The planetary health effects of COVID-19 in dental care: a life cycle assessment approach.

Aims COVID-19 has significantly impacted the safety guidelines for personal protective equipment (PPE) within dental services. We quantified and compared the environmental impact of different forms of PPE.Methods The PPE items were divided into three categories: 1) the body protection category, which included disposable and reusable gowns; 2) the eye protection category, which included a visor with a disposable face shield and a reusable visor; and 3) the respiratory protection category, which included respirator FP2SLw, respirator FFP2 and surgical masks. The OpenLCA software was used for analysing and comparing the environmental impact of all PPE products in the three categories.Results The life cycle assessment results of this study showed that damage to human health was more significant for the reusable gown than the disposable gown for the body-protection-category PPE. A visor with a disposable face shield had a higher environmental footprint than the reusable visor across all impact categories for the eye protection category. In addition, a visor with a disposable face shield released five times more carbon dioxide equivalent emissions and used four times more dissipated water and three times more fossil fuels than the reusable visor. A disposable gown used four times more dissipated water and three times more fossil fuels than reusable gowns. For respiratory PPE, the FP2SLw respirator had the highest burden in all 16 categories, followed by the FFP2 respirator and then the surgical mask.Conclusion The environmental impact of PPE is notable and could be reduced through using less damaging domestic products and increased usage of reusables. In addition, the selection of PPE that are reusable and made of recyclable materials can help to minimise the environmental impact and reduce environmental resource depletion.

Comparing the environmental impact of reusable and disposable dental examination kits: a life cycle assessment approach.

Introduction The global climate crisis has increased the emphasis placed on the sustainability and environmental consequences of our actions. The dental examination accounts for a large portion of dentistry's carbon footprint, more specifically, the production, sterilisation, transport, use and disposal of the dental examination kit. An attributional life cycle assessment (LCA) was carried out to compare the impact of a reusable stainless-steel examination kit and that of a disposable plastic examination kit.Materials and methods All inputs, outputs and processes across the life cycle were accounted for using Ecoinvent database v3.7.1 and openLCA software. Impacts were considered across 16 European-recommended environmental impact categories and eight human health impact categories.Results The disposable kit performed worse across all categories of ecological and human health harm. Categories with most notable impact were climate change, metal-mineral and fossil fuel resource depletion and water scarcity. Impacts were primarily attributable to material processing, instrument production and sterilisation procedures.Conclusion Healthcare is responsible for a significant proportion of greenhouse gas emissions. The single-use examination kit poses greater ecological and human health threat than does the reusable examination kit; this aligns closely with related research in the field. The dentist seeking to adopt more environmentally-conscientious practices should consider using a reusable, stainless-steel examination kit.

Hand hygiene with hand sanitizer versus handwashing: what are the planetary health consequences?

In order to reduce the transmission of pathogens, and COVID-19, WHO and NHS England recommend hand washing (HW) and/or the use of hand sanitizer (HS). The planetary health consequences of these different methods of hand hygiene have not been quantified. A comparative life cycle assessment (LCA) was carried out to compare the environmental impact of the UK population practising increased levels of hand hygiene during the COVID-19 pandemic for 1 year. Washing hands with soap and water was compared to using hand sanitizer (both ethanol and isopropanol based sanitizers were studied). The isopropanol-based HS had the lowest environmental impact in 14 out of the 16 impact categories used in this study. For climate change, hand hygiene using isopropanol HS produced the equivalent of 1060 million kg CO2, compared to 1460 million for ethanol HS, 2300 million for bar soap HW, and 4240 million for liquid soap HW. For both the ethanol and isopropanol HS, the active ingredient was the greatest overall contributing factor to the environmental impact (83.24% and 68.68% respectively). For HW with liquid soap and bar soap, there were additional contributing factors other than the soap itself: for example tap water use (28.12% and 48.68% respectively) and the laundering of a hand towel to dry the hands (10.17% and 17.92% respectively). All forms of hand hygiene have an environmental cost, and this needs to be weighed up against the health benefits of preventing disease transmission. When comparing hand sanitizers to handwashing with soap and water, this study found that using isopropanol based hand sanitizer is better for planetary health. However, no method of hand hygiene was ideal; isopropanol had a greater fossil fuel resource use than ethanol based hand sanitizer. More research is needed to find hand hygiene sources which do not diminish planetary health, and environmental impact is a consideration for public health campaigns around hand hygiene.

Webinars reduce the environmental footprint of pediatric cardiology conferences.

