How to assess a dental practice’s environmental impact and how to lessen it

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The typical dental practice’s carbon footprint is significant. Because practices have high water and electricity usage, while also generating excessive waste and chemical pollution, most produce substantial greenhouse gas emissions. This means dental practices have a sizeable environmental impact, making it critical for the dental industry to invest in sustainable measures and take steps toward carbon neutrality.

Rochelle Guastella, director of business development for Artisan Dental in Madison, Wisconsin, knows what it takes to create a more sustainable, environment-friendly practice. In 2017, Artisan Dental became the first general dental office in Wisconsin (and the second in the United States) to become a Certified B Corporation. Subsequently, in 2020, the practice became the first general-dental office in the nation to go carbon neutral by offsetting 100% of the carbon generated by purchasing carbon credits from Green Tree’s Advanced Carbon Restored Ecosystem (ACRE) system.

“Sustainability has always been a priority from our inception in 2014,” Guastella explains. “Our mission is to optimize the health and happiness of our patients, team members, suppliers, community, and the environment through exceptional quality care and sustainable business practices.”

While going carbon neutral may seem like a daunting task to many dental practices, taking the steps to create a more sustainable business model can be simple—and have a big impact. But where should practices start?

Preparing for Change

“The most important piece of advice I can share is that you don’t need to start out big,” Guastella says. “I actually recommend starting with 1 or 2 small ideas that you can easily implement so that the team can see that it is easy to make changes and [that] creates buy-in.”

Starting out small is as simple as determining some baselines and setting reasonable goals. For example, Guastella says, practices can weigh their trash and recycling separately, and keep track for a set period of time to determine a baseline. Once the practice has an idea of that baseline, it can set a goal of improvement, such as a trash reduction of 15%. Communicate with the team about the goal and how the practice is going to achieve it, and ask for their suggestions on what they think is the best way to accomplish it.

Getting this team input and buy-in can make a huge difference to the success of your program. Creating a group of team members to serve as a “Green Team” to discuss projects and steps to reach your goals and make them a priority can also get staff invested in sustainability initiatives.

“The team members that volunteer are already showing a commitment to sustainability simply by joining the Green Team,” Guastella says. “You’ll be amazed at all of the ideas that they will come up with. Some ideas may not be possible at first—or ever—but many of the ideas are possible, and with very little cost to the practice. Some ideas may actually save the practice money. Fringe benefit: It’s a great way to create team bonding too.”

As additional motivation for employee buy-in, practices can also implement an alternative transportation incentive, rewarding team members for pursuing more sustainable transportation options such as walking, carpooling, biking, and using public transportation, or low- or no-emission vehicles. This extends the practice’s sustainable impact beyond the walls of the office.

To assess their impact beyond waste production or easily measurable in-house measures, practices can consult with a company that specializes in sustainability assessments. In 2020, Artisan Dental collaborated with Carbon Credit Capital to complete a comprehensive carbon-footprint analysis.

“After completing the analysis, we determined [we had] a total carbon footprint of slightly less than 12 metric tons,” Guastella says. This assessment provided a framework for where Artisan Dental could go from there. “Once you’re ready to make a larger commitment, you can research companies that help with these assessments, such as Carbon Credit Capital, and choose one to work with.”

Once a practice has initiated a transition toward lessening environmental impact, it’s time to start making effective changes.

Steps Towards Sustainability

Simple waste reduction can be a solid first step toward lessening one's environmental impact. Encourage team members and patients to properly dispose of recyclables by placing recycling bins wherever there is a trash can. The bins can also be labeled with the items that can be recycled, such as cans, bottles, or paper to make it easy to see what goes where. Although recycling is a critical component of going green, even more important is reduction. By reducing the need for things that will end up having to be thrown away, practices can make an even bigger impact.

The Front Office

Reducing the use of paper products in the front office is a great way for practices to be more sustainable. Digital patient management software eliminates the need for patient charts, and digital patient-appointment reminders cut down on mailers and paper reminder cards.

Instead of printing out your patients’ insurance benefits or photocopying their insurance cards, Guastella recommends scanning and saving them digitally and placing them in the patient’s document center for future reference. For situations in which paper is unavoidable, practices should use recycled paper products. Ultimately, even basic reductions in paper consumption can make a big difference, she says.

“Stop printing route slips. This can initially create some anxiety within the team, so we started by not printing the hygienists’ route slips only and later stopped printing the doctors' slips. It’s really just a change in mindset; the biggest hurdle will likely be the idea of change, but if you start small you will create buy-in from your team, and once you have that, the sky’s the limit.”

Transitioning to digital platforms can help reduce waste within the office, but it doesn’t cut down on waste entering the office. According to the Eco-Dentistry Association (EDA), packaging accounts for 33% of garbage.¹ To cut back on this, practices can purchase commonly used items in bulk and consolidate supply orders to cut down on the number of boxes being shipped. Additionally, boxes that do arrive can be saved and reused.

The Operatory

Despite ambitious recycling efforts in the office, reducing waste in the operatory can be a hurdle, which is particularly the case with dental products that aren’t offered in recyclable or reusable forms, or are more conveniently available in disposable varieties. This especially applies to personal protective equipment (PPE). As a result, dental practices' contributions toward waste are astronomical: The EDA reports that dental practices generate 680 million pieces of single-use infection-control items (such as patient bibs, chair barriers, and light-handle covers) on an annual basis.²

“Dental supplies can be a real challenge,” Guastella notes, “gloves in particular. There are no medical-grade gloves that are currently recyclable. And the pandemic has created an abundance of waste with increased PPE.”

To combat the increased waste caused by the need for more PPE in the face of the pandemic, practices can take a closer look at the options available on the market and, whenever possible, choose the greenest option. For example, at Artisan Dental this meant purchasing reusable cloth jackets rather than disposable paper ones. Other steps practices can take to reduce PPE waste include switching to cloth sterilization bags, stainless steel impression trays, and reusable cups, and using reusable face shields. The Eco Dentistry Association (EDA) reports that just by switching to reusable bibs alone, a dental practice can divert up to 40,800 pieces of paper and 20,400 pieces of plastic from the landfill every year.¹

However, waste created by the use of PPE, disposable barriers, and so on, is only one part of what the EDA refers to as the “Big Four” of dental office waste and pollution.² The other areas include the following:

• Mercury: The placement and removal of dental material containing mercury creates 3.7 tons of mercury waste every year.
• Non-digital imaging: Conventional x-ray systems generate 28 million liters of toxic x-ray fixer and 4.8 million lead foils annually.
• Wastewater: Dental vacuum systems can use up to 360 gallons of water every day—resulting in a single dental practice using up to 57,000 gallons of water per year. This contributes to an annual total of 9 billion gallons used by dental practices across the country.

The good news is that some of the fixes are simple. The EDA recommends implementing the following practices to combat the aforementioned outputs:

1. Utilize an amalgam separator to eliminate mercury from wastewater. Separators such as the Rebec® CatchHG boast a 99.6% mercury removal efficiency³, and HealthFirst’s Amalgam Recovery mail-back service makes it simple to return amalgam waste.
2. Switch to a digital imaging system to reduce waste from x-rays. This has the added bonus of connecting digitally with practice-management software that reduces the need for paper forms in the front office.
3. Get rid of the conventional suction system and use a high-tech, dry-vacuum system to reduce water use.

The Building

In addition to reducing waste, creating a more sustainable building is a great way to reduce your practice's environmental impact. The American Dental Association recommends installing energy-efficient products to reduce energy waste from lighting, heat, and water. Some steps to accomplish this include the following:

1. Maximize natural lighting through the addition of windows to minimize the energy use created by artificial lighting.
2. Install occupancy sensors that only turn the lights on when someone is in the room, or use dimmers to compensate for levels of natural light.
3. Use LED bulbs to reduce energy consumption.
4. Install energy-efficient or Energy Star appliances.
5. Consider investing in solar panels or other alternative energy sources.
6. Transition to water-saving toilets and sensor-operated faucets
7. Use ceiling fans instead of air conditioning to increase circulation without unnecessary energy expenditure.

Looking at the composition of your actual building or furnishings is also a good idea. Artisan Dental built sustainability into their practice with steel wall-framing studs that contain more than 50% recycled content, wall panels that have 40% recycled content and are 100% recyclable, and low-VOC (volatile organic compound) paints.

“Our ceiling tiles contain greater than 50-percent recycled content and low-VOC emissions per LEED and CalGreen Title 24 standards,” Guastella says. “We also use Greenguard-certified counters with recycled content and low-emitting adhesives and sealants per LEED standards.”

Benefits for the Environment, Benefits for the Practice

In addition to benefitting the environment, taking steps to lower your practice’s environmental impact can have a positive effect on your business. Getting the word out about your practice’s sustainable initiatives will provide an attractive selling point to prospective patients, community members, other businesses, and potential team members.

“Communicate with your patients, team and other stakeholders [about] all of the new green initiatives you are implementing,” Guastella recommends. “Through this communication you can receive a return on your investment by demonstrating your commitment to the environment and, in turn, attracting and retaining new patients. We’ve seen an increase in patient loyalty as well; there is a growing desire, particularly among younger people, to do business with companies that have a ‘business for good’ mindset.”

A sustainable approach to dentistry not only fulfills that “business for good” quality, but also differentiates a practice from others. For Artisan Dental, becoming a B-Lab certified B Corporation and the first general dental practice in the United States to go carbon neutral has set them apart from everyone else—enough so that they don’t have to invest in attracting new patients.

“We’ve had to do zero paid marketing,” Guastella explains. “Sharing our story and initiatives via social media, magazines, awards, etc, has sustained a steady stream of new patients without the need for paid advertising.”

In short, reducing your practice’s environmental impact is a win-win for both the world and your bottom line. An investment into a more sustainable practice is an investment in the future of the environment and your business’ success. As for what Guastella would tell a practice considering pursuing a more sustainable approach to dentistry?

“Do it,” she says. “It is truly simpler than you think. It’s also contagious. Once you get started, you get energized and share that enthusiasm with friends and family and hopefully create a ripple effect to magnify your impact.”

References

1. Why reduce waste. Eco Dentistry Association. Accessed 14 April 2022. https://ecodentistry.org/green-dentistry/what-is-green-dentistry/reduce-waste/
2. Dental office waste. Eco Dentistry Association. Accessed 12 April 2022. https://ecodentistry.org/green-dental-professionals/dental-office-waste/
3. Dental Amalgam Waste Recovery Service with Rebec. HealthFirst. Accessed 12 April 2022. https://www.healthfirst.com/waste-management/amalgam-waste-recovery/