Saudi Journal for Health Sciences

: 2014  |  Volume : 3  |  Issue : 2  |  Page : 61--65

Eco-dentistry: The environment-friendly dentistry

Amandeep Chopra, Nidhi Gupta, Nanak Chand Rao, Shelja Vashisth 
 Department of Public Health Dentistry, Swami Devi Dyal Hospital and Dental College, Golpura, Barwala, Panchkula, Haryana, India

Correspondence Address:
Amandeep Chopra
Department of Public Health Dentistry, Swami Devi Dyal Hospital and Dental College, Golpura, Barwala, Panchkula - 134 009, Haryana


Green dentistry is a high-tech approach that reduces the environmental impact of dental practices and encompasses a service model for dentistry that supports and maintains wellness. It is based on waste reduction, energy conservation, and pollution prevention. Increasing consumption of diminishing natural resources, air and water pollution, ever-growing landfills, and the effects of global warming, makes saving our environment imperative. The aim of this article was to provide a series of DQgreenDQ recommendations that dentists around the world can implement to become leading stewards of the environment. By conserving water, using digital imaging and recycling the many recyclable items that pass through the office of a green dentist, a great impact is made. So, going green is the need of the hour.

How to cite this article:
Chopra A, Gupta N, Rao NC, Vashisth S. Eco-dentistry: The environment-friendly dentistry.Saudi J Health Sci 2014;3:61-65

How to cite this URL:
Chopra A, Gupta N, Rao NC, Vashisth S. Eco-dentistry: The environment-friendly dentistry. Saudi J Health Sci [serial online] 2014 [cited 2022 Aug 19 ];3:61-65
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Full Text


"The ultimate purpose of business is not, or should not be, simply to make money. Nor is it merely a system of making and selling things. The promise of business is to increase the general well-being of humankind through service, a creative invention and ethical philosophy".

Paul Hawken . [1]

Environmental awareness and accountability has become the priority of humanity consciousness due to which environmentally responsible practices have become more evident. Many organizations have altered their practices by voluntarily taking environmental responsibility.

The concept to conserve natural resources can be traced back to the 1800s. However, it was not until 1970 that the first Earth Day was established. [2] Increasing consumption of diminishing natural resources, air and water pollution, ever-growing landfills, and the effects of global warming, makes saving our environment imperative. So going green is the right thing to do. The concept of going green involves a person, family, or group becoming more conscious about the destruction of the environment and adopts practices that help reduce waste or become more energy efficient. The color green is used because it reminds us of the outdoors and the environment. [3] Similarly, field of dentistry has adopted this concept so as to make it environmental-friendly.

Dentists have adopted practices to reduce/minimize the environmental impacts in office administration, marketing, construction, design, and dental processes and materials. This is called as green dentistry or eco-dentistry. [4] Eco-dentistry association defines green dentistry as "a high-tech approach that reduces the environmental impact of dental practices and encompasses a service model for dentistry that supports and maintains wellness". [5] It is based on waste reduction, energy conservation, and pollution prevention. The purpose of this review is to raise widespread awareness of environmental alternatives in the dental community and to provide a series of "green" recommendations that dentists around the world can implement to become leading stewards of the environment.


Four processes are responsible for most dental practice waste product which is as follows: [6]

(1) Infection control methods including disposable barriers and sterilization items and toxic disinfectant. They can jeopardize employee health, contribute to poor office air quality, and can also pollute community's water stream. Nontoxic alternatives for infection control and sterilization have the same or greater effectiveness in getting the job done while protecting the health and safety of dental practitioners, patients, and our neighborhoods

(2) Conventional x-ray systems- Conventional x-rays create trash and toxic chemical-waste that the dental office is left to dispose of. The chemical fixers and lead foils from x-ray processes have to go somewhere, which often means public sewer systems. X-ray fixers contain chemicals such as ammonium thiocyanate and boric anhydride. These chemicals are known to be skin, eye, and respiratory tract irritants, and hazardous if ingested or inhaled. They also may be toxic to the blood, thyroid, kidneys, and liver, and repeated or prolonged exposure can produce target organ damage. The products of the degradation of these materials are shown to be as toxic as the original product. Another by-product of traditional x-rays is lead foils. In the environment, lead waste is held in the topsoil, where it can remain for as long as 2000 years. It is readily picked up by plants and enters our food system. Lead is a deadly neurotoxin

(3) Conventional vacuum systems- Suction systems, also known as dental vacuum systems, are a critical piece of machinery for any dental office. Unfortunately, they use a tremendous amount of water. It is estimated that a typical dental office uses as much as 57,000 gallons of water per year, with the average vacuum system using 360 gallons of water a day. With the world facing a serious water crisis, we should not be pouring this precious resource down the drain. High-tech, dry vacuum systems accomplish the same results yet use no water at all

(4) Placement and removal of mercury-containing dental material- Amalgam-filling material includes equal parts of elemental mercury and an alloy powder mostly composed of silver, tin, and copper. Mercury in drinking, irrigation, and fishing waters is a serious environmental and human-health concern. A potent neurotoxin, mercury poisoning is devastating to animal species and is a tragic and debilitating experience for people and families suffering its effects. Major source of mercury entering local wastewater treatment facilities originates in dental offices.