BACKGROUND: Webinars have recently replaced in-person medical conferences, including paediatric cardiology conferences, given the COVID-19 pandemic. METHODS: With increasing environmental concerns, we analysed the differences between the environmental footprint of a paediatric cardiology webinar with a hypothetical conference. Travel data was collected, with assumptions made on the amount of computer use, internet use and accordingly the overall use of electricity for both forms of conference. Life Cycle Assessment methodology was used (OpenLCA and Ecovinvent v 3.7). RESULTS: We showed that the theoretical environmental impact of a virtual conference is significantly less (4 tons CO2 equivalent) than the traditional international face-to-face conference (192 tons CO2 equivalent). The life cycle assessment methodology showed that resource use for a face-to-face conference lasting 2.5 days for 1374 attendees is equivalent to 400 times what an average person would use in one year, the climate change and photochemical ozone formation approximately 250 times and the eutrophication terrestrial equivalent to 225 times. However, using carbon equivalent emissions to measure environmental harm from flying is an under estimate of the potential damage, when one considers the additional production of airplane contrails. Notwithstanding this, there is a 98% reduction in climate change impact when meetings are held virtually. CONCLUSIONS: While the virtual conference may never completely replace the traditional in-person paediatric cardiology conference, due to networking benefits, the significant theoretical benefits to the environment highlighted in this study, warrants consideration for the virtual conference taking a more common place in sustainable academia.

The life cycle analysis of a dental examination: Quantifying the environmental burden of an examination in a hypothetical dental practice.

OBJECTIVES: Global sustainability is considered the number one health concern facing our planet. Dental care is currently not provided in a sustainable way. This study aims to quantify the potential environmental burden of an examination in a hypothetical dental practice and identify major contributors to environmental harm. MATERIALS AND METHODS: A life cycle analysis was performed for the life cycle of an examination of one patient in a hypothetical dental practice. The equipment and products analysed were those available at the Faculty of Dentistry, Malmö University. The Ecoinvent version 3.5 database and the life cycle assessment software tool OpenLCA version 1.10 were chosen for this study. RESULTS: Normalized results indicate that the impact categories to which the modelled examination most significantly contributes are water scarcity, freshwater eutrophication and human toxicity (cancer effects). The major contributors or hotspots relating to the environmental harm of an examination procedure are soaps and detergents, disposable bibs, surface disinfection, stainless-steel instruments, clothing, water use and wastewater. CONCLUSION: Normalized results indicate that the potential environmental impact of an examination compared to one individual's impact per year is minimal. Considering the potential number of dental examinations and other dental procedures performed every year puts the findings in another perspective. This paper touches on some of the ways that the environmental burden of an examination could be reduced. Small changes to everyday practice, such as always making sure the dishwasher and washing machines are full when turned on, using less environmentally damaging soaps, more sustainable clothing alternatives and using necessary instruments could significantly reduce dentistry's environmental impact. Changes in materials and practice may result in potential trade-offs. Research would need to be carried out comparing the environmental burden of any alternatives. We hope in the near future that there will be more evidence relating to products used within dental care settings, potential trade-offs and dentistry's environmental burden.

Environmental sustainability in endodontics. A life cycle assessment (LCA) of a root canal treatment procedure.

BACKGROUND: To analyse via life cycle analysis (LCA) the global resource use and environmental output of the endodontic procedure. METHODOLOGY: An LCA was conducted to measure the life cycle of a standard/routine two-visit RCT. The LCA was conducted according to the International Organization of Standardization guidelines; ISO 14040:2006. All clinical elements of an endodontic treatment (RCT) were input into OpenLCA software using process and flows from the ecoinvent database. Travel to and from the dental clinic was not included. Environmental outputs included abiotic depletion, acidification, freshwater ecotoxicity/eutrophication, human toxicity, cancer/non cancer effects, ionizing radiation, global warming, marine eutrophication, ozone depletion, photochemical ozone formation and terrestrial eutrophication. RESULTS: An RCT procedure contributes 4.9 kg of carbon dioxide equivalent (CO2 eq) emissions. This is the equivalent of a 30 km drive in a small car. The main 5 contributors were dental clothing followed by surface disinfection (isopropanol), disposable bib (paper and plastic), single-use stainless steel instruments and electricity use. Although this LCA has illustrated the effect endodontic treatment has on the environment, there are a number of limitations that may influence the validity of the results. CONCLUSIONS: The endodontic team need to consider how they can reduce the environmental burden of endodontic care. One immediate area of focus might be to consider alternatives to isopropyl alcohol, and look at paper, single use instrument and electricity use. Longer term, research into environmentally-friendly medicaments should continue to investigate the replacement of current cytotoxic gold standards with possible natural alternatives. Minimally invasive regenerative endodontics techniques designed to stimulate repair or regeneration of damaged pulp tissue may also be one way of improving the environmental impact of an RCT.

