Abstract
A significant amount of dentistry's carbon emissions originate from travel (64.5%). Dental-associated travel affects air quality, releasing over 443 tonnes of nitrogen oxides (NOx) and 22 tonnes of particulate matter (PM2.5) annually. This reduction in air quality reduces over 325 quality-adjusted life years (QALY) per year. Wider health impacts associated with noise and traffic incidents doubles the impact on health in QALYs. Dental procedures that require shorter appointment times have disproportionately higher emissions due to patient travel. The dental team can reduce appointment times by combining visits for family members or combining operative procedures, or reducing appointment frequency based on patient risk. Community oral health programmes and preventive programmes reduce travel emissions. The number of physical dental appointments can be reduced using information technology such as global positioning systems (GPS), telemedicine and teleconferencing. The mode of travel is important, with the air and carbon emissions generated by active travel negligent compared to a private car. Travel plans can help encourage active travel, as can flexible working hours, cycle to work schemes, cycle racks and shower facilities. Practices should consider purchasing locally sourced or sustainably transported goods and, ideally, use local dental laboratories.
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References
Duane B, Berners Lee M, White S, Stancliffe R, Steinbach I. An estimated carbon footprint of NHS primary dental care within England. How can dentistry be more environmentally sustainable? Br Dent J 2017; 223: 589-593.
Sustainable Development Unit. Carbon footprint update for NHS in England 2015. 2016. Available at https://www.sduhealth.org.uk/policy-strategy/reporting/nhs-carbon-footprint.aspx (accessed March 2019).
Sustainable Development Unit. Health Outcomes of Travel Tool (HOTT). 2019. Available at https://www.sduhealth.org.uk/delivery/measure/health-outcomes-travel-tool.aspx (accessed March 2019).
Committee on the Medical Effects of Air Pollutants (COMEAP). Statement on the evidence for the effects of nitrogen dioxide on health. 2015. Available at https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/411756/COMEAP_The_evidence_for_the_effects_of_nitrogen_dioxide.pdf (accessed March 2019).
Department for Environment, Food and Rural Affairs. Air Pollution in the UK 2016. 2017. Available at https://uk-air.defra.gov.uk/assets/documents/annualreport/air_pollution_uk_2016_issue_1.pdf (accessed March 2019).
Royal College of Physicians. Every breath we take: the lifelong impact of air pollution. 2016. Available at https://www.rcplondon.ac.uk/projects/outputs/everybreathwetakelifelongimpactair-pollution (accessed March 2019).
National Institute for Health and Care Excellence. Glossary. 2019. Available at https://www.nice.org.uk/glossary?letter=q (accessed March 2019).
Sustainable Development Unit. Health Outcomes of Travel Tool: Full Guide. 2017. Available at https://www.sduhealth.org.uk/documents/Delivery/HOTT_Full_guide_V2_web.pdf (accessed March 2019).
Department of Health and Social Care. Chief Medical Officer annual report 2017: health impacts of all pollution. 2018. Available at https://www.gov.uk/government/publications/chief-medical-officer-annual-report-2017-health-impacts-of-all-pollution-what-do-we-know (accessed March 2019).
Macpherson L M, Ball G E, Brewster L et al. Childsmile: the national child oral health improvement programme in Scotland. Part 1: establishment and development. Br Dent J 2010; 209: 73-78.
Scottish Intercollegiate Guidelines Network. SIGN 138: Dental interventions to prevent caries in children: a national clinical guideline. 2014. Available at https://www.sign.ac.uk/assets/sign138.pdf (accessed March 2019).
Public Health England. Delivering better oral health: an evidence-based toolkit for prevention. 2017. Available at https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/605266/Delivering_better_oral_health.pdf (accessed March 2019).
National Institute for Health and Care Excellence. Dental checks: intervals between oral health reviews. 2004. Available at https://www.nice.org.uk/guidance/cg19(accessed March 2019).
Vantage Health. Dental Referrals. 2019. Available at http://referral.management/dental-referrals/ (accessed March 2019).
Sustainable Development Unit. Module: An Integrated Metrics Approach. 2016. Available at https://www.sduhealth.org.uk/documents/publications/2015/IMP_Notes__Metrics_independentprovidersv2.pd (accessed March 2019).
ArcGIS Resources. Location-allocation analysis. 2019. Available at http://resources.arcgis.com/en/help/main/10.1/index.html#//004700000050000000 (accessed March 2019).
Johansson T, Wild C. Telerehabilitation in stroke carea systematic review. J Telemed Telecare 2011; 17: 1-6.
Kairy D, Lehoux P, Vincent C, Visintin M. A systematic review of clinical outcomes, clinical process, healthcare utilization and costs associated with telerehabilitation.Disabil Rehabil 2009; 31: 427-447.
Rocca M A, Kudryk V L, Pajak J C, Morris T. The evolution of a teledentistry system within the Department of Defense.Proc AMIA Symp 1999; 921-924.
Healthcare Innovation. Teledentistry making a difference in rural New York. 2015. Available at https://www.hcinnovationgroup.com/policyvaluebased-care/medicare-medicaid/blog/13026034/teledentistrymakingadifferenceinruralnew-york (accessed March 2019).
Wootton R, Tait A, Croft A. Environmental aspects of health care in the Grampian NHS region and the place of telehealth.J Telemed Telecare 2010 16: 215-220.
Estai M, Kruger E, Tennant M, Bunt S, Kanagasingam Y. Challenges in the uptake of telemedicine in dentistry. Rural Remote Health 2016; 16: 3915.