New products and technologies for cleaner, greener dental practices are emerging, allowing practitioners to mediate, or completely eliminate, much of this waste. But still there are a lot of things to be done.

One of the easiest ways to start a going green initiative is to develop a waste reduction plan. Whenever possible, waste reduction plans should include the four R's: [3]



Recycling triangle is made up of the three green arrows. Collecting materials to be recycled is the first arrow in the recycling triangle. "Remanufacturing", or making something new out of the recycled materials, is represented by the second arrow and "resale," or offering for-sale items created from recycled materials is represented by the third. [7] [Figure 1]{Figure 1}

Various ways of recycling are as follows:

Capture and recycle : Dentists can collect and store all contact and noncontact scrap amalgam for recycling. This waste must be sent to an approved recycler that is able to reprocess the mercury [8],[9]Installing an amalgam separator not only keeps this mercury-containing material out of the water system, but recycling waste amalgam means that more of the material does not have to be created [10],[11]If using traditional x-rays, recycle fixer and developer solutions and recycle lead foil from x-rays [8]In the office rest room, discontinue the use of disposal kitchenware or make sure to only use biodegradable plastic ware. Washing and reusing basic kitchenware will reduce plastic wasteAnother way to recycle is to always use recycled toner and inkjet cartridges and it is a great cost saving measure for the practiceUse of recycled materials such as toilet tissue, paper towels, and office furniture, when possibleBuy rechargeable batteries for digital cameras and flashlights, and retip or transform broken instruments for other purposes also aid in recycling efforts [3]Hand instruments: For over 12 years, Hu-Friedy has offered a program called Environdent, which allows practitioners to recycle old hand instruments and receive a free instrument for helping the planet [12]Use a community's existing recycling program to separately recycle the paper and plastic halves of autoclave bags. [8]


The easiest way to have more of a resource is to use less of it. These can be done in following ways:

Saving water: Some ways in which dental office can help in saving water includes the following:

Follow Centre for Disease Control hand sanitation guidelines and use hand sanitizer instead of hand-washing when appropriate [13],[14] When hand-washing is required, turn off the water while latheringParticipate in the "Save 90 A Day" Campaign educating patients to turn off the water while brushing [14] Use a dry dental vacuum pump, instead of a wet one [8] Only run full loads when using sterilization equipment or the practice laundry machines. Low flow aerators can be installed on all sink faucetsCheck for leaks throughout the office every 6 months. [3]

Reducing the consumption of disposable items used in dentistry would help in the preservation of the environment [3],[8],[15]The ultimate way to reduce in the dental office is to go "paperless". Going paperless involves the office using computer and digital technology whenever possible to create, use, and store office recordsEliminate the use of plastic bags by using paper when possible. [3]


By reusing items instead of throwing them away, resources and energy necessary to manufacture new products are saved. It includes the use of reusable and biodegradable sundries wherever possible:

Reusable operating room cotton towels instead of disposable plastic or paper patient bibs,Reusable stainless steel high- and low-volume, surgical/endodontic suction tips as an alternative to disposable plastic,Reusable glass irrigation syringe as a substitute for disposable plastic,Biodegradable disposable cups instead of regular paper cups,Chlorine-free, high postconsumer recycled paper products instead of traditional paper products, andReuse paper when appropriate. Shred used paper to use as packing and/or reuse packaging materials. [3],[8]


Implementing small, affordable changes can make a significant impact on long term environmental sustainability. [3] Thinking about practices and protocols and discussing them with dental team may reveal ways to reduce, reuse, and recycle.


