Environmental Sustainability in Oral Health Professional Education: Approaches, Challenges, and Drivers-ADEE Special-Interest Group Report.

INTRODUCTION: This paper reports on the scholarship activity of the 'Sustainability in Dentistry' Special-interest Group (SiG), which met at the Association for Dental Education in Europe (ADEE) annual conference in Liverpool on 25 August 2023. The aim of this study was to (i) identify current teaching practices and approaches to embedding Environmental Sustainability (ES) in the curriculum in ADEE attendee schools and (ii) explore existing barriers/challenges to incorporating ES in dental education and consider potential solutions. METHODOLOGY: A mixed-methods approach was used to fulfil the aims of this study. A pre-workshop questionnaire was used to explore current teaching practices, challenges and drivers of embedding ES in the curriculum. An interactive workshop at the in-person meeting in Liverpool was used to propose key strategies to overcome the most frequent challenges to embedding ES in the curriculum. RESULTS: The majority of respondents (56%) reported that their institutions do not currently teach ES. Traditional didactic forms of teaching were mostly reported to teach ES in non-clinical environments, and a transition to more environmentally sustainable materials and instruments was the most popular response for clinical teaching. Key barriers to embedding ES in the curriculum were identified, including time constraints and the overloaded curriculum, a lack of expertise/knowledge to teach and lack of practical guidance to support educators, limited learning resources for staff and students and resistance from colleagues regarding the relevance of ES in dentistry. The special-interest group participants proposed strategies to overcome these challenges that centred around 14 themes. CONCLUSION: This paper reports recent scholarship activity by ADEE's 'Sustainability in Dentistry' SiG. Key strategies for overcoming the most common challenges to embedding ES in the curriculum are also discussed.

Investigating the effectiveness of water fluoridation.

DESIGN: This retrospective cohort study used treatment claims data submitted over a 10-year period to explore the effect of water fluoridation on specified National Health Service (NHS) dental treatments, number of Decayed Missing and Filled Teeth (DMFT) and its cost-effectiveness. Ethical approval was granted and data was collected from NHS primary care settings via claims submitted to the NHS Business Services Authority (NHS BSA). To be included, participants must have attended dental services twice in the study period, been 12 years or over and had a valid English postcode. Those with claims related solely to orthodontic care were excluded, as were those who had requested NHS National Data Opt-out. Costs relating to water fluoridation were supplied by Public Health England. NHS BSA data was used to calculate NHS costs at 2020 prices. COHORT SELECTION: A personalised water fluoride exposure for the 2010-2020 period was assigned to all individuals, who were then split into two groups, above 0.7 mg F/L (optimally fluoridated group) or lower (non-optimally fluoridated group). Individuals in each group were matched for analysis using propensity scores, estimated via logistic regression. DATA ANALYSIS: Values of absolute standardised mean differences were used to determine covariate balance between the two groups, alongside a generalised linear model with matching weights and cluster robust standard errors and a patient deprivation decile as an interaction term. An Incremental Cost-Effectiveness Ratio (ICER) was calculated and differences in the overall costs to the public sector were illustrated by the return on investment estimate. RESULTS: The cohort contained data on 6,370,280 individuals. Negative binomial regression models were used to analyse health outcomes. In the optimally fluoridated group, the rate of invasive dental treatments was 3% less than in the non-optimally fluoridated group, and the mean DMFT in the optimally fluoridated group was 2% lower. There was no evidence of a difference in the predicted mean number of missing teeth between groups. There was a small reduction in the predicted number of invasive treatments in the optimally fluoridated group but the largest predicted reduction was in the most deprived decile. DMFT did not exhibit the expected social inequalities gradient, and for the mean number of missing teeth there were small differences in each decile of deprivation between groups but the direct effect was inconsistent. Water fluoridation expenditure between 2010 and 2019 was estimated to be £10.30 for those receiving optimally fluoridated water. The marginal effects estimate illustrated savings of £22.26 per person (95% CI - £21.43, -£23.09), which is a relative reduction in costs to the NHS of 5.5% per patient. A subsequent estimation of cost effectiveness calculated the cost of water fluoridation to avoid one invasive dental treatment (the ICER) as £94.55. The estimated return on investment using a variety of NHS dental attendance estimates all lead to a positive return. CONCLUSIONS: These results suggest that water fluoridation appears to be producing less impactful effects on oral health, with water fluoridation resulting in 'exceedingly small' health effects and very small reductions in use of NHS dental services. A positive return for the public sector was identified as the costs of NHS dentistry are high and costs of water fluoridation are low, though this study did not include the original set up costs of fluoridation programmes.