An International Association for Medical Education (AMEE). Conferences. Available at https://amee.org/conferences/amee-live (accessed March 2019).
The Institute of Public Health in Ireland. Active travelhealthy lives. 2011. Available at https://www.publichealth.ie/files/file/Active%20travel/Active%20travel%20-%20healthy%20lives.pdf (accessed March 2019).
Department for Business, Energy and Industrial Strategy. Greenhouse gas reporting Conversion factors 2016. 2016. Available at https://www.gov.uk/government/publications/greenhouse-gas-reporting-conversion-factors-2016 (accessed March 2019).
National Atmospheric Emissions inventory.Emission factors for transport. 2018. Available at http://naei.beis.gov.uk/data/ef-transport (accessed March 2019).
Department for Environment, Food and Rural Affairs. Damage costs by location and source. 2019. Available at https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/770576/air-quality-damage-cost-guidance.pdf (accessed March 2019).
Goodall C. How to reduce your carbon footprint. The Guardian (London) 2017 January 19.
National Institute for Health and Care Excellence. Physical activity in the workplace. 2008. Available at https://www.nice.org.uk/guidance/ph13 (accessed March 2019).
Saunders L, Green J, Petticrew M P, Steinbach R, Roberts H. What are the health benefits of active travel? A systematic review of trials and cohort studies. PLoS One 2013; 8: e69912.
Andersen L B. Active commuting is beneficial for health. BMJ 2017; 357: j1740.
Department for Transport. The economic benefits of walking and cycling. 2014. Available at https://tfl.gov.uk/corporate/publications-and-reports/economic-benefits-of-walking-and-cycling (accessed March 2019).
Mapping Greener Healthcare. Walking Incentives by Kings College Hospital NHS Foundation Trust. Available at http://map.sustainablehealthcare.org.uk/walking-incentives (accessed March 2019).
ETA. CO2 emissions from cycling revealed. 2011. Available at https://www.eta.co.uk/2011/12/13/co2-emissions-from-cycling-revealed/(accessed March 2019).
Queensland Government, Department of Transport and Main Roads. Cycling benefits. 2018. Available at https://www.tmr.qld.gov.au/Travel-and-transport/Cycling/Benefits.aspx (accessed March 2019).
Cycling UK. Overcoming the barriers to riding to work. 2016. Available at https://www.cyclinguk.org/article/cycling-guide/overcoming-barriers-riding-work (accessed March 2019).
Bike to Work, Ireland. About Bike to Work. 2019. Available at https://www.biketowork.ie/ (accessed March 2019).
Department for Transport. Cycle to work scheme implementation guidance for employers. 2011. Available at https://www.gov.uk/government/publications/cycle-to-work-scheme-implementation-guidance (accessed March 2019).
Mapping Greener Healthcare. Green Travel Incentive by Hillingdon Hospital NHS Trust. Available at http://map.sustainablehealthcare.org.uk/green-travel-incentive (accessed March 2019).
Liftshare. Homepage. Available at https://liftshare.com/uk (accessed March 2019).
Hickman L. Are electric cars bad for the environment? The Guardian (London) 2012 5.
Office for Low Emission Vehicles. Homepage. Available at https://www.gov.uk/government/organisations/office-for-low-emission-vehicles (accessed March 2019).
Eco-environments. Electric vehicle charging points. 2019.
Neslen A. Electric cars emit 50% less greenhouse gas than diesel, study finds. The Guardian (London) 2017.
Kingdom F M. Driver efficiency course saves council thousands on fuel. 2017. Available at https://www.kingdomfm.co.uk/news/local-news/driver-efficiency-course-saves-council-thousands-on-fuel/(accessed March 2019).
Transport for London. Developing and implementing travel plans: a good practice guide for the NHS in London. 2006. Available a http://www.eltis.org/sites/default/files/tool/nhs-travel-plan-guide-part-1.pdf (accessed March 2019).
Health Staff Discounts. NHS Discounts Cycle Shop. Available at https://www.healthstaffdiscounts.co.uk/category.aspx.aspx?r=cycle-shop (accessed March 2019).
Berners Lee M, Clark D. What's the carbon footprint of… a banana? The Guardian (London) 2010.
Green Logistics. CO2 Emissions from Freight Transport: An Analysis of UK Data. Available at http://www.greenlogistics.org/SiteResources/c0b0286e-10ab-4355-b263-19ff1b442473_A.McKinnon%20-%20CO2%20Emissions%20from%20Freight%20Transport%20-%20Analysis%20of%20UK%20Data.pdf (accessed March 2019).
Duane B, Harford S, Ramasubbu D et al. Environmentally sustainable dentistry: a brief introduction to sustainable concepts within the dental practice. Br Dent J 2019; 226: 292-295.
Duane B, Harford S, Steinbach I et al. Sustainable dentistry energy use within the dental practice. Br Dent J 2019; 226: 367−373.
Duane B, Ramasubbu D, Harford S et al. Sustainability and procurement within the dental practice. Br Dent J 2019; In press.
Duane B, Ramasubbu D, Harford S et al. Sustainability and waste within the dental practice. Br Dent J 2019; In press.
Duane B, Ramasubbu D, Harford S et al. Sustainability and biodiversity within the dental practice. Br Dent J 2019; In press.
Duane B, Croasdale K, Ramasubbu D et al. Measuring and embedding sustainable practice into the dental practice. Br Dent J 2019; In press.
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Duane, B., Steinbach, I., Ramasubbu, D. et al. Environmental sustainability and travel within the dental practice. Br Dent J 226, 525–530 (2019). https://doi.org/10.1038/s41415-019-0115-z
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