Environmental sustainability: measuring and embedding sustainable practice into the dental practice.

This final paper within the sustainability series focuses on creating a framework for embedding sustainability within a dental practice and builds upon sustainability principles and practices explored in the preceding papers. The dental practice could be a high street dental practice, a community setting or a trust.

Environmental sustainability and biodiversity within the dental practice.

This paper forms part of a series of papers, seven in total, which have been requested by colleagues to help them as clinicians understand sustainability as it relates to dentistry. This paper focuses on biodiversity and how the dental team can become more sustainable. It is hoped that these series of papers stimulate interest, debate and discussion and, ultimately, influence dentistry to become more environmentally sustainable.

Environmental sustainability and travel within the dental practice.

A significant amount of dentistry's carbon emissions originate from travel (64.5%). Dental-associated travel affects air quality, releasing over 443 tonnes of nitrogen oxides (NOx) and 22 tonnes of particulate matter (PM2.5) annually. This reduction in air quality reduces over 325 quality-adjusted life years (QALY) per year. Wider health impacts associated with noise and traffic incidents doubles the impact on health in QALYs. Dental procedures that require shorter appointment times have disproportionately higher emissions due to patient travel. The dental team can reduce appointment times by combining visits for family members or combining operative procedures, or reducing appointment frequency based on patient risk. Community oral health programmes and preventive programmes reduce travel emissions. The number of physical dental appointments can be reduced using information technology such as global positioning systems (GPS), telemedicine and teleconferencing. The mode of travel is important, with the air and carbon emissions generated by active travel negligent compared to a private car. Travel plans can help encourage active travel, as can flexible working hours, cycle to work schemes, cycle racks and shower facilities. Practices should consider purchasing locally sourced or sustainably transported goods and, ideally, use local dental laboratories.

Environmental sustainability and waste within the dental practice.

This paper forms part of a series of papers, seven in total, which have been requested by colleagues to help them as clinicians understand sustainability as it relates to dentistry. This paper focuses on waste and how the dental team can influence how waste is processed and disposed of. It is the authors' hope that this series of papers stimulates interest, debate and discussion and, as well as being economically responsible, ultimately motivates and inspires the dental team to be more socially and environmentally sustainable which in turn will help promote health and illness prevention.

Environmentally sustainable dentistry: energy use within the dental practice.

This paper forms part of a series of papers, seven in total, which have been requested by a number of colleagues to help them understand sustainability as it relates to dentistry. This paper focuses on energy and how the dental team can influence the amount and type of energy it uses, in order to become more sustainable. It is the authors' hope that this series of papers stimulates interest, debate and discussion and that, as well as being economically responsible, ultimately motivates and inspires dental practices to be more socially and environmentally sustainable; which will in turn help promote health and illness prevention.

Environmental sustainability and procurement: purchasing products for the dental setting.

Sustainable procurement, when applied to dentistry, is the practice by which the dental surgery addresses environmental, social and ethical considerations when purchasing goods or services. This paper focuses on procurement and how the dental team can influence what is purchased in order to become more sustainable. It is the authors' hope that this series of papers will stimulate interest, debate and discussion and, as well as being economically responsible, ultimately motivate or inspire dentistry to be more socially and environmentally sustainable which in turn will help promote health and illness prevention.

Environmentally sustainable dentistry: a brief introduction to sustainable concepts within the dental practice.

This paper introduces clinicians to sustainability as it relates to dentistry. There are seven papers in the series. These include this introduction, followed by papers on energy, procurement, travel, waste, biodiversity and engagement and embedding sustainability into current dental practice. A sustainable world aims to ensure the basic needs and quality of life of everyone are met, now and for future generations. The current delivery of healthcare in the modern world is not sustainable due to rising financial costs, increasing demands and a high environmental burden. Dentists, like their medical counterparts, need to consider the General Dental Council (GDC) standards and the relationship between planetary health and human health within their practice. There is increasing awareness of the problems associated with global warming but a lack of knowledge on how to become more environmentally sustainable. There are also financial and reputational benefits to becoming more sustainable for practices. The carbon footprint is one proxy of sustainability and is closely related to expenditure. In 2014-2015, the carbon footprint of dentistry was calculated to be 675 kilotonnes carbon dioxide equivalents (CO2e) with 64.5% related to travel, 15.3% from energy and 19% from procurement. The GDC should consider incorporating sustainability education into the undergraduate framework in line with student demands and similar moves by the General Medical Council.