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ORIGINAL ARTICLE
Year : 2017  |  Volume : 15  |  Issue : 1  |  Page : 53-56

Green Dentistry: Practices and Perceived Barriers Among Dental Practitioners of Chandigarh, Panchkula, and Mohali (Tricity), India


National Dental College and Hospital, Derabassi, Punjab, India

Date of Web Publication14-Mar-2017

Correspondence Address:
Amandeep Chopra
National Dental College and Hospital, Derabassi, Punjab
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2319-5932.201930

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  Abstract 

Introduction: Dental professionals have a responsibility to conserve natural resources and to eliminate/reduce toxic wastes from their practices that could harm human health and environment. Aim: To investigate the implementation of eco-friendly dental office strategies by the dentists of tricity (Chandigarh, Panchkula, and Mohali). Materials and Methods: Self-designed questionnaires were distributed to 120 Indian Dental Association registered dentists. Descriptive statistics and cross tabulations were calculated using the Statistical Package for the Social Sciences version 20.0 software. Results: Most of the dentists followed eco-friendly dental practices including the alternatives to amalgam filling (98%), use of light-emitting diode bulbs (91%), unplugging electronic devices when not in use (96%), use of steam sterilization with cloth instrument wraps (93%), using reusable lab coats (89%), and using digital radiography (78.6%). The most frequently identified barriers to implementation of eco-friendly dental office strategies were cost and lack of incentives from the government. Conclusion: Eco-friendly practice implementation by dentists is at its stage of infancy. There is a need for creating awareness among dentists regarding eco-friendly dental practices through formal and continuing dental education.

Keywords: Dental professionals, eco-friendly, green dentistry, questionnaire


How to cite this article:
Chopra A, Raju K. Green Dentistry: Practices and Perceived Barriers Among Dental Practitioners of Chandigarh, Panchkula, and Mohali (Tricity), India. J Indian Assoc Public Health Dent 2017;15:53-6

How to cite this URL:
Chopra A, Raju K. Green Dentistry: Practices and Perceived Barriers Among Dental Practitioners of Chandigarh, Panchkula, and Mohali (Tricity), India. J Indian Assoc Public Health Dent [serial online] 2017 [cited 2019 Aug 25];15:53-6. Available from: http://www.jiaphd.org/text.asp?2017/15/1/53/201930


  Introduction Top


With growing awareness, many businesses, either voluntarily or due to regulatory pressures, are striving to alter their practices by taking environmental responsibility. Similarly, the field of dentistry, which generates a significant amount of waste on a regular basis, has adopted the concept of “Going Green” so as to make it environment-friendly. Materials that have a minimum effect or cause no harm to the environment are known or defined as eco-friendly or environment friendly.[1]

Dental professionals have a responsibility, along with other health-care professionals, to conserve natural resources and to reduce the impact on the environment of toxic waste generated from their practices on the environment. Eco-friendly or green dentistry is a newly evolving practice of dentistry, which encompasses a simultaneous devotion to sustainability, prevention, precaution, and a minimally invasive patient-centric, as well as, global-centric treatment.[2] This type of practices not only help in controlling the waste pollution in the dental practice, but also save water, energy, and other resources in the dental clinic.

In 2008, Eco-friendly Dental Association (EDA) was co-founded by Dr. Fred Pockrass and his wife Ina Pockrass.[3] EDA provides “Education, standards and connection to patients and dentists who practice green dentistry.” EDA aims to help dentists “Come up with safe and reusable alternatives that lower a dentists operating cost by replacing paper with digital media whenever possible.”

There is a need for dentists to be environmentally conscious and take the necessary steps to make their dental practice “Eco-friendly.” The objective of this study was to investigate the implementation of eco-friendly dental office strategies by dentists of tricity (Chandigarh, Panchkula, and Mohali).


  Materials and Methods Top


A cross-sectional questionnaire study was conducted from February to May 2016 among dental practitioners of tricity. Ethical clearance was obtained from the Institutional Ethical Committee and informed written consent was obtained from the participants.

