Send your letters to the Editor, British Dental Journal, 64 Wimpole Street, London, W1G 8YS. firstname.lastname@example.org. Priority will be given to letters less than 500 words long. Authors must sign the letter, which may be edited for reasons of space.
Sir, the recent 'Blue Earth' programme highlighted dangers from the increasing use of plastics in disposable items. The future of marine life, the plant, and humanity appears to be at some risk.
As dentists our contribution of non-biodegradable plastics is not being addressed. The European Union Directive; Health and Safety (Sharps Instruments in Healthcare) Regulations 2013 and equivalent UK Regulations 2013 move dental practitioners away from reusable syringes towards disposable syringe-needle combinations, the rationale being to reduce the number of needle-stick injuries and hence a burden of disease, injury, and permanent or temporary impairment or handicap. Assuming hypothetical figures of 10,000 dentists administering five local anaesthetics a day over a working year of 200 days, this amounts to 1,000,000 plastic syringes added to the plastic waste for disposal.
HTM 01-05 and other legislation introduced sealable pouches for most dental instruments. Although the need to pouch has since been reduced, again assuming 10,000 dentists using, say, 20 pouches a day, there will be in excess of 4,000,000 plastic sleeves, headrest covers and instrument pouches (most have plastic windows) to be disposed of annually, probably a conservative estimate.
Building healthy public policy, one of the five areas for action determined by The Ottawa Charter for Health Promotion, recommended the use of Health Impact Assessments (HIA) as 'means of assessing the health impacts of policies, plans and projects in diverse economic sectors'. One of the principles of this approach is 'sustainability', defined as 'a process that aims to meet the needs of the present generation without harming the ability of future generations to meet their needs'.
HIAs may be an overlooked governmental concern, but in dentistry we are not only statutorily required to carry out risk assessments and show evidence-based benefits for all procedures, but are ethically obliged and professionally responsible for doing so. Should we or could we carry out risk analyses as part of an HIA? The policy to introduce disposable syringe-needle combinations, and the demands of HTM 01-05, have been criticised for the impossibility of a true evaluation of outcomes without a valid starting database to show how many needle-stick injuries there were before the change, or the incidence of proven dental surgery induced infections prior to 2007. Without these data it may not be possible to carry out any objective based or economic evaluation, or a valid risk-assessment to see how any reduced risk of personal injury might balance against the gradual destruction of marine environment.
But we do need to seriously consider our responsibility to our planet, to future generations, and whether our actions are responsible. Perhaps the BDA could set up a commission to investigate the sustainability of policy developments, to assess the true health impacts, and to inform policy makers of the wider consequences of their decisions?
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Aukett, J. Environmental issues: Dental sustainability. Br Dent J 224, 468 (2018). https://doi.org/10.1038/sj.bdj.2018.277