Can traditional oral hygiene methods compete with conventional toothbrushes in effectiveness?

DESIGN: The study was designed as a single-blinded, parallel, randomized controlled trial to compare the effectiveness of the Salvadora persica toothbrush (MTB), Salvadora persica chewing stick (MCS), and a standard toothbrush (STB) in controlling plaque and gingivitis. A total of 78 participants were randomly divided into three groups and instructed to use their assigned oral hygiene tool in a standardized manner for three. CASE SELECTION: Participants were non-dental students and staff of Universiti Kebangsaan Malaysia, Kuala Lumpur Campus, selected through convenience sampling. They met specific inclusion criteria, such as being systemically healthy, having ≥20 teeth, and having a Basic Periodontal Examination score of 0, 1, or 2, with no periodontal pockets greater than 5.5 mm. DATA ANALYSIS: Clinical outcomes were measured using the Plaque Index (PI) and Periodontal Inflamed Surface Area (PISA) at baseline, one-, and three-weeks post-intervention. Data analysis was performed using mixed-model analysis of variance for continuous variables and Fisher's exact test for categorical variables. RESULTS: All three groups showed significant improvements in plaque levels and severity of gingivitis from baseline to three weeks post-intervention. The MCS group demonstrated a significant improvement in mean PISA values of the anterior teeth compared to the MTB and STB groups. However, there was no significant difference in plaque level reduction or overall gingivitis severity among the three groups. This indicates that when used correctly, Salvadora persica toothbrushes and chewing sticks are as effective as standard toothbrushes in plaque control and gingival health. CONCLUSIONS: The study concludes that both Salvadora persica toothbrushes and chewing sticks can serve as effective alternatives to the standard toothbrush for plaque control and gingival health. This showcases the beneficial anti-plaque and anti-gingivitis properties of Salvadora persica. However, the effectiveness of these oral hygiene tools is contingent upon the correct usage techniques.

Sustainable oral healthcare: what is it and how do we achieve it?

In recent years, there has been an increase in interest in what environmental sustainability means for healthcare, including oral health and dentistry. To help facilitate discussions among key stakeholders in this area, the Scottish Dental Clinical Effectiveness Programme held a workshop in November 2022. The purpose of this workshop was to explore current thinking on the subject of sustainability as it relates to oral health and to help stakeholders identify how to engage with the sustainability agenda. This paper presents an overview of the presentations and discussions from the workshop and highlights potential avenues for future work and collaboration.

Immediate and sustained root caries prevention of fluoride varnish combined with toothpastes: findings of clinical relevance?

