impact in 15 out of 16 environmental categories. The bamboo and replaceable-head plastic toothbrushes had the lowest impact in all categories. The climate change potential of the electric toothbrush was 11 times greater than the bamboo toothbrush.

Discussion Switching toothbrushes from the traditional toothbrushes to bamboo or replaceable-head plastic is more environmentally sustainable. These results could be used to inform individual consumer choice, oral health recommendations, procurement of toothbrushes for public health programmes and toothbrush manufacturers. LCA methodology can be used to make healthcare more sustainable.

This is a preview of subscription content, access via your institution

Relevant articles

Open Access articles citing this article.

Access options

Rent or buy this article

Prices vary by article type



Prices may be subject to local taxes which are calculated during checkout

Fig. 1
Fig. 2
Fig. 3


  1. Costello A, Abbas M, Allen A et al. Managing the health effects of climate change. Lancet 2009; 373: 1693-1733.

  2. Pichler P P, Jaccard I S, Weisz U, Weiscz H. International comparison of health care carbon footprints. Environ Res Lett 2019; 14: 064004.

  3. Sustainable Development Unit. Carbon footprint update for NHS in England 2015. 2016. Available online at (accessed November 2019).

  4. The Health Foundation. The NHS as an anchor institution. 2019. Available at (accessed November 2019).

  5. NHS. The NHS Long Term Plan. 2019. Available online at (accessed November 2019).

  6. Sustainable Development Unit. What we do. 2019. Available at (accessed November 2019).

  7. Sustainable Development Unit. Sustainable clinical and care models. 2014. Available online at (accessed November 2019).

  8. International Organization for Standardization. ISO 14001:2015 - Environmental management systems - Requirements with guidance for use. 2015. Available online at (accessed November 2019).

  9. Sustainable Development Unit. Coalition for Sustainable Pharmaceuticals and Medical Devices. 2019. Available at (accessed November 2019).

  10. European Commission Joint Research Centre. Product Environmental Footprint Category Rules Guidance, Version 6.3. 2018. Available at (accessed November 2019).

  11. Public Health England. Delivering better oral health: an evidence-based toolkit for prevention. 2017. Available online at (accessed November 2019).

  12. Yaacob M, Worthington H V, Deacon S A et al. Powered versus manual toothbrushing for oral health. Cochrane Database Syst Rev 2014; DOI: 10.1002/14651858.CD002281.pub3.

  13. Scottish Dental. Sustainability and the Childsmile Programme. 2019. Available at (accessed November 2019).

  14. Love J. The 6 best electric toothbrush choices in the UK. 2020. Available at,that%20are%2010%20years%20old (accessed July 2020).

  15. Bamboo Grove. Bamboo Agriculture. 2019. Available at (accessed November 2019).

  16. De Klein C, Novoa R S A, Ogle S et al. N2O Emissions from Managed Soils, and CO2 Emissions from Lime and Urea Application. In Eggleston H S, Buendia L, Miwa K, Ngara T, Tanabe K (eds) 2006 IPCC Guidelines for National Greenhouse Gas Inventories. Volume 4: Agriculture, Forestry and Other Land Use. Geneva: IPCC, 2006.

  17. Yang Y, Hui C. China's Bamboo: Culture, Resources, Cultivation and Utilization (Part 1) - Technical Report No. 33. 2010. Available at (accessed July 2020).

  18. American Dental Association. Toothbrush care: cleaning, storing and replacement. J Am Dent Assoc 2006; 3: 415.

  19. Buranyi S. The plastic backlash: what's behind our sudden rage - and will it make a difference? The Guardian (London) 2018 November 13.

  20. Laville S. Plastic waste set to beat price as UK shoppers' top concern - study. The Guardian (London) 2018 September 10.

  21. Maoyi F. Sustainable Management and Utilization of Sympodial Bamboos. Hong Kong: China Forestry Publishing House, 2007. Available at,F)%20e_Sustainable%20Management%20and%20Utilization%20of%20sumpodial%20Bamboos_e.pdf (accessed July 2020).

  22. Zheng Z. Bamboo reusable cups are not always biodegradable & can be harmful to health. 2019. Available at (accessed November 2019).

  23. Macek P, Terek-Derszniak M, Zak M et al. WHO recommendations on physical activity versus compliance rate within a specific urban population as assessed through IPAQ survey: a cross-sectional cohort study. BMJ Open 2019; DOI: 10.1136/bmjopen-2018-028334.

Download references

Author information

Authors and Affiliations



AL collected the data and drafted the paper; PA co-initiated the collaborative project, monitored data collection and revised the draft paper; SS and MC refined the bamboo cultivation dataset, monitored data analysis and revised the paper; BU revised the paper; BD co-initiated the collaborative project, carried out all data analysis and revised the paper. All authors give their final approval and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Alexandra Lyne.

Ethics declarations

This study was funded by the Eastman Dental Institute (University College London). The authors declare no conflict of interest.

Electronic supplementary material

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lyne, A., Ashley, P., Saget, S. et al. Combining evidence-based healthcare with environmental sustainability: using the toothbrush as a model. Br Dent J 229, 303–309 (2020).

Download citation

  • Published:

  • Issue Date:

  • DOI:

This article is cited by


Quick links