Is your office environmentally responsible?

by Karen Donaldson, CDA, RDH, BS, EFDA

Just because your office recycles soda cans and gallon water jugs, you cannot call yourself a "green" office. Becoming green in 2011 takes much more effort, but the planet Earth deserves it and so do you. The Eco-Dentistry Association gives the following definition of green dentistry: reduces waste and pollution; saves water energy and money; incorporates high tech; is wellness based.

Let's evaluate your level of "green" to determine where you stand in today's environmental responsibility. Here are four main areas you need to address to be green:

Solid waste prevention
Pollution prevention
Water conservation/quality
Energy conservation

Does your office address each of these areas with a focused interest to prevent, preserve, and conserve? Do you practice the three R's: Reduce, Reuse, and Recycle? What are we wasting in dentistry? Let's take a closer look.

Solid waste

►Plastic bags take from 20 to 1,000 years to degrade. Did you know approximately 1.7 billion sterilization pouches and 680 million chair barriers, light handle covers, and patient bibs are thrown away each year? Some biodegradable plastics contain a small percentage of nonoil-based materials, such as cornstarch, and others are photodegradable. Try purchasing these from a green distributor, or do away with plastics and just wipe with a disinfectant, such as cocamide diethanolamine, that does not use toxic chemicals. Use paper bags for patient giveaways.

►Paper waste. The average office worker discards more than 175 lbs. of high-grade paper per year. One way to eliminate this mass volume of waste is to go completely paperless. Computerize all charting and data. Send reminder cards either electronically or via an automated phone system, such as voice or text. Make sure your patient information includes e-mail addresses and cell phone numbers. Make sure your marketing materials are either electronically sent or recycled.

Americans receive approximately 4 million tons of junk mail every year, most of which ends up incinerated or in the landfill. Reduce junk mail by removing your dental practice's name from the national databases at www.stopjunkmail.org.

►Disposable instruments and oral health items. Avoid using disposable air/water tips, bite registration holders, and one-time-use burs. Purchase saliva ejectors and high-volume suction tips that are made from recycled materials. You can purchase toothbrushes made of recycled yogurt containers from www.preserveproducts.com. Have patients return their old toothbrushes to you to ship back to the company in postage paid mailers so they can be recycled again. These also are BPA and phthalate-free. The company also makes recycled razors. Offering these for sale to patients is a great marketing tool, and it helps the environment!

►Amalgam, X-ray chemicals, petroleum-based impression materials. When using high-speed turbines to remove amalgam fillings, the bacterial count of microscopic particles in the air can reach 300 cfu/m3 during a 50-minute appointment. Eliminate the use of amalgam for future restorations. Install a mercury separator to prevent water contamination. Only 11 states and 19 localities require dental offices to have amalgam separators, with varying levels of enforcement success. In general, the dental industry is self-regulating regarding amalgam waste, and our communities rely on individual dental offices to protect the water stream from mercury-containing dental waste.

Many of today's modern dental practices choose state-of-the-art, tooth-colored restoration materials. But even if your office does not place amalgam fillings, you still need an amalgam separator. In a survey taken at the 2009 American Dental Association Annual Session, only 39 of 100 dental offices surveyed had amalgam separators. The popular answer for not installing a separator was that the office did not place amalgam fillings, not recognizing that the removal of these fillings directs significant mercury-containing waste into the water stream. In a typical one-dentist office that only removes amalgam fillings, the amalgam separator captured 2 lbs. of mercury-containing waste material in one year.

Only 28% of dentists use digital radiography. Going digital eliminates disposal of X-ray chemicals. There are no paper and plastic covers or lead shields to dispose of in landfills, and the patient receives less radiation. Digital also saves time, a resource all offices need! By converting to digital X-rays, a typical office can prevent disposal of at least 200 liters of toxic fixer and 17,200 lead foils in just five years. And digital patient charting saves as many as 10,000 sheets of paper per year in the typical dental practice.

Eco-friendly on-site disposal products are available from companies such as Wastewise, rendering them harmless or shipping them appropriately to a waste management site compliant with the ADA's guidelines. Information is available at www.wcminc.net.

Pollution prevention

Toxic items and chemicals. Never throw these items in the trash or pour down the sink:
Batteries
Paint
Used toner or ink-jet cartridges
Compact fluorescent lamps and tubes
Electronics
Aerosol cans that are not completely empty

Local waste management companies can help you find the best disposal site for these items. Electronic recycling of products such as cell phones, monitors, copiers, and calculators is handled by UNICOR and shipped free of charge by UPS. Contact UNICOR at www.unicor.gov/recycling.

Make sure your office has installed a mercury separator, as mentioned before, to remove toxic waste from your sewage waste. Replace the filters on your vacuum system monthly. Perform regular maintenance on the vacuum system, as well as your heating and cooling system. Have air purification systems installed in all treatment rooms.

Make sure filters in the HVAC systems are changed every two to four months. Install a programmable thermostat to conserve energy. Set your thermostat to 68 degrees in the winter and 78 degrees in summer, with a night temperature of 55 degrees.

Water conservation/quality

►Water usage in office. Take a closer look at your water bill. Higher usage from one month to another may indicate leaks or other problems. Replace pre-1992 toilets that use three or more gallons per flush with newer, more efficient ones that use only 1.6 gpf or less. A leaky toilet can waste as much as 260 gallons per day.