Incorporating sustainability into assessment of oral health interventions.

Prior to 1966, consumers purchased food items with very little (if any) nutritional labels. Now, nutritional labelling is an integral part of informed consumer choice. This paper advocates for a similar approach for healthcare-related products, using the toothbrush as an example, with the need to quantify and publish data on their clinical efficacy and environmental impact. In this paper, we consider different manufacturing models and measure the environmental impact (carbon footprint) and also the human health impact (disability-adjusted life years [DALYs]) for the most commonly used oral health product: the toothbrush.

Combining evidence-based healthcare with environmental sustainability: using the toothbrush as a model.

Introduction Healthcare professionals should consider environmental sustainability when recommending medical devices to patients, although there is currently little quantitative data available. The toothbrush is a widely recommended healthcare device worldwide. The aim of this study was to compare the sustainability of different types of toothbrush.Materials and methods Four types of toothbrush were studied: a traditional plastic and electric toothbrush, as well as a plastic manual toothbrush with replaceable heads and a bamboo manual toothbrush. Life cycle assessment (LCA) methodology was applied to quantify the environmental impact of these toothbrushes over five years.Results The electric toothbrush performed consistently poorly compared to the three manual toothbrush types and had the greatest impact in 15 out of 16 environmental categories. The bamboo and replaceable-head plastic toothbrushes had the lowest impact in all categories. The climate change potential of the electric toothbrush was 11 times greater than the bamboo toothbrush.Discussion Switching toothbrushes from the traditional toothbrushes to bamboo or replaceable-head plastic is more environmentally sustainable. These results could be used to inform individual consumer choice, oral health recommendations, procurement of toothbrushes for public health programmes and toothbrush manufacturers. LCA methodology can be used to make healthcare more sustainable.

Data for life cycle assessment of legume biorefining for alcohol.

Benchmarking the environmental sustainability of alcohol produced from legume starch against alcohol produced from cereal grains requires considering of crop production, nutrient cycling and use of protein-rich co-products via life cycle assessment. This article describes the mass balance flows behind the life cycle inventories for gin produced from wheat and peas (Pisum sativum L.) in an associated article summarising the environmental footprints of wheat- and pea-gin [1], and also presents detailed supplementary results. Activity data were collected from interviews with actors along the entire gin value chain including a distillery manager and ingredient and packaging suppliers. Important fertiliser and animal-feed substitution effects of co-product use were derived using detailed information and models on nutrient flows and animal feed composition, along with linear optimisation modelling. Secondary data on environmental burdens of specific materials and processes were obtained from the Ecoinvent v3.4 life cycle assessment database. This article provides a basis for further quantitative evaluation of the environmental sustainability of legume-alcohol value chains.

Just the tonic! Legume biorefining for alcohol has the potential to reduce Europe's protein deficit and mitigate climate change.

Industrialised agriculture is heavily reliant upon synthetic nitrogen fertilisers and imported protein feeds, posing environmental and food security challenges. Increasing the cultivation of leguminous crops that biologically fix nitrogen and provide high protein feed and food could help to address these challenges. We report on the innovative use of an important leguminous crop, pea (Pisum sativum L.), as a source of starch for alcohol (gin) production, yielding protein-rich animal feed as a co-product. We undertook life cycle assessment (LCA) to compare the environmental footprint of 1 L of packaged gin produced from either 1.43 kg of wheat grain or 2.42 kg of peas via fermentation and distillation into neutral spirit. Allocated environmental footprints for pea-gin were smaller than for wheat-gin across 12 of 14 environmental impact categories considered. Global warming, resource depletion, human toxicity, acidification and terrestrial eutrophication footprints were, respectively, 12%, 15%, 15%, 48% and 68% smaller, but direct land occupation was 112% greater, for pea-gin versus wheat-gin. Expansion of LCA boundaries indicated that co-products arising from the production of 1 L of wheat- or pea-gin could substitute up to 0.33 or 0.66 kg soybean animal feed, respectively, mitigating considerable greenhouse gas emissions associated with land clearing, cultivation, processing and transport of such feed. For pea-gin, this mitigation effect exceeds emissions from gin production and packaging, so that each L of bottled pea gin avoids 2.2 kg CO2 eq. There is great potential to scale the use of legume starches in production of alcoholic beverages and biofuels, reducing dependence on Latin American soybean associated with deforestation and offering considerable global mitigation potential in terms of climate change and nutrient leakage - estimated at circa 439 Tg CO2 eq. and 8.45 Tg N eq. annually.