DESIGN: An in vitro study to determine the immediate and sustained effect of fluoride varnish and its combination with fluoride toothpastes in preventing the development of root caries. CASE SELECTION: Human root dentine samples (150) were randomly divided into five experimental protocols of 30 specimens each: 1) fluoride varnish (22,600 ppm fluoride and 1-5% CPP-ACP); 2) fluoride varnish followed by Paste One (1100 ppm sodium fluoride and CPP-ACP); 3) fluoride varnish followed by Paste Plus (900 ppm sodium fluoride and CPP-ACP); 4) fluoride varnish followed by Paste One and Paste Plus; and 5) no treatment (control). A layer of varnish was applied to specimens except the control group and was left in situ for 18 h. The varnish layer was removed, and the various toothpaste treatments were initiated. Half of the specimens in each group were assigned to a short-term incubation model in which they were immediately subjected to a 7-day cariogenic challenge consisting of a combination of human saliva and artificial saliva containing 2% sucrose. The other half of the specimens in each group were assigned to the long-term incubation model in which the experimental protocol was continued for 8 weeks before initiating the seven-day cariogenic challenge. The protocols were evaluated by assessing dentine porosity (rhodamine intensity), mineral density, biofilm biomass, and viability assays. DATA ANALYSIS: Confocal laser scanning microscopy was used to determine dentine porosity and Levene's test was used to verify the assumption of equality of variances and normal distribution of errors before two-way ANOVA and the Games-Howell test were carried out at a significance level of 0.05 for both incubation models. Microcomputed tomography was used to determine mineral density with statistical analysis involving Levene's test, two-way ANOVA and Tukey's test at a significance level of 0.05 for both incubation models. Biomass was evaluated using a biofilm biomass assay with analysis of optical density data using Levene's test, ANOVA and Scheffe's test at a significance level of 0.05. RESULTS: For both the short- and long-term incubation models, all the experimental regimes resulted in a statistically significant decrease in dentine porosity and an increase in mineral density when compared to the control group. Fluoride varnish followed by both pastes and fluoride varnish followed by Paste One resulted in a statistically significant decrease in dentine porosity for some depths in both models when compared to fluoride varnish alone. Changes in dentine porosity and mineral density were observed within groups over time. All the experimental regimes demonstrated anti-biofilm effects. Immediate and sustained anti-caries effects were observed for all preventive protocols, with the combination of fluoride varnish and Paste One resulting in superior additional anti-caries effects. CONCLUSIONS: The authors concluded that all protocols demonstrated immediate and sustained anti-caries effects against the development of root caries despite variations in effects over time. The combination of fluoride varnish and Paste One resulted in additional anti-caries effects that were consistently superior, with no additional effects being observed when Paste Plus was added in combination. The authors suggest that, within the study's limitations, topical fluoride varnish seems to have a protective effect on root surfaces for up to eight weeks and that fluoride varnish should be considered as an important adjunct strategy in the prevention of root caries in older adults.

Do chewing gums and sweets containing xylitol prevent caries in children?

DATA SOURCES: Three electronic databases (Pubmed, Embase and the Cochrane Library) were searched in December 2022, and again for additional literature on 3-5th January 2023. Reference lists of relevant systematic reviews were hand searched for other eligible studies for inclusion. STUDY SELECTION: Randomised controlled clinical trials and controlled clinical trials conducted on children (aged ≤ 18 years), conducted between 1974-2022 and available in English, were eligible for inclusion. Studies were excluded if caries was not an outcome, the control group was not sufficient, they were lab-based studies or studies where xylitol delivery was not a sweet or chewing gum and where the xylitol product contained a component such as fluoride which may influence the outcomes. DATA EXTRACTION AND SYNTHESIS: Four calibrated reviewers independently screened titles and abstracts, and disagreements were resolved via group discussion. Preventative effect was determined by comparing the mean caries increment in the control and intervention groups, producing a preventative fraction. A total of 617 titles were initially screened for relevance. After duplicate removal, 268 abstracts were screened and 16 full text articles reviewed, with one more study then excluded. 10 studies investigated xylitol-containing chewing gum, and six looked at xylitol candy (one did both). Eight included studies were randomised controlled trials. Data extraction was undertaken by two reviewers. RESULTS: 3466 participants were included in the 10 studies that investigated xylitol chewing gum, and all 10 studies reported a statistically significant preventive effect compared to a no chewing gum or placebo control. In 9 studies, the preventive fraction was clinically significant. The six studies investigating xylitol candies contained a total of 1023 participants, and only one study demonstrated a significant preventative effect. CONCLUSIONS: There is some evidence that incorporating xylitol chewing gum daily has a caries-reducing effect in those with a moderate-to-high baseline caries level. This effect was not present for xylitol sweets.

Has children's oral health-related quality of life improved more following necrotic primary molars pulpectomy or extraction?

