COLUMN: Environmentally friendly dentistry

By Dr Hisham Abdalla

Do your bit for the environment by making sure your dentist is following these eco-friendly procedures, Dr Hisham Abdalla blog on MiNDFOOD.

This topic struck me while I was watching Avatar in 3D. Amazing movie, isn’t it? Makes one wonder how beautiful our world would be, both physically and emotionally, without the greed and hostility towards others that seem rampant in the world today. 

So I’ve thought of what health care professionals can do for our environment, and what I’m already doing?

Dental practitioners and other health care professionals recognise that many of the materials and procedures we use to provide services present challenges to the environment. We should take measures to minimise the production of these wastes and limit their environmental effects. Reducing the carbon and environmental footprint of our profession should be every practitioner’s duty. Simultaneously, it should improve the quality of service we provide to our patients.

Here are some of the serious environmental concerns that face dental clinics, and how we have dealt with them in our dental institute. The benefits go to the patients, the clinic, the environment and, subsequently, the world.


There are more than 20 studies from Europe, Canada and the US that identify the dental industry as the leading source of mercury to sewer systems. Dentistry is estimated to contribute up to 70 per cent of the total mercury load entering wastewater treatment facilities.

Amalgam fillings are made up of 50 per cent mercury, plus silver, copper, zinc and various other metals. It is a common, easy-to-use and cheap method to fill cavities in teeth. Amalgam corrosion and bacteria present in the mouth release methyl-mercury in the human body. This can pose health risks to some individuals.

The placement and removal of dental amalgam fillings generate solid and dust wastes that can enter the environment if they are not properly captured and managed. Once in the environment, changes in pH, oxygen and temperature can allow the mercury to be used by bacteria, which convert it to toxic organic methyl-mercury. In a bio-available form, it enters the food cycle and accumulates in higher organisms, particularly game fish and birds. This has led to restrictions on human consumption of many big fish species to minimise the potential adverse health effects.

The best way to control dental mercury amalgam contamination is to stop using it for fillings, be very careful when removing them and make sure the amalgam is not let out into the environment.

Safe removal is done under rubber dam with high volume suction so nothing goes down the patient’s throat or gets inhaled. The pieces that come out should not be thrown in the rubbish but sealed in airtight containers under fluid until they are recycled. The dust and small particles that go into the suction should never be let out into the water pipes. 

Our system separates 99.5 per cent of the amalgam before letting the water out into the pipes. The sediment goes back to Austria in sealed containers, marked toxic waste, for recycling.


Lead, like mercury, is highly toxic and persists in the environment. Even at low levels of exposure, lead produces adverse health effects on humans. It is a byproduct of traditional X-rays, the lead shields contained in each film packet. Dentists all over the world use thousands of films daily, and should collect this lead and send it for recycling. Unfortunately, manufacturers report that only about 5 per cent of products sold are returned for recycling.

The use of digital X-rays which don’t use film, lead shields or chemical processing are becoming more popular. They need lower radiation than normal X-rays, which is safer for the patient. Digital X-rays can be viewed on large computer screens, are easier to see and diagnose from, and do not need space or plastic holders to store. I have been using digital X-rays for over 11 years now, and have never looked back.


Silver is another heavy metal that can enter our water system via improper disposal of dental clinic waste. Although silver is a component of amalgam, the silver thiosulfate in the fixer (a solution used in the processing of photographic film and dental X-rays) presents a greater environmental concern. Used fixer solution should never be let down the drain, instead it should be collected in sealed containers and sent for recycling. The best way to get rid of the whole problem and cost of compliance is to go with digital X-rays and photography, eliminating the use of fixers.


Potentially infected items and used sharp needles and scalpels should also be disposed off in the appropriate containers and collected by designated agencies.


Like any other office/business, dental clinics can significantly contribute to reducing their carbon and environmental footprint by following general recommendations like purchasing products with minimal packaging and using reusable plastic containers (e.g. for cleaning and disinfecting solutions). Products, such as paper towels, made from recycled or partially-recycled materials should also be used.

Energy-efficient lighting and temperature regulation can limit office energy use. Recycling paper and digitising the office decreases the amount of paper used and the trees that need to be cut down. Recycling printer cartridges, unused furniture and IT equipment all help, too.

Have a lovely day and enjoy our beautiful world with passion.

TO WIN ORAL B’s most technologically advanced toothbrush with Bluetooth, the TRUIMPH 5000 (worth $209) answer this questions: How much of the total mercury contamination in water management centres is attributed to dentists worldwide?

Email your correct answer with your name, contact number and city to: [email protected] in association with Oral B.



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