A self-structured, closed-ended questionnaire was designed after an intensive literature review by the research team. Content validity was done by the panel of experts in this field. These subject-matter experts were provided with an access to the measurement tool and were asked to provide feedback on how well each question measures the construction in question. Their feedback was then analyzed, and informed decisions were made about the effectiveness of each question.

The original version of the questionnaire was pilot tested to determine the test–retest reliability of the survey. The subjects who participated in the pilot study were not included in the final sample. Few modifications were done to improve the understanding of the questionnaire based on the responses. The participating dentists were asked to answer the questionnaire which was given personally to them and provide feedback on content, clarity, and format. Final questionnaire consisted of three parts: demographic information, implementation of eco-friendly practice, and information about dentists perceived barriers to implementation of eco-friendly strategies. On the basis of a pilot study, sample size was estimated for the main study (n = 120).

A list of private dental practitioners was obtained from the respective Indian Dental Association branches across tricity. From the lists obtained and pilot study results, a total of 120 private dental practitioners were randomly approached to participate in the survey. Participants who were not willing to participate in the study or who were absent during three consecutive visits were excluded from the study. The final sample consisted of 100 dentists.

Statistical analysis

Data were entered into the Microsoft Word Excel Sheet 2010 version and was analyzed using the Statistical Package for the Social Sciences version 20.0 software (SPSS Inc., Chicago, IL, USA). Descriptive analysis for demographic variables, implementation of eco-friendly dental office strategies and perceived barriers were computed. Further, chi-square test was applied to find out whether there is any difference in implementation and demographics. P ≤ 0.05 was considered statistically significant.


  Results Top


The majority of dentists in the study were female (66%) and held a master’s degree (54%) and were seeing 0–10 patients every day (68%) [Table 1]. Only 23.2% of subjects were aware of green building.
Table 1: Demographic characteristic of study population

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[Table 2] depicts implementation of eco-friendly dental office strategies among practicing dentists of tricity. Most of them followed eco-friendly dental practices including alternatives to amalgam filling (98%); use of light-emitting diode (LED) bulbs (91%); unplugging electronic devices when not in use (96%); use of steam sterilization with cloth instrument wraps (93%) versus paper and plastic autoclave bags; and using digital radiography (78%). 86.0% dentists used sterilized instruments, trays, and film holding devices, rather than disposable ones and 89% used reusable lab coats.
Table 2: Implementation of eco-friendly dental office strategies among practicing dentist of tricity

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No significant difference was observed in the implementation of eco-friendly dental office strategies based on gender, qualification, and number of patients seen per day (P > 0.05).

[Figure 1] portrays perceived barriers to implementation of eco-friendly strategies. Cost factor and lack of awareness were the major perceived barriers.
Figure 1: Perceived barriers to implementation of eco-friendly strategies

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  Discussion Top


Dental professionals share global responsibility for elimination or reduction of toxic wastes that could harm human health and environment. Amalgam restoration materials, plastic covers, radiographic chemicals, lead foils, and disinfectant solutions are waste materials from dental settings that eventually end up in landfills and water supplies. Using eco-friendly strategies in dental offices can improve public health through minimizing waste and, hence, reducing pollution. Therefore, the present study was conducted to assess the implementation of eco-friendly dental practices among dentists.

Green building is the practice of increasing efficiency with which buildings use resources such as energy, water, and materials were unknown to majority of dentists.

The use of pre-capsulated alloys in different sizes which has been recommended by American Dental Association[4] was not in much practice (36 out of 100 dentists) by the participating dentists. This is contradictory to that of Sawair et al.[5] who found that about 76% of Jordanian general dental practitioners use amalgam. This might be because most of the dentists of tricity were using alternatives to amalgam such as composite, ceramic, gold and porcelain.

Very few dentists were using renewable resources. Using sustainable forms of energy, such as wind or solar power will help minimize the impact on the environment.

Our results revealed that 62 dentists are using computer-based records systems. There is a need for an up-gradation like an electronic record keeping device, which saves time while updating patient’s records and displays the changes using simple and easily understandable graphs. The study’s results also revealed a frequency of 78 using scrap office/computer paper for scratch pads and internal notes which is in concordance with the study done by Rastogi et al.[2] among Jordan dentists.