STUDY DESIGN: A randomised parallel controlled clinical trial was conducted between 2013 and 2015 at the University of Sao Paulo, Brazil, to assess the impact of pulpectomy or extraction on the oral health-related quality of life (OHRQoL) of children with pulp necrosis in primary molars. STUDY SELECTION: Children between the ages of 3 and 5 who were in good health but had extensive caries in at least one primary molar with signs of pulpal necrosis (also as seen radiographically, caries reaching the pulp with no signs of internal or external resorption) were considered for inclusion. Additionally, teeth with sufficient structure for rubber dam placement were also included. Children with any systemic, neurological, or other conditions that negatively impacted their growth were excluded. CLINICAL PROCEDURES AND SUCCESS CRITERIA: After computer-generated randomisation, 100 children were assigned randomly into two groups: 50 in the pulpectomy group and 50 in the dental extraction group. A paediatric dentist performed all procedures under local anaesthesia without sedation or general anaesthesia, and a rubber dam was used for pulpectomy with composite restoration in a single session. The OHRQoL scores were evaluated at baseline, 4, 8, and 12 months using the Brazilian version of the Early Childhood Oral Health Impact Scale (B-ECOHIS) via face-to-face interviews with parents conducted by a researcher trained in a single-blinded fashion. Additionally, the child's self-reported dental anxiety was measured using the Facial Image Scale (FIS), and dental pain was assessed using the Wong-Baker Faces Pain Scale (WBFPS) immediately after the treatment as secondary outcomes. RESULTS: The mean difference (SD) in the total B-ECOHIS score between baseline and after 12 months was 12.66 (6.79) for the pulpectomy group and 10.94 (9.28) for the extraction group, with effect sizes of 3.2 (95% CI: 2.42-4.20) and 1.4 (95% CI: 0.84-2.11), respectively. While both treatments significantly improved the children's OHRQoL after 12 months, the pulpectomy group showed greater long-term improvement compared to the extraction group, with mean differences (SD) of 4.86 (6.13) and effect sizes of 0.8 (0.46-1.13; p < 0.001). Moreover, children in the extraction group showed higher levels of anxiety compared with those in the pulpectomy group at 12-month follow-up (OR = 2.52; 95% CI = 1.30-4.89), and they reported 93% more odds of 'dental pain with high level' immediately after treatment than those in the pulpectomy group (OR = 1.93; 95% CI = 0.83-4.49). CONCLUSION: Children treated with pulpectomy in their necrotic primary molars were found to have better OHRQoL than those who had their primary molars extracted.

A life cycle analysis of the environmental impact of procurement, waste and water in the dental practice.

Background Health care is a significant contributor to climate change. Global pressure for a change towards a more sustainable way of providing dental health care has resulted in the creation of the Green Impact Toolkit, which is comprised of a list of suggested changes that dental practices can make to become more sustainable in a number of categories, such as procurement, waste and water.Aims To compare the effectiveness of changes suggested by the Green Impact Toolkit.Materials and methods A comparative life cycle assessment (LCA) was conducted using the Ecoinvent database v3.8 and these data were processed using OpenLCA v1.10.3 software.Results The carbon footprint per patient was significantly reduced after the recommendations were implemented. For instance, using water from a rainwater collection tank instead of the mains supply saved 30 g CO2eq (carbon dioxide equivalents) per patient, a 90% reduction in carbon footprint.Discussion This comparative LCA identified some effective changes which can be easily made by a dental practice. Nevertheless, some actions require some initial financial investment and may be difficult to implement in a busy modern dental practice setting.Conclusion The findings from this study can be used to guide dental practices to making choices which are more sustainable and eco-friendly in the future.

Environmental sustainability of post-orthodontic dental retainers: a comparative life-cycle assessment of Hawley and Essix retainers.

