It's been a busy few years. Not only with COVID, but the growing realisation that we can no longer live in the world the way we have been for the last few hundred years. Health care produces around 5-11% of the carbon footprint and we know that dentistry is a significant contributor, especially in travel.1

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When I first tried to publish my carbon footprint work in 2011, it was almost impossible to get past stage one. Now, sustainability is regarded as a vital part of academic research and journals such as the British Dental Journal can be proud of the way they have embraced this area. In this edition, we've tried to move the discussion on sustainability in dentistry forward by highlighting meaningful, actionable changes that could be made now.

In the three fluoride papers (water fluoridation, toothbrushing and fluoride varnish), we have teased out the environmental aspects of each programme. What we find is perhaps obvious for people who are already familiar with our environmental footprint work; anything that requires a high travel component will result in a high environmental footprint. The winner in prevention is water fluoridation, which can be regarded as the most environmentally friendly prevention programme.

In the HTM 01-05 paper, and in Almutairi et al.'s paper, we show the environmental consequence of the use of PPE, and question the balance between the environmental harm of this level of decontamination and PPE. Like all health care providers, we need to balance the public health benefits of decontamination as a vital patient safety measure against the public health harms from over-use of resource and waste. This use of resource is echoed in Byrne et al.'s paper where we demonstrate the health harm of disposable versus reusable exam kits. As a mantra, readers would be wise to keep repeating 'single use bad, multiple use good'. This works in dentistry as well as in life.

Finally, in Halton et al.'s paper, we look at how patients will pay more to use more sustainable toothbrushes.

A colleague recently said to me that dentistry is behind the game in sustainability. I would beg to differ. Our profession was one of the first to carbon footprint,2 has published a series of sustainability articles predating many others,3 has looked at the environmental sustainability of materials,4 is writing learning outcomes for dentistry in academia,5 is developing CPD6 and has engaged with the FDI to create consensus statements.7 More and more industry leads are working with academics to embrace this area. My colleagues are busy mapping many parts of dentistry to try and find out how to reduce our environmental footprint (see for more on this!)

There is a lot the dental team can do to reduce the environmental impact of the dentistry we perform

There is a lot the dental team can do to reduce the environmental impact of the dentistry we perform, from better communication with our patients (teledentistry) to better use of minimal invasive dentistry, and longer-lasting restorations. We need to engage and work hand in hand with our industry partners. We discuss these elements in much more detail in our new textbook published by Springer Nature.

But what we really need is wider system change. We need a pivotal shift in how we deliver sustainable health care. A system would think about the WHO building blocks of health care. We would radically improve the social determinants of health, and in doing so, lower inequality.8 We would prioritise prevention, and low environmental footprint care such as low-sugar diets and community fluoride programmes. We would allow our whole population to easily access a preventive-focused service delivery model.

I hope you enjoy these papers, and thank you for all of you who have embraced this field.