Make your own distilled water for use in the dental equipment systems. Make sure you are treating your dental lines for biofilm. Disconnect water containers every night and make sure waterlines are blown out.

Use the dishwasher only when full. Place "use water wisely" stickers near sinks, and install standard faucet aerators or flow restrictors to conserve water. A water miser system can reduce overall water by use 75%.

Save 90 glasses of water a day just by turning the water off while brushing your teeth, instead of running it continuously. A faucet with a slow leak can waste 50 gallons every day!

Energy conservation

►Lighting. Convert at least 50% of existing lighting to energy-efficient alternatives, such as fluorescent lights, low-voltage track lighting, or halogen lights. Upgrade existing fluorescents to T8 or T5 lamps with electronic ballasts. Replace exit signs with LED or high-efficiency alternatives. Turn off lights in areas not in use.

►Appliances, computers, equipment. Program computer monitors to sleep mode after 15 minutes or less. Turn off all electronic equipment at night, and unplug equipment not in regular use. Set the photocopier default to the energy-saver feature.

Make sure any new equipment purchased is Energy Star-certified. Use a thermos to maintain warm coffee or tea so you can turn off and unplug the maker after it is brewed.

Insulate water heaters, storage tanks, and hot water pipes. Install water heaters that heat only the water being used. Install solar panels to generate power.

Learn to take small steps to reach your goal

If you find these lists overwhelming, you are not alone. Becoming eco-friendly, or green, is a major step. Focus on each area, choosing single goals that are easily reached. Develop an office plan by setting goals for the future that can be discussed at staff meetings and easily reached one at a time. Determine which changes are priorities and try to meet those first.

The Internet has lots of information and resources that can help you become green. One of the best sources for helping you organize your plan and go green is ecodentistry.org. There, you will find a list of ways to make your office more eco-friendly as well as resources for suppliers with multiple products and equipment to ensure that you achieve your goals.

A visit to a green dentist

Recently, I visited the office of Dr. Robert Hodous, in Fayetteville, Ark., to see a green dental office. His office participates in the Green Dentist Marketing Group. Their mission statement reads like this:

The Green Dentist Marketing Group, Inc. was created to unite and educate dentists, their patients, and those in their communities who are interested in a more healthy and sustainable life and business.

Dr. Hodous and his team in Fayetteville, Ark.

By joining this group, Dr. Hodous receives guidance and resources to ensure success in becoming a green dental office, as well as a connection to a network of other offices for support. Dr. Hodous can advertise as a certified green dental office, which helps bring new patients who are seeking eco-friendly health-care providers to the practice. Initially, you can become a certified member by qualifying with only three items in each category. This allows you to get certified without a large initial expense, and then you can continue to advance your level of green as changes are made. Becoming more advanced as a certified green dentist, however, can be quite an investment to make positive changes within your office. Setup and installation of equipment that helps save money ranges in cost based on the supplier you use. Dr. Hodous shared the following expenses he incurred while becoming a green office. Keep in mind that fees are approximate, and additional fees will be necessary to establish continued levels of change when going green.

Mercury separator $4,000
Water Miser (provides 75% reduction) $3,000
Change lighting to T8 energy-efficient bulbs $4,000
One-time fee to become a Certified Green Dentist $200

These expenses will pay for themselves in time and continue to save your office money. If you are planning a new office site or a remodeling project, that is the perfect time to make major changes. In the meantime, you can implement step-by-step changes to work toward becoming a green office.

In addition to the numerous ways to go green mentioned earlier in this article, Dr. Hodous uses a CEREC CAD/CAM to generate all porcelain restorations. This not only saves time for both the office staff and patient, but it also eliminates the use of petroleum-based impression materials and reduces the use of gypsum materials and electricity. Another savings is on the postage and packing materials required to send the case to the lab.

Dr. Hodous' eco-friendly environment offers patients a more relaxed visit for their dental care. Patients receive local anesthesia calmly in a meditation room on a heated biomat of amethyst crystals. These infrared heated mats are known for reducing stress, relaxing muscles, and relieving arthritic pain. What better way to help your patients reach a higher level of wellness in your green office?

An eco-friendly 'green' future

At your next staff meeting, bring up the topic of going green. Suggest simple goals to reach by the next staff meeting. Become the green advocate for your office. Promote the changes to your patients and encourage them to participate in eco-friendly practices at home. If we all work toward a safer, healthier environment, we can ensure a greener dental world and a greener Earth. Remember: Nothing wasted. Everything gained.

Karen Donaldson, CDA, RDH, BS, has worked as a dental hygienist since 1989 when she graduated from the University of Southern Indiana as a nontraditional student. She graduated magna cum laude in 1990 with a bachelor's degree in health sciences with a geriatrics and social services emphasis. She also holds certification from DANB as a Certified Dental Assistant and has had expanded functions training. Karen practices clinical dental hygiene in Northwest Arkansas.

Resources

Christian L. Business going green, Missouri dentists go green. Missouri Business e-News; Feb. 2010.
Myers TL. X-files #2: Green dental heroes save the environment daily. Dentistry IQ.com. Mar. 1, 2009.