The various ways of conserving energy include the following:

1. Green Buliding- A green building is environmentally responsible and resource efficent through its life cycle: From its design, construction, operation to maintainance, renovation, and demolition. US based Leadership in Energy and Environmental Design (LEED) is the dominant global rating system, also popular in India. TERI concieved Green Rating for Integrated Habitat Assessment, a National Rating System of India is equivalent of LEED. It uses a star rating (five stars equivalent to LEED's platinum rating). A green dental building may cost more up front but, in the long run, will save money through lower operating costs over the life of the building. Simple ways to go green are as follows:

Use concrete instead of bricks. Its improved thermal efficency reduce heating and cooling load. It's light reduces cost and energy in transportationUse double wall glass in window so as to reduce direct heat gain and glare while maximizing the sunlight entering your roomsPaint your exteriors and room walls with eco-friendly nontoxic paints that do not use petrochemicals involved in creation of traditional paints that can pollute the atmosphere throug toxic fumes when discarded irresponsiblyUse linoleum, a more environmentally friendly choice for flooringHire an environmentally friendly landscape company that uses natural growth product and procedures as an alternative to harmful pesticides to care for your office's lawnCheck around windows and doors for cold or hot air escaping into or out of the building. Use weather stripping or re-caulk in areas where leakage is found. [3],[8],[16],[17],[18],[19]

2. Water heaters- Lowering the temperature on water heaters is a quick and easy step for energy conservation. It is adviced use the cold rinse cycle in the washer for laundry

3. Programmable thermostat - The thermostat(s) can be programmed to run on different temperatures at different times of the day. Depending on the outside temperature, adjust the temperature while the office is closed to conserve electricity

4. Maintenance - It includes the following

Up-to-date maintenance on the high-volume evacuation (HVE) system, autoclave and handpieces are just a few ways efficiency can be improved. Also, regularly check items such as furnaces and air conditioning unitsPermanent filters should be cleaned according to a schedule and replaceable filters should be changed out every two months, or according to manufacturer's instructionsThe temperature of the supply and personal refrigerators can be monitored to ensure they are running efficiently.

5. Appliances - Purchasing appliances that have an ENERGY STAR® label and rating, will conserve energy and save the practice up to 1/3 on energy costs [3],[8]

6. Computer and electronic equipment - It is advised to:

Use light emitting diode monitors as it can cut energy consumption in halfTurn off computers at night to save on electricity consumption, as computers in sleep mode still use energyItems plugged into surge protectors draw a small amount of energy all the time, so turn them off to save even more energy. [3],[8],[15]

7. Lights- It is advised to:

Turn off light as it is an easy way to conserve energyConvert high-energy consuming office lights to energy-efficient fluorescent lighting. [18]


Webster defines pollution as the contamination of air, soil, or water by the discharge of harmful substances. [20] There are various steps that can be taken in the dental office to prevent pollution:

Steam sterilization - It is time efficient and reliable; eliminates toxic chemical sterilization vapors in the dental office environment. It also eliminates hazardous waste; allows for reusable sterilization warps [21],[22]Use of digital radiography instead of traditional film-based x-rays. It eliminates toxic x-ray fixer solutions and lead foils. Along with this, it has other advantages such as instant image availability; improved image quality; enhanced diagnostic efficacy; minimal radiation exposure [8],[21],[23]Refrain from using cold sterilization solutionsKeep dumpsters covered and watertight [3]Always use licensed handlers for offsite recycling of hazardous materialsDental amalgam:Using HVE and water spray reduces the level of mercury dust and vapor created when amalgam restorations are removedEliminate the use of bulk mercury and train staff in the proper handling, management, and disposal of mercury-containing materials, including extracted teeth with amalgam restorationsDo not use bleach (sodium hypochlorite) to disinfect vacuum lines, as it speeds up the release of mercury from the amalgamCollected scrap amalgam should be stored in an appropriate sealed containerAmalgam separators that comply with the International Organization for Standardization (ISO) 11143, when used with traps and vacuum pump filters can achieve better than 95% amalgam removal efficiency. [3],[24]

American Dental Association Suggestions for Going Green [3]

The Council on Dental Practice of the American Dental Association has framed list of their top ten ways to go green in the dental office.

Install an amalgam separatorTurn off equipment when not in useReuse paper scrapsUtilize recycle bins and create a "Green Team" to bring items to recycle centersRecycle shredded confidential patient informationConvert to digital technology; for example, digital radiographyInstall solar or tinted shadesInstall locked or programmable thermostatsInstall high efficiency light bulbsUse nontoxic cleaners and do not use too much disinfectant.


The going green movement, which is rapidly becoming a worldwide priority, seeks to address environmental contamination, waste, and other critical environmental issues. Dentistry can lessen the combined environmental impact by utilizing the Four R's of going green (recycle, reduce, reuse, and rethink) can be easily applied to the dental office.

It has been said that it is not possible to have healthy people on a sick planet. It is recommended that the dentist should take the initiative to practice better environmental management now. By conserving water, using digital imaging, and recycling the many recyclables that pass through the office of a green dentist, a great impact is made. However, that impact can be made greater as more dentists join the green dentistry movement and help make the world a cleaner and healthier place.


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