Reusable drinking cups and metal suction tips were used by 50–60% dentists. Its use should be promoted as this can be sterilized and is more eco-friendly.[6]

Majority of dentists (89%) prefer using cloth lab coats that can be laundered rather than disposable ones. Sawair et al.[5] study is one with a different view that mentioned low use of cloth lab by practitioner. Low use among dentists was because of the need for extra equipment such as a dishwasher with a special sanitizer cycle for reusable cups, and it requires additional staff responsibility to meet health code requirements and universal standards.

A few practitioners used tree oil or thyme (enzyme-based cleaners) as a surface disinfectant. Using enzyme-based cleaners that are biodegradable, nontoxic, and nonchlorinated protects both human health and the environment. Only 16.0% of the practitioners use cork or linoleum flooring which is environmental friendly. Most of them use vinyl flooring in their clinics. Once installed, vinyl may function as off-gas harmful compounds (such as lead, cadmium, and phthalate plasticizers) for years. Half of the respondents use enamel low-luster paint in their clinics. These contain ultra-low quantities of solvents which release volatile organic compounds into the air.

Low implementation of radiographic waste management was observed, which is similar to the study done by Al Shatrat et al.[7] However, this might be due to high use (77%) of digital radiography and, therefore, a low need to dispose off chemicals.

Majority of respondents chose “the cost” and “lack of awareness” as the most common barriers to the implementation of eco-friendly practices. The government might encourage dentists to implement eco-friendly strategies in their offices by providing tax incentives, no duties on purchases, and use of equipment or materials that have minimum effect on the environment.

This study has some limitations, such as self-reported questionnaires that may have caused recall bias and some level of researcher imposition.


  Conclusion Top


Eco-friendly practice implementation by dentists is at its stage of infancy. However, there is a rise in implementation with most followed eco-friendly dental practices including alternatives to amalgam filling, use of LED bulbs, unplugging electronic devices when not in use, paper waste management, use of steam sterilization with cloth instrument wraps, using reusable lab coats, and using digital radiography. The most frequently identified barriers to implementation of eco-friendly dental offices strategies were cost and lack of incentives from the government. There is a need for creating awareness among dentist practitioners regarding eco-friendly dental practices through formal and continuing dental education.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Higgins N. Going “Green” in Your Dental Office. Sidekick. [Internet]; 2009 summer. Available from: http://sidekickmag.com/office_design/articles-office-design/goinggreen-inyour-dentaloffice. [Last accessed on 2016 Jul 10].  Back to cited text no. 1
    
2.
Rastogi V, Sharma R, Yadav L, Satpute P, Sharma V. Green dentistry, a metamorphosis towards an eco-friendly dentistry: A short communication. J Clin Diagn Res 2014;8:ZM01-2.  Back to cited text no. 2
    
3.
EnviroMed Design Group. The Case for Green Dentistry. Available from: http://www.enviromedgroup.com/eda. [Last accessed on 2016 Jul 10].  Back to cited text no. 3
    
4.
American Dental Association. Best Management Practices for Amalgam Waste. [Internet]. Chicago, Illinois: American Dental Association; 2007October. Available from: http://www.ada.org/sections/publicResources/pdfs/topics_amalgamwaste.pdf. [Last accessed on 2016 Jul 10].  Back to cited text no. 4
    
5.
Sawair FA, Hassoneh Y, Jamleh AO, Al-Rabab’ah M. Observance of proper mercury hygiene practices by Jordanian general dental practitioners. Int J Occup Med Environ Health 2010;23:47-54. doi: 10.2478/v10001-010- 0012-9.  Back to cited text no. 5
    
6.
Eco Dentistry Association. About Green Dentistry. [Internet]; 2012. Available from: http://www.ecodentistry.org/?page=AboutGreenDentistry. [Last accessed on 2016 Jul 16].  Back to cited text no. 6
    
7.
Al Shatrat SM, Shuman D, Darby ML, Jeng HA. Jordanian dentists’ knowledge and implementation of eco-friendly dental office strategies. Int Dent J 2013;63:161-8.  Back to cited text no. 7
    


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    Tables

  [Table 1], [Table 2]



 

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Introduction
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