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Green Dentistry (GD)

Green dentistry (GD) is the practice of dentistry using ecologically friendly approaches to minimise carbon footprint. This initiative, pioneered by Universiti Malaya Faculty of Dentistry senior lecturers Dr Aisyah Ahmad Fisal, Dr Maryani Mohamed Rohani, Associate Professor Dr Nor Azlida Mohd Nor and Dr Tengku Nurfarhana Nadirah Tengku Hamzah is in line with the United Nations’ sustainable development goals No. 11 (Sustainable Cities and Communities) and No. 12 (Responsible Consumption and Production).


According to principal investigator Dr Aisyah, GD can be explained simply using the 4Rs concept, namely reduce, reuse, recycle and rethink. It can be carried out on an individual basis, extended to a clinical practice, a public practice unit or even an entire hospital.


“GD saves money, water, energy and supports a greener lifestyle. These benefits are meant to save the planet, benefit the practice and patients as participants in this movement,” she said.


With dentistry being a major contributor to waste, Dr Aisyah explained that both clinical (contaminated with blood and body fluids) and general waste (non-contaminated) are generated on a daily basis.

Image by alexroma from Pixabay


“Clinical waste, which includes the disposable bib or any cotton gauze used during treatment, is very difficult to process as it needs to be separated from general waste and disposed of by incineration, costing our faculty RM7.50 per kg for waste processing. General waste, on the other hand, is easier to dispose of and costs UM Central RM 0.12 per kg but still makes up a lot of rubbish because we have many items such as dental instruments and dental materials that need to be packed individually,” she said.


The majority, she shared, are disposable single-use items that are easy, sterile and convenient but lead to increased disposal costs, which is the main target of GD that advocates reducing disposable items use while maintaining the safety and comfort of patients.


“More specific examples include using reusable cups instead of paper cups, cloth operatory and sterilisation methods instead of disposables and reusable metal instead of plastic suction tips to minimise waste ending up in landfills. Using tooth-coloured instead of silver amalgam restoration to reduce mercury usage worldwide. The Faculty of Dentistry, UM also practised digitalisation of billing, charting, and x-rays to reduce paper usage. Furthermore, the installation of energy-efficient light bulbs and motion sensors reduces the usage of disinfectant wipes for surface disinfection of high-touch areas,” she said.


As GD is still a very new concept in Malaysia, Dr Aisyah believes research is fundamental as positive results would help bolster the need for such approaches in dental practices.


“From the early research results, we can create infographics to educate both dental practitioners and patients alike who attend the dental practice. We can also disseminate the research through local and international conferences for better coverage and impact,” she explained.


On how GD can impact the overall care and experience for patients, Dr Aisyah reassures that nothing really changes.


“The impacts are felt directly as dental practitioners, supporting staff and the administrators who are the major stakeholders in GD practices but for patients, they are indirectly being a supporter of GD and sustainability-friendly dental practices,” she said.


Since starting this initiative in UM, she noticed a significant reduction in waste disposal.


“Comparing our clinical waste data from April to September 2023 with 2022, there has been a reduction of 4470 kg of waste, saving RM33,525.00 of waste processing cost, attributed to the use of autoclave sheets and increased knowledge on waste segregation among staff and students. From recycling itself, we have received RM17.34 from supporting recycling buy-back activities organised in UM, offsetting 183.3 kg of carbon dioxide emissions,” she shared.


Like all newly introduced initiatives, there are multiple challenges that need to be overcome.


“Most dentists are not aware that dentistry itself can be sustainable, so the concept of GD is foreign to them. When we carried out an impromptu poll during our webinar in June on GD, less than half of the respondents were aware of how inadequate biomedical waste management contributes to environmental pollution and global warming,” she said.


This is consistent with preliminary research data conducted by UM on the knowledge, attitudes and practices of undergraduate dental students on GD that showed 48.1% of respondents were previously unaware of this concept and although almost all respondents agreed that GD was a sustainable effort with long-term benefits, only 57.7% used eco-friendly products in their everyday lives.


