A peer-reviewed journal that offers evidence-based clinical information and continuing education for dentists.

Sustainability in Clinical Practice–Are You Aware?


Sustainability can be defined as avoidance of the depletion of natural resources to maintain an ecological balance. At a recent Dentsply Sirona World Conference, Jill Rethman, RDH, BA, editor in chief of Dimensions of Dental Hygiene (sister journal to Decisions in Dentistry), sat down with three individuals involved in the sustainability movement in dentistry. Cherée H. Johnson is the senior vice president, chief legal officer, general counsel and secretary, and chair of sustainability at Dentsply Sirona. Steven Mulligan, BDS, MJDF RCS (Eng), is a founding member of the FDI World Dental Federation’s Sustainability in Dentistry Task Team. And Susannah Schaefer is the CEO of Smile Train, the world’s largest cleft-focused organization. They shared their thoughts on the current state of sustainability in oral healthcare, how clinicians can become involved, and the intersection of good oral healthcare and promoting a healthier planet.

Rethman: As a dental company, why did Dentsply Sirona decide to become involved in the sustainability effort, and why is this important to you personally?

Johnson: While I’ve only been at Dentsply since the end of February 2022, I’m realizing how strong its commitment is. When I came on board, I immediately became the chair of the Sustainability Committee because it has always been an incredibly important part of my life. And my kids “hold my feet to the fire” as well. Sustainability is a key challenge not only for the dental industry but for the world. Before becoming deeply involved, Dentsply Sirona fielded a Global Sustainability Study where we interviewed about 1,300 dentists around the world. We asked some basic questions to get information about their views on sustainability and how we can help shape those views. Their responses were quite enlightening. A large majority of dentists–about seven out of 10–say that the dental industry is lagging in sustainability. But what was also surprising was that nine out of 10 of those dentists indicated that sustainability is important to them personally. Efforts like this often start with a personal mission or personal journey or decision to then make a change in one’s professional life. So as a company we decided it was time to try to move the needle on the sustainability effort in dentistry as well as help dental professionals go beyond. We are committed to helping dental professionals on their journey toward sustainability and that is why we decided to become involved. Not only because the data from the study spoke very clearly but we also believe that it’s the right thing to do.

Dimensions of Dental Hygiene Editor in Chief Jill Rethman, RDH, BA, interviews (left to right) Justin McCarthy, senior director of corporate partnerships at Smile Train; Steven Mulligan, BDS, MJDF RCS (Eng), FDI World Dental Federation, Sustainability in Dentistry Task Team Founding member; Cherée H. Johnson, senior vice president, chief legal officer, general counsel and secretary, chair of Sustainability at Dentsply Sirona; and Susannah Schaefer, CEO of Smile Train.
Dimensions of Dental Hygiene Editor in Chief Jill Rethman, RDH, BA, interviews (left to right) Justin McCarthy, senior director of corporate partnerships at Smile Train; Steven Mulligan, BDS, MJDF RCS (Eng), FDI World Dental Federation, Sustainability in Dentistry Task Team Founding member; Cherée H. Johnson, senior vice president, chief legal officer, general counsel and secretary, chair of Sustainability at Dentsply Sirona; and Susannah Schaefer, CEO of Smile Train.

The study highlighted a significant gap in knowledge about sustainability in general and what needs to happen to move that needle. As a result, we have started a new sustainability education curriculum to help address some of those gaps. Dentsply Sirona is contributing its knowledge, technology, and passion for the effort as well as processes and a structured approach to assist dental professionals. Our first course has four interactive on-demand modules that are hosted on our website. It addresses key opportunities and challenges and how to tackle them. Looking forward, we plan to complete the entire educational module on sustainability by the end of 2023. In addition, we are a founding member of the FDI world sustainability effort. The FDI has released a consensus statement and we are proud to be a part of that. There is also a pledge that has been released in FDI journals that encourages all dental professionals to play a part. In addition, we have an online toolkit with lots of information on how to begin a sustainability journey and to track progress.

Rethman: How is the FDI helping to educate dental professionals about sustainability?

Mulligan: While FDI represents over 1 million dentists worldwide, we want to help all members of the dental team. Introducing the sustainability pledge at our congress in Geneva is truly a red-letter day for the FDI World Dental Federation. It’s a call to everyone who wants to do their part and anyone who is willing to be sustainable in dentistry is encouraged to sign the pledge. On the FDI website’s sustainability section there is a lot of useful, accessible, and easy-to-understand information that dental professionals can use. The consensus statement Cherée referred to is rather large, so we’ve also launched an FDI toolkit that incorporates aspects of the statement to make it easy for those in clinical practice. We have a whole gamut of different actions we can take within the dental practice. Some things are easy, some moderate, and some difficult. There are also certain aspects that are essential and others that are aspirational. The toolkit allows people to learn all these things and then become accredited at a bronze, silver, and gold level. The levels of accreditation are meant to be an incentive to do more. For clinicians looking for a way to start, these online toolkits are key. Any dental professional can access these toolkits from either the Dentsply Sirona or FDI websites.

Rethman: What can dental hygienists do to help achieve sustainability?

Johnson: There are practical things that a hygienist can do around the office. Simple things like being aware of turning off the lights, to more awareