Dental Tribune Nordic Edition No. 3, 2016

07 Dental Tribune Nordic Edition | 3/2016 OPINION By Kristin Hübner, DTI Measures to reduce waste and pollution and to conserve natural resources such as water and energy already play a major role in many as- pects of daily life. Likewise, acting in an environmentally friendly manner is becoming increasingly important in dentistry as well. Dental Tribune spoke with Dr Claudio Pinheiro Fernandes, head of the Sustainable Dentistry Center at Fluminense Federal University in Nova Friburgo in Brazil and consultant to the FDI World Dental Federation’s Science Committee, about sustainability principles in dentistry, the preser- vation of natural resources and the economic dynamics of going green. Dental Tribune: Being environ- mentally friendly is becoming in- creasingly important in everyday life. When did this topic first gain momentum in dentistry? Dr Claudio Pinheiro Fernandes: Sustainability is relevant to every- one and we face this challenge every day. Every single newspaper that one opens includes some- thing about climate change or sustainable development. It is the responsibility of dentistry too to become involved as a profession to pursue sustainability in the field of oral health for the good of society. The dental profession is being challenged by the increasing de- mand for better oral health care for more people in more countries than ever. At the same time, we havethechallengeofneedingtodo so using less resources. In this con- text, the question of how exactly we are to do that arises. What can dentists do and what de- fines a sustainable practice? As dentists, we have to realise that there are certain aspects and areas of our work that can be or- ganised better. From a procedural point of view and concerning the equipment used, there are certain sustainability principles to con- sider. Take a simple example: when one buys a refrigerator or an air conditioner today, one looks for en- ergy efficiency labels that indicate the most efficient device in terms of its energy use. This means that it is good both for one’s pocket, being cheaper to run, and for the envi- ronment, since it needs less energy. Why do we not have this kind of labelling on dental equipment? We could introduce energy-efficient dental equipment, with labels indi- cating the device’s energy use. That would be one way of going green. Another thing to keep in mind is how much water we use. That is an extremely important issue in dentistry. A dentist uses eight times more water than the average person does—a large volume! Usu- ally the equipment used in daily practicecausesthishighconsump- tion. For example, some brands of suction equipment use clean water to drive the suction mechanism. On average, they use 200 litres per hour and this water goes from the pumps directly to the drain. Of course, suction is important, but could we not apply different technologies to achieve the same results? Do we have to waste clean water for this? In many respects, dentists cannot implement a shift themselves alone; awareness of the importance of sustainability is important on the company side as well. That is why the FDI is taking a stand on the sustainability issue right now. The whole thing started back in 2012 during the Rio+20 meeting, the United Nations Con- ference on Sustainable Develop- ment, in which the FDI had decided to participate. Back then, we had already begun collecting informa- tion and thinking about what we could do in dentistry. I represented the FDI in those meetings and I was able to see how much we could do even without going to a great deal of trouble. For example, the most sustainable thing to do is to focus on prevention. If we act on preven- tion of oral disease, this would re- duce the need for extensive treat- ment and the related use of prod- ucts and, in particular, the associ- ated generation of a large volume of waste, as well as the substantial amount of water and energy re- quired, and the large carbon foot- print that all of this creates. Speaking of waste management, what should dentists consider? A great deal of waste is gener- ated in dentistry and some of it very toxic. Another issue that the FDI has pursued is the Minamata Convention on Mercury, which in- cludes the phase-down of dental amalgam. We have to face our re- sponsibility of dealing with amal- gam waste, for example. Nordic countries are a good example in this regard, having implemented well-established amalgam man- agement practices for many years. One area in which we could do a great deal more is the manage- ment of recyclable materials. All the disposable materials that we use in dentistry generate hundreds of kilograms of waste every day. What can we do to address recy- cling of those materials? A con- siderable amount of waste is gen- erated with disposable barriers, gloves and masks. Much of this could be safely recycled with cur- rent technologies. How open is the dental community regarding this? When it comes to change, such as going digital, there are early adopters and some that find it difficult to adjust to some- thing new. That is a good point. Digital dentistry represents a different mindset on production. The pri- mary objective is to have more control and to be more efficient in production; however, a third point is that digital