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

Abstract

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.

The Impact of Multiple Autoclave Cycles on the Surface Roughness of Thermally Treated Nickel-Titanium Endodontic Files

“…However, this single-use policy has been put into question, with nothing to prove that autoclave-resistant prion-related infections may be transmitted by dental instruments. Not to mention it is having an increasing impact on the environment, especially with endodontic instruments being the second largest contributor to greenhouse gas emissions, compared to other root-canal procedure materials [48]. It appears to simply translate into more profit for the manufacturer [49] and an increase in the cost of root-canal treatment [4].…”

Embedding environmental sustainability within oral health professional curricula—Recommendations for teaching and assessment of learning outcomes

“…The concepts of horizontal and vertical integration are further discussed by Hays 24 . Over time, as the relatively new concept of ES in clinical dentistry evolves, curriculum leads will need to regularly review content and practice to ensure that taught approaches remain valid—examples of suggestions for informing curriculum review include the disciplines of Endodontics 1 and Restorative Dentistry 25 …”

“…The oral healthcare sector is not currently considered to be environmentally sustainable; it is a significant contributor to global greenhouse gas emissions, produces other pollutants, and generates unrecyclable waste 1 . In response to the impact of the wider healthcare sector on the environment, multiple national and international stakeholders have produced policy documents in response to the climate emergency.…”

Sustainability in orthodontics: Challenges and opportunities for improving our environmental impact

“…Some studies have attempted to quantify the environmental impact of the most common dental procedures (Public Health England and the Centre for Sustainable Healthcare, 2018), such as dental examinations (Borglin et al, 2021), root canal treatments (Duane et al, 2020), the environmental impact of using toothbrushes (Lyne et al, 2020), different forms of personal protective equipment (PPE) (Almutairi et al, 2022) and the importance of preventative measures (Ashley et al, 2022; Duane et al, 2022b; Lyne et al, 2022). There are, however, marked knowledge gaps pertaining to the impact of orthodontic treatment.…”