She also cited cost is the number one challenge because the initial investment is necessary for the implementation of GD practices such as the purchasing of recycle bins, education and enforcement of the recycling and waste segregation process, transportation of the recyclable materials to the recycling centres as well as collaboration with NGOs for upcycling and buy-back recycling activities.


Dr Aisyah Ahmad Fisal supporting the Trash to Cash campaign held on the 6th of June 2023 at Faculty of Science


The idea of this initiative first came about when Dr Aisyah furthered her postgraduate studies in Dublin, Ireland.


“In St. James’ Hospital, I noticed that they had separate bins for their recyclable dental waste. I was also instructed to recycle autoclave sheets, thus that kickstarted the idea of doing the same in UM,” she said, adding that she looks up to Dr Brett Duane from her alma mater, Trinity College Dublin, who is the pioneer of sustainable dentistry.


Besides Ireland, she shared other successful cases of GD including Mahidol University in Thailand which attempted reusing autoclave pouches up to three times and found no evidence of microbial contamination. In Malaysia, Hospital Lam Wah Ee, Penang carried out a 3R (Reduce, Reuse, Recycle) project since June 2002. Over a 10-year period up to December 2011, the hospital managed to recycle 537,828.41 kg of general solid waste that were was sold off at USD 98,143.58.


Assoc. Prof. Dr Nor Azlida Mohd Nor and Dr Tengku Nurfarhana Nadirah Tengku Hamzah at the Jom Kitar Semula campaign held in UM on the 20th of July, 2023

Dr Aisyah Ahmad Fisal and Dr Maryani Mohamed Rohani buying back paper to be recycled at the latest Jom Kitar Semula campaign held by UM Zero Waste Campaign on the 25th of October, 2023


Thermoplastic injection moulding machine at the Faculty of Engineering, UM to process the recycled plastic.

To all dental professionals, Dr Aisyah advises that the implementation of GD has to start out small, at an individual level first through raising awareness of the need for sustainable dental practice in a world that is increasing in rubbish leading to more landfills and ocean pollution.


“Record how much disposable items you’re consuming, how much rubbish you’re producing, how much you’re recycling, and how much needs to be processed. Inform your patients about the sustainable GD initiatives, some patients are very ecologically conscious, and they will be glad to know that the practice they’re frequenting is also part of the green movement. Finally, reach out to NGOs that carry out recycling and buy-back facilities to know your options on how to manage your recyclable waste,” she said.


Recycle bins for paper and plastic in the dental student’s polyclinic.

Dr Aisyah Ahmad Fisal showing the separated plastic polypropylene sheets from the autoclave sheets to be recycled

Plastic keychains as the final product of recycled plastic to be sold

 

Researchers featured:

Principal investigator of Green Dentistry Project, Dr Aisyah Ahmad Fisal

Department of Paediatric Dentistry & Orthodontics, Faculty of Dentistry




Co-investigator of Green Dentistry Project, Dr Maryani Mohamed Rohani

Department of Paediatric Dentistry & Orthodontics, Faculty of Dentistry





Co-investigator of Green Dentistry Project, Assoc. Prof. Dr Nor Azlida Mohd Nor

Department of Community Oral Health & Clinical Prevention, Faculty of Dentistry




Co-investigator of Green Dentistry Project, Dr Tengku Nurfarhana Nadirah Tengku Hamzah

Department of Paediatric Dentistry & Orthodontics, Faculty of Dentistry






Author:

Wong Zhi Yong

A passionate medical student who seeks the balance between science and writing. From dissecting the intricacies of the human body to weaving narratives, I am intrigued by both medicine and the written word.






Copyedit:

Siti Farhana Bajunid Shakeeb Arsalaan Bajunid

Assistant Registrar, Universiti Malaya


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