Facilitators and Barriers to Implementing Sustainability in Oral Health Care.

OBJECTIVE: The aim of this research was to study the facilitators and barriers to implementation of sustainable oral health care in Dutch dental practices using a qualitative research design. METHODS: A conceptual framework was developed and based on 2 theories for implementation in dental practices. The framework covered 4 levels: structural, dental practice, oral health care practitioner, and method and product level. Semi-structured interviews were conducted to collect guided and in-depth data. Fourteen key stakeholders were interviewed: dentists, dental hygienists, dental assistants, managers and owners of dental practices, and suppliers of dental goods. Data were analysed using both a thematic analysis approach and open coding. RESULTS: Participants were aware of the compromised planetary health and, in part, of their contribution to it. However, turning this awareness into action proved to be challenging. Barriers that were identified included limited knowledge and awareness of the largest sources of planetary burden in oral health care. Also, information and availability of sustainable products and methods cannot yet meet the requirements of current performance standards, costs, and infection control guidelines. Facilitators that were observed included a growing awareness to contribute to planetary health and to implement sustainability outside oral health care, especially in women and younger people. Overviews and guides of existing sustainable methods are available, but additional methods and products should be developed as well. CONCLUSIONS: Many participants considered infection control guidelines as the most prominent barrier to sustainable oral health care. Women felt more involved with planetary health compared to men, which is in line with the concept of ecofeminism. It is essential for stakeholders to collaborate to reach the next levels of implementation. Action is required on all levels to secure both oral and planetary health. Now is the time to act.

Effect of erythritol on microbial ecology of in vitro gingivitis biofilms.

Gingivitis is one of the most common oral infections in humans. While sugar alcohols such as erythritol are suggested to have caries-preventive properties, it may also have beneficial effects in prevention of gingivitis by preventing maturation of oral biofilms. The aim of this study was to assess the effect of erythritol on the microbial ecology and the gingivitis phenotype of oral microcosms. Biofilms were inoculated with stimulated saliva from 20 healthy donors and grown in a gingivitis model in the continuous presence of 0 (control group), 5, and 10% erythritol. After 9 days of growth, biofilm formation, protease activity (gingivitis phenotype), and microbial profile analyses were performed. Biofilm growth was significantly reduced in the presence of erythritol, and this effect was dose dependent. Protease activity and the Shannon diversity index of the microbial profiles of the biofilms were significantly lower when erythritol was present. Microbial profile analysis revealed that presence of erythritol induced a compositional shift from periodontitis- and gingivitis-related taxa toward early colonizers. The results of this study suggest that erythritol suppresses maturation of the biofilms toward unhealthy composition. The gingivitis phenotype was suppressed and biofilm formation was reduced in the presence of erythritol. Therefore, it is concluded that erythritol may contribute to a healthy oral ecosystem in vitro.