Investigation by Caroline Holland

Can a dental practice go green and increase profits? After considerable research, I can conclude that it is possible to operate an eco-friendly practice and make a difference to the bottom line. It may not be easy, but what aspect of running a dental practice is ever easy?

When I first broached the topic, I found some dental opinion-formers believe that an evidence-based dentistry makes a sustainable approach to business impossible. It's true that some aspects of the guidelines that dental practices must follow, for instance single use instruments in endodontics or HTM 01-05, are inherently un-ecological. It's also true that making that first step towards an eco business is costly. But should that deter you?

Once you have decided to ignore the gainsayers who believe it's too difficult to be green, where do you start? According to those experienced in these issues, it's essential to keep your sights fixed on the long term.

Carbon neutral practice

Bob Bhamra of Jivadental in Kingston-upon-Thames has probably done more than any other UK dentist to operate a carbon-neutral practice. His electricity comes from a green supplier, he has installed a water meter and he has motion-activated light sensors in some rooms. These are some of the activities which have earned him accreditation with the Carbon Neutral Company and make Jivadental the UK's greenest dental practice.

Caroline Holland on sustainability in dentistry.

While other businesses demonstrate good husbandry by switching suppliers to save money, Bob demonstrates his green credentials by staying with Ecotricity. Operating a 100% green tariff, Ecotricity describes itself as the UK's leading supplier of green energy. Jivadental's consumption of electricity is 'put back' into the grid by Ecotricity which sources its energy from solar and wind power.

Says Bob: 'It would be easy for me to change suppliers and save money. It definitely costs me more staying with them but I like what they are doing. I want to affiliate myself with companies which have similar values.'

It's this outlook on life which is winning Bob recognition among like-minded patients who conclude that a dentist who is taking a holistic and caring approach to the planet is likely to be a caring clinician. He opened Jivadental as a private squat in 2007 after witnessing the tsunami at first hand while travelling in Thailand. This experience left him with an acute sense of responsibility to his fellow man. As the UK went into recession, he persevered with his dream of running a green practice with a holistic approach to patient care.

There were times, he admits, when he nearly gave up: 'I did have my doubts but I stuck to my guns, driven by a belief that this was the right thing to do and it would work out for the best in the long term.'

Now he has 1,000 active patients and is operating a profitable practice. While he pays more for his energy, his watchful use of water is evidently reducing water charges. The LED lighting he has invested in recently was costly, he says, but ultimately, the cost of lighting will come down because the bulbs need replacing less frequently and consume less energy.

Waste management

Waste management is another aspect of running a dental practice which might seem totally at odds with a sustainable approach. But there are a variety of ways in which you can develop eco guidelines for your practice which will both save money and minimise your impact on the environment.

According to Rebecca Allen, a manager with Initial Medical and expert in waste management, some dental practices are pushing up their costs by failing to segregate their waste streams correctly. When she goes into a practice to provide training, she finds that general rubbish is being thrown into sharps containers while paper towels and other packaging are thrown into clinical waste. 'I point out to dental teams it costs far less to dispose of your general waste at a landfill site than disposing of it by specialist incineration or treatment as part of clinical waste.'

Research was carried out by Initial Medical, says Rebecca, which showed that when NHS personnel were properly trained in waste management and segregation, costs went down by a third.

Clinical waste is usually disposed of by treatment or incinerated. To support environmental standards, Initial Medical promotes the disposal of clinical waste at 'energy from waste plants' which generate energy in the form of electricity or heat from waste and when possible, waste streams are recycled.

It is the only UK waste management company which has ISO 14001 accreditation in recognition of its environmental standards and with its own dedicated site for dental recycling and, not surprisingly, is the preferred choice of Jivadental.

Of all the products in a dental practice with an environmental impact, amalgam has the most potential for harm. Most mercury is recycled and then returned to the manufacturers after processing. But separating the amalgam in the practice so it does not enter the water stream is critical. Rebecca recommends that practices have an amalgam separator attached to the dental chair as well as plumbed under the 'dirty' sink so that every trace of amalgam is collected.

What about transport? Rebecca says: 'A high percentage of containers which are used for collecting and transporting amalgam are not doing their job properly.'

Initial Medical has developed containers with mercury suppressants in the lid and around the side so that there is minimal risk of the vapour escaping.

Environmental policies

Many of the organisations which work with and support dentists in the UK appear to have an environmental policy for their own operation. For instance, the NHS has developed a Sustainable Development Strategy for the Health and Care System 2014-2020.

The British Dental Industry Association (BDIA) says member companies are required to have an environmental policy because BDIA feel that they should be able to 'demonstrate a commitment to environmentally sound procedures.'

Denplan has achieved ISO 14001 as well as Carbon Smart Silver Standard Certification while the British Dental Health Foundation has shared an initiative with the Save Water Save Money organisation. The list of green initiatives goes on.

What seems to be missing in the UK, however, is galvanising leadership, pushing dental practices and their teams to be more environmentally considerate. This is unlike the USA where the Eco-dentistry Association supports and celebrates all green initiatives.

Here, with the exception of a few products, such as recyclable Biotips and eco refill packs, the dental consumables trade still appears to be distinctly ungreen. Says Bob Bhamra: 'The fact is, it's almost impossible to buy green products.'

The distributors of dental products say it comes down to the manufacturers who are not making 'green' products available. The truth is, I suspect, that unless there is the demand from dentists for green products change is going to be slow.

What Bob Bhamra has shown is that it takes significant investment to develop green credentials. But over time, and in a variety of ways, the up-front costs deliver a return in the form of goods and equipment which last longer (see box for ten steps to a more sustainable practice).

There are also significant marketing returns. Freddie Edwards-Rost, who is in the British Dental Association's business team, is convinced of the benefits. He recommends that practices carry out an Environmental Impact Assessment (EIA) to measure the effects your practice has on its locality and its resources. The BDA business team will advise members who are interesting in adopting green policies.

Going green

If the scale of the investment seems daunting, I can tell you that it's possible to get loans for green equipment finance thanks to a collaboration between Siemens Financial Services Ltd and the Carbon Trust. (To date, no dental practices appear to have applied.)

Your investment in a greener practice will enrich your life...

Ahead of the 21st Climate Change Conference in Paris next year, perhaps, dentists who want to engage with their patients will get on board with green policies and sound sustainable practices, and call on the manufacturers of dental materials as well as service providers to do the same. Perhaps economies of scale will be possible as dentists act together? Perhaps sustainability will be recognised by the BDA Good Practice scheme and by the publications that run award ceremonies? Or green practices get welcome tax breaks? So much more could be done to inspire practice-owners to be bold and be green.

Your investment in a greener practice may take some time to pay for itself but, until it does, you will enrich your life knowing you may not quite have increased your profits, but you won't be depleting the earth's resources at such an alarming rate.boxed-text