We all have our roles within our family and one of mine is to dutifully take out the trash on Monday nights. The sport has become breaking down, cleaning and sorting items; trying to put as little as possible in landfill container while filling up the compost bin and overflowing the recycling bin. Which got me thinking about our work environment.
We know that preserving environmental health is also good for our patients since countless studies have shown that climate health has a direct effect on human health. If we improve the sustainability of our practices, we will preserve the health of our patients and our planet.
The True Costs of Clinic Waste
Let's start by talking about clinic waste. At first glance, the expense includes the initial purchase of materials and the cost of disposal after use, but that’s not the full picture. Each stage of clinic materials’ life—from production, to use, to disposal—inflicts harms on the environment. Despite efforts to reduce waste, the UCSF School of Dentistry clinics at 707 Parnassus Avenue generate approximately eight tons of landfill waste and four tons of recyclable materials each week. We pay a considerable amount for the hauling and disposal, but that does not account for the societal costs of air pollution generated by the trash trucks, and the greenhouse gas emissions and groundwater contamination associated with landfills.
Covid-19 spurred more waste generation in clinical settings due to increased use of personal protective equipment (PPE). This increased consumption has not gone away post-pandemic. We can break that cycle and lessen the toll on the environment if we choose reusable options when available. In our clinics, gowns are an example of something disposed of after each patient. There are environmental costs in reusing gowns, such as increased water use for cleaning and fuel and emissions from delivery vehicles, but when we shift to a non-disposable option it is an example that demonstrates the value of reuse and shows there are alternatives to disposable items.
There is a financial incentive to reduce waste. Establishing clinical practices that reduce waste and downstream pollution can reduce costs significantly. Accidental contamination of sterile instruments, for example, has financial and environmental costs. Using the minimum amount of materials necessary to complete jobs is another way to benefit both the environment and the bottom line. Perhaps the economic argument is the one that will draw the most attention from some. For younger generations, however, climate health is rightfully seen as an existential crisis.
Younger Generations Understand the Stakes
In 2020, a group of UCSF School of Dentistry students formed an organization called Green Teeth to raise awareness of the link between climate health and oral health. They identified plastic waste disposal as a critical route to sustainable healthcare. In 2021, Green Teeth created a soft plastics recycling program in some of our clinics that presently recycles 40 gallons of soft plastics per day. This one step has minimized the environmental harms of our clinical operations while saving what is estimated to be between three to four dollars for each patient visit.
Green Teeth has also created an annual event at SOD where graduating students sell or trade their dental supplies to continuing students or donate to departments within the school. Extending the life of these tools spares them from a trip to the landfill while simultaneously reducing the financial burden on continuing students. An event like this where everyone wins also helps create a practical and positive example of the benefits of reusing, reducing, and recycling.
The best way to increase awareness of any topic for students is to add it to the school curriculum. Green Teeth helped integrate the idea of sustainability into the general biomedical sciences curriculum for first-year dental students. Topics covered include the handling of medical waste, the association between air pollution and asthma, and how to reduce the amount of waste generated in dental practices.
Actions for Sustainability in Practice
There are some practical measures we can consider to promote sustainability in practice.
Patient and staff travel is the main source of clinic-related greenhouse gas emissions. Scheduling patient visits to combine procedures or considering the individual patient’s risk when determining visit frequency is one way to cut emissions. Members of the same household might have their appointments coordinated to reduce travel.
Equipment and supply deliveries are also a concern for the environment. Larger deliveries arriving less often generate fewer carbon emissions. Also, more than 30% of garbage generated in clinics is packaging. Selecting products that are shipped in bulk or with minimal packaging is an important way to reduce waste.
Even simple things like reducing water use, using energy-efficient lighting, and preventing nitrous oxide leaks by regularly checking hoses, connections, and fittings all help reduce harm to the environment.
Effective Prevention Lessens Environmental Harm
Finally, we can look at effective prevention as not just the best practice for caring for our dental patients, but also necessary for the environment. When we prevent disease in our patients, we also prevent harm to the environment by reducing the amount of clinical waste. While effective prevention is already a goal, compensation for prevention-based approaches might be increased as an added incentive.
The well-being of humanity and our planet are interrelated. We have a responsibility to be stewards of our patients’ and the planet’s health. I haven't gotten to zero landfill at home or work, but we should all keep trying.
Michael S. Reddy, DMD, DMSc
Dean, UCSF School of Dentistry
Associate Vice Chancellor, Oral Health Affairs