BACKGROUND: Environmental sustainability has been brought into the limelight due to the global climate crisis. This crisis is driven by human activities and even the healthcare sector is no exception. Within dentistry, orthodontics is a large global market; hence, the use of post-orthodontic retainers has a significant environmental footprint. The aim of this study was to determine the environmental sustainability of post-orthodontic retention using Hawley and Essix retainers. MATERIALS AND METHODS: A comparative life-cycle assessment (LCA) was carried out to compare the environmental impact of both retainers. All inputs and outputs were accounted for using the Ecoinvent database, v3.7.1, and openLCA software. Sixteen impact categories were used to determine their environmental burden. RESULTS: Of the 16 impact categories, the Hawley had a greater environmental burden than the Essix retainer in 12 categories. The Hawley's most significant contributors to its impact values are factory manufacturing and in-house production, with an average of 41.45% and 52.52%, respectively. For the Essix, the greatest contributor is factory manufacturing, with an average of 64.63%. However, when factoring in the lifespan of the retainers, the Essix would have a greater environmental impact than the Hawley retainer. LIMITATIONS: This study employed a comparative LCA. There were also assumptions made, but these were supported by research. CONCLUSIONS: On the basis of the evidence gathered in this study, Hawley retainers are more environmentally sustainable than Essix retainers. These results would better enable clinicians to factor in the environmental impact and make informed decisions on the choice of retainer type.

What is the environmental footprint of a dental practice? A life cycle analysis (Part 1).

Introduction Growing awareness of environmental sustainability is essential. The Intergovernmental Panel on Climate Change's report stresses urgent carbon reductions to limit global warming to 1.5 °C. The NHS in all four countries of the UK aims to be net zero. Dental practices must prioritise sustainability for public health. This paper uses life cycle analysis (LCA) where possible to study a dental practice's environmental footprint.Methodology LCA methodology was used where possible to calculate the carbon footprint (CFP) of a full-time dental clinic operating 220 days/year. The Ecoinvent database and OpenLCA software were used to calculate greenhouse gas emissions, normalised factors and disability-adjusted life years. Attributional and spend-based approaches were used to analyse procurement items.Results Compared with our 2015 paper, the 2023 CFP, which used more current impact factors, shows reduced water use emissions and increased total waste emissions. Staff travel and patient travel continues to significantly impact the CFP.Discussion Addressing waste and promoting low-carbon transport within the dental practice is crucial. Procurement's impact requires detailed analysis. Normalised scores highlight the environmental impact compared to an average person.Conclusion The CFP of a dental practice was updated using more current impact factors to reinforce the high contribution of travel within the dental CFP, with an increase in the CFP of waste and a reduction in the CFP of water.

A carbon calculator: the development of a user-friendly greenhouse gas measuring tool for general dental practice (Part 2).

The need to reduce carbon emissions and limit global warming to 1.5 °C has spurred various sectors towards net-zero emission goals. This paper introduces a specialised carbon calculator for dental practices to compute and monitor their carbon footprints (CFPs). The carbon calculator is developed using recent carbon modelling, utilising methodologies and data from estimating the average NHS dental practice's CFP. It employs both spend-based and activity-based carbon accounting methods, simplifying carbon emission estimation. It offers dental practices a user-friendly, rudimentary, cost-free tool to determine their baseline CFP and track sustainability progress. It includes conversion factors for patient travel, procurement and waste management, enabling practices to input data and generate personalised CFP charts. It also acknowledges assumptions and uncertainties related to procurement and waste management, emphasising the availability of personalised consultancy services for more precise carbon footprinting. This carbon calculator supports environmental sustainability in dental practices as an accessible starting point. By raising awareness of their CFP, it encourages progress in 'green dentistry' and promotes environmental responsibility in oral healthcare. The calculator is freely downloadable and part of a broader 'green dentistry' initiative. Continuous carbon emission measurement and monitoring are crucial for a sustainable future, with this tool aiding dental practitioners in their environmental contributions.

Environmental impact of low-dose methoxyflurane versus nitrous oxide for analgesia: how green is the 'green whistle'?