technology gener- ates less emissions, since there is less transportation and less prod- uct waste. This is just one example that serves to demonstrate that there are many more efficient means of manufacture. Certainly, digital dentistry is one of those areas of increasing technology use that results in greater sustainabil- ity. Science, technology and in- novation play a key role in most areas of business. Improvements in efficiency, accessibility and cost- effectiveness of products and pro- cesses may allow fulfilment of global need in a more sustainable way. Furthermore, dental research needs to be directed towards im- proving sustainability in dentistry. Dentistry may be considered a very conservative profession. How diffi- cult is it to change the predominant mindset? We are doing that already. One way or another, people are coming to realise that going green is our business, not somebody else’s, but everybody’s responsibil- ity. We as dentists have to play our part as well. In addition to efficient equipment and waste manage- ment, we should consider the topic of recycling, particularly in light of all the products that we use in daily practice. I think that the most impor- tant thing is education. We need to include education on sustaina- ble development in undergraduate programmes and in continuing education programmes. That way, new and experienced dentists alike will learn how to actually practise environmentally friendly dentistry. The national dental asso- ciations too can do a great deal to increase awareness and promote sustainable development. A good example is the Norwegian Dental Association, which has decided to include sustainability aspects of dentistry in its agenda. What is the situation right now? Is the topic covered in the curriculum at all? There is a great deal going on right now. I would say that we are in the moment of great activity. For example, the International Organization for Standardization has developed very good materials for action. There is also a United Nations Educational, Scientific and Cultural Organization platform for integrating education on sustaina- ble development. It is called Educa- tion for Sustainable Development. In addition, it should be noted that manyuniversitiesarealreadygoing green today. So, there is progress. Behind it all, there is one driving force, the United Nations’ 2030 Agenda for Sustainable Devel- opment. This agenda has defined 17 sustainable development goals that were adopted by all member states in September 2015. This is very recent, but we are on a sched- ule of looking into the reduction of poverty, the reduction of hunger, better health for more people and more educational opportunities— a number of issues that will im- prove the environment on the one hand, as well as social and eco- nomic development on the other. By utilising the environment in an intelligent, sustainable manner, we allowsocietytodevelopinahealthy way. We need to have jobs, we need to produce, but we can all do that in a responsible manner and at the same time sustain a good economy. When it comes to food and cloth- ing, an eco-friendly lifestyle is often more expensive than the alter- native. For dentists, is there an economic barrier to going green as well? Yes, there are challenges re- garding entry, and investment is required because everything must be reoriented to the future. As with everything, it is very dif- ficult to start all over again, but when attitudes change, when den- tists actively decide to pursue sustainability, then they will start reviewing their own procedures and little by little implement change. The good news is that, once one actually starts to implement a sustainable approach, it becomes evident that energy and resources were wasted before—which is not a good business strategy. There will be a return on investment. One’s patients, one’s clients and the pub- lic will recognise one as an active member of a responsible society. It will take time and effort, but the dental profession will achieve this. So in the future it could be a selling point for companies to identify themselves as “green”. Yes, this is already happening in many business areas, because the public is driving sustainability awareness by seeking more sus- tainable alternatives. As always, there may be some companies that already say that about themselves even if they have not achieved that yet. However, standards have al- ready been established to deter- mine whether certain things have been applied. Based on these indi- cators of sustainability, auditors and reviewers are able to evaluate objectively whether sustainability is being achieved by the company. Of course, investment is re- quired in the beginning. However, some business reports indicate that going green can save as much as 40percentofcostsonwater,energy and unnecessary product waste, which is a great deal of money. Many companies, big and small, are already considering it their cor- porate responsibility to act for the social and environmental good. Thank you very much for the inter- view. “Going green is our business, not somebody else’s, but everybody’s responsibility” An interview with Dr Claudio Pinheiro Fernandes, Brazil Dr Claudio Pinheiro Fernandes

Dental Tribune Nordic Edition No. 3, 2016

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