THE PLASTIC WASTE TSUNAMI FACING DENTISTRY
From toothpaste tubes to disposable gloves, dentistry greatly contributes to plastic waste. This month, Dr Davinder Raju discusses sustainable changes for practices and patients.
Belgian chemist Leo Baekeland developed the first fully synthetic plastic in 1907. Over 100 years later, plastic(s) remain valuable materials for modern society. Because of plastic’s versatility and low cost, its use within the dental health sector is ubiquitous. At home, plastic oral health care products adorn many bathroom shelves.
Yet, despite the versatility and beneficial practical applications of plastics, with their increasing production and concomitant waste generation, it also has increasingly worse environmental impacts.
In fact, according to a recent report from the Organisation for Economic Co-operation and Development (OECD), the world is producing twice as much plastic waste as two decades ago. But unfortunately, only nine per cent of the plastic waste we generate is successfully recycled. Consequently, the bulk of it ends up in landfills (50%), incinerated (19%) or leaking into the environment (22%), where it can cause damaging effects to humans, wildlife and their habitats.
According to the same report, in 2019 over 6.1 million tonnes of plastic waste leaked into aquatic environments and 1.7 million tonnes flowed into oceans. As a result, there is now an estimated 30 million tonnes of plastic waste in seas and oceans. In addition, a further 109 million tonnes have accumulated in rivers. This will continue to leak into the oceans for years to come.
Some of that waste, no doubt, will include discarded toothbrushes. This is highly probable as an estimated 3.5 billion toothbrushes are sold worldwide each year. A little closer to home, 256 million toothbrushes are discarded in the UK each year. In addition, toothpaste tubes, interdental cleaning aids etc., as well as their containers, all contribute to that waste.
Typically, plastic tooth and interdental brushes are not biodegradable and are challenging to recycle at local recycling plants because of their hardness and the composition of different plastics used. One of the most significant barriers to effective plastic recycling is separating the different plastics used in a product. Unfortunately, when different polymers are mixed, the resulting material doesn’t usually have the same valuable properties.
Most toothpaste tubes are also made of multiple materials, including aluminium; they can’t be processed successfully at local recycling plants either.
So, as dental care professionals, what can we advise our patients?
Healthcare professionals are in a position of authority. Therefore, when our patients attend our practices, we can suggest environmentally sustainable products. To help mitigate their plastic impact on the environment while maintaining an effective oral health home care regime, we can:
Consider stocking or advising patients to use manual toothbrushes with reusable handles. These toothbrushes have a replaceable toothbrush head, use considerably less (80%) plastic than a conventional manual plastic toothbrush, and overall have very low environmental impacts
Contemplate offering patients manual bamboo toothbrushes. These are biodegradable, and some producers have ranges available with reusable handles, reducing their impacts further
Encourage manual toothbrushes over electric toothbrushes as the latter have significantly higher environmental impacts
Publicise ethical manufacturers who take responsibility for the products they produce. e.g. Reswirl manufactures their toothbrushes using recyclable plastic and ultimately biodegradable plastic. In addition, they offer a return postal service for their products to ensure they are recycled or composted effectively
Point patients to the nearest terracycle drop-off points. The Colgate and hello Oral Care Free Recycling Programme will recycle toothbrushes, floss containers and mouthwash bottles. The Philips Dental Care Free Recycling Programme will also recycle electric toothbrush heads, flossing sticks and interdental brushes
Consider offering your patients ‘toothpaste’ tablets instead of regular toothpaste. Being tablets instead of a paste negates the need to be housed within difficult-to-recycle plastic tubes.
Surgery plastic waste
Now, within the surgery plastics are omnipresent. We are all aware of how much plastic we get through during a typical day. Therefore you won’t be surprised to read that most of the waste generated in dental practices is also plastic.
Take, for example, disposable gloves worn by the clinical team – it is estimated that delivering NHS dentistry alone necessitates the use and subsequent disposal of 330 million gloves annually. Other items of PPE and single-use plastic devices are also used to complete clinical procedures or provide barrier protection. Over 20 SUPs are used for the average dental procedure and ultimately need to be disposed of correctly.
And, of course, during the Covid-19 pandemic, there was a mammoth and justifiable increase in the amount of single-use PPE. But now, post-pandemic, perhaps is the right time to look at where we can reduce the amount of single-use plastic devices we use.
There is a growing recognition among healthcare professionals that the status quo is not sustainable. Afraid of litigation from governing bodies and a belief that single-use devices are mandatory to prevent cross-infection, we have become too risk-averse. In addition, we do more and more for patient safety without questioning whether we can do it differently.
Moreover, single-use plastic devices are profitable yet cheap to manufacture and, furthermore, easy to sell to a fearful profession.
Transitioning to sustainability
Very recently, Scotland became the first UK nation to ban ‘problematic’ plastics. These new rules make it an offence for businesses to offer single-use plastic cutlery, plates, stirrers, food containers, cups and other beverage containers made of expanded polystyrene.
The dental profession could be a leader in transitioning to sustainable practice and commit to reducing single-use plastic devices. Additionally, collaboratively, we could apply pressure to supply chains to reduce the amount of single-use plastic they use for their products.
At my practice, we are making that transition. We have looked at single-use plastic devices used for dental procedures. Where feasible, we have replaced them with reusable devices. The upfront costs may be a little higher, but in the long term, there are cost savings.
Take, for example, autoclavable stainless steel trays – I bought mine 16 years ago and they are still in use. Other areas where we can reduce our plastics consumption and waste include:
Biodegradable nitrile gloves
Autoclavable aspirator tips
Autoclavable 3-in-1 tips
A digital intra-oral scanner (thus eliminating/reducing the amount of polymer impression materials used)
Autoclavable dappens pots
Washable surgical gowns
Offering our patients paper cups.
Before the delayed Tokyo 2020 Olympic games started, the Environment Agency encouraged Team GB’s Olympic athletes to sign up for the ‘Big Plastic Pledge’. It aims to unite athletes and fans worldwide to help tackle plastic pollution and eradicate single-use plastic in sport. The pledge also encourages athletes to speak more about their support for preventing plastic pollution and using their position as worldwide role models to influence others.
And more recently in May 2022, Greenpeace initiated the Big Plastic Count. This was an initiative where participants were asked to count their plastic waste for a week to make the UK government understand the scale of the plastic waste problem. Greenpeace will use the results to push for legislative changes to reduce the use of single use plastic and reduce plastic waste.
Why can’t we, as a profession, do the same? As healthcare professionals, we are respected and well-positioned to help educate our patients toward more sustainable practices. Also, why don’t we pledge to eradicate single-use plastic devices where reusable devices are available? We could start by targeting our waste bins – identifying single-use plastic devices that take up the most volume, looking for and then implementing an effective alternative. We could even go further and collate our data and push for a ban on single-use plastics within dentistry.