BACKGROUND: The NHS has the target of reducing its carbon emission by 80% by 2032. Part of its strategy is using pharmaceuticals with a less harmful impact on the environment. Nitrous oxide is currently used widely within the NHS. Nitrous oxide, if released into the atmosphere, has a significant environmental impact. Methoxyflurane, delivered through the Penthrox 'green whistle' device, is a short-acting analgesic and is thought to have a smaller environmental impact compared with nitrous oxide. METHODS: Life cycle impact assessment (LCIA) of all products and processes involved in the manufacture and use of Penthrox, using data from the manufacturer, online sources and LCIA inventory Ecoinvent. These data were analysed in OpenLCA. Impact data were compared with existing data on nitrous oxide and morphine sulfate. RESULTS: This LCIA found that Penthrox has a climate change effect of 0.84 kg carbon dioxide equivalent (CO2e). Raw materials and the production process contributed to majority of the impact of Penthrox across all categories with raw materials accounting for 34.40% of the total climate change impact. Penthrox has a climate change impact of 117.7 times less CO2e compared with Entonox. 7 mg of 100 mg/100 mL of intravenous morphine sulfate had a climate change effect of 0.01 kg CO2e. CONCLUSIONS: This LCIA has shown that the overall 'cradle-to-grave' environmental impact of Penthrox device is better than nitrous oxide when looking specifically at climate change impact. The climate change impact for an equivalent dose of intravenous morphine was even lower. Switching to the use of inhaled methoxyflurane instead of using nitrous oxide in certain clinical situations could help the NHS to reach its carbon emission reduction target.

Environmental impact of the supervised toothbrushing programme amongst children in Scotland.

OBJECTIVES: To understand the environmental impact of providing a nationwide supervised toothbrushing programme (Childsmile) for 5-year-old children in Scotland. METHODS: A life cycle assessment was conducted to assess the annual environmental effects of the supervised toothbrushing programme in early years childcare, as well as each dental procedure (dental restoration under local anaesthesia (LA), single tooth extraction under LA, and multiple teeth extraction under general anaesthesia) spanning from 2001/02 to 2009/10. The expected savings in annual carbon dioxide equivalent (CO2e) emissions for all combined dental treatments in subsequent years were calculated compared to those in 2001/02. RESULTS: An overall decrease in CO2e emissions was evident in the Childsmile programme and across all dental procedures. The estimated reduction in emissions across all procedures varied from 102.5 tonnes in 2002/03 to 461.1 tonnes in 2009/10 when compared to 2001/02. Within three years, the expected emissions savings from all combined dental procedures surpassed the emissions generated by implementing the Childsmile programme. CONCLUSIONS: Over time, there was a significant reduction in annual CO2e emissions for all combined dental treatments in children. In the eighth year of the Childsmile, emissions savings were more than 4.5 times greater than the emissions generated during its implementation. CLINICAL SIGNIFICANCE: The study highlights the importance of educating public by individual dentists about the environmental impact of caries prevention programmes and paediatric dental treatments as this may influence patient choice. It also encourages commissioners of community dental programmes to support the implementation of supervised toothbrushing programmes in early years childcare.

Mouthwashes: Alternatives and Future Directions.

This narrative review summarises "alternative" or "natural" over-the-counter (OTC) mouthwashes not covered elsewhere in this supplement and newly emerging products, as potential mouthwashes of the future. The "natural" mouthwashes reviewed include saltwater, baking soda, coconut oil, charcoal, propolis, seaweeds, and probiotics. Other than essential oils, it is apparent that their clinical effectiveness is still under debate, but there is some evidence to suggest that propolis reduces plaque and gingivitis. This review also covers the host immune response, via novel anti-inmmunomodulant mouthwashes, such as erythropoietin to reduce inflammation with oral mucositis (OM) after radiotherapy. The emerging concept of nanoparticle-containing mouthwashes, such as iron oxide, is further discussed for OM, this agent having the potential for more targeted delivery of chemical antimicrobials. Unfortunately, there are impacts on the environment of widening mouthwash use with more new products, including increased use of packaging, antimicrobial resistance, and possible detrimental effects on marine life. Further, there are roadblocks, relating to regularly approvals and side effects, that still need to be overcome for any OTC deivered immunomodulant or nanoformulation mouthwashes. Despite these caveats, there are many new mouthwashes under development, which could help manage major oral diseases such as caries, gingivitis, and periodontal disease.

Responsible waste management: using resources efficiently (Part 2).

This chapter aims to describe the types of waste produced in dental practice, the costs associated with disposal of this waste, and the impact that the disposal method has on the environment and on human health. It discusses the waste hierarchy and explores how dental surgeries can reduce their waste generation through simple changes in practice. The chapter continues by highlighting the benefits of performing a waste audit, with examples of how correct segregation of the waste produced in practice is both cost-effective and reduces the environmental impact of its disposal. Finally, we discuss some of the barriers and enablers of changing waste disposal behaviours in the dental practice and identify how the environmentally minded practitioner can encourage pro-environmental behaviour in their dental team.

Responsible waste management: using resources efficiently (Part 1).

This chapter aims to describe the types of waste produced in dental practice, the costs associated with disposal of this waste, and the impact that the disposal method has on the environment and on human health. It discusses the waste hierarchy and explores how dental surgeries can reduce their waste generation through simple changes in practice. The chapter continues by highlighting the benefits of performing a waste audit, with examples of how correct segregation of the waste produced in practice is both cost-effective and reduces the environmental impact of its disposal. Finally, we discuss some of the barriers and enablers of changing waste disposal behaviours in the dental practice and identify how the environmentally minded practitioner can encourage pro-environmental behaviour in their dental team.

An environmental impact study of inter-dental cleaning aids.

AIM: The aim of this study was to compare the environmental footprint of eight inter-dental cleaning aids. MATERIALS AND METHODS: A comparative life cycle analysis was conducted based on an individual person using inter-dental cleaning aids every day for 5 years. The primary outcome was a life cycle impact assessment. This comprised of 16 discrete measures of environmental sustainability (known as impact categories), for example, greenhouse gas emissions (measured in kilograms of carbon dioxide equivalent, or kg CO2 e), ozone layer depletion (measured in kilograms of chloroflurocarbon equivalent, or kg CFCe), and water use (measured in cubic metres). Secondary outcomes included normalized data, disability-adjusted life years, and contribution analysis. RESULTS: Inter-dental cleaning using floss picks had the largest environmental footprint in 13 of 16 impact categories. Depending on the environmental impact category measured, the smallest environmental footprint came from daily inter-dental cleaning with either bamboo inter-dental brushes (five impact categories, including carbon footprint), replaceable head inter-dental brushes (four impact categories), regular floss (three impact categories), sponge floss (three impact categories), and bamboo floss (one impact category). CONCLUSIONS: Daily cleaning with inter-dental cleaning aids has an environmental footprint that varies depending on the product used. Clinicians should consider environmental impact alongside clinical need and cost when recommending inter-dental cleaning aids to patients.

Mapping the graduating European dentist to established undergraduate dental education activities at Trinity College Dublin.

INTRODUCTION: "The Graduating European Dentist" Curriculum (GED) was adopted in 2020 by the Irish Dental Council as its new expectation for competencies. The Dublin Dental University Hospital (DDUH) sought to map the teaching activities for its undergraduate dental training programme to the GED. This paper describes the process developed for curriculum mapping. MATERIALS AND METHODS: Guided by historical mapping data and materials on the DDUH's virtual learning environment; teaching activities in a bespoke curriculum mapping system were edited, added and/or deleted to match existing teaching activities currently delivered by staff to students. These activities were then remapped to GED Learning Outcomes. Staff members with oversight responsibilities for a collection of activities then received and provided feedback on reports tabulating the preliminary map. Feedback from staff members around their activities was accommodated to produce an accurate reflection of teaching activities across the 5 years program. RESULTS: A process for mapping existing teaching activities to a new set of curriculum expectations using a bespoke application and several other widely available technologies was established. Informal feedback from staff has been positive and has raised ideas for future opportunities to improve the alignment of educational activities with learning outcomes. CONCLUSION: Other dental schools may find this accounting of the DDUH's efforts useful in guiding their own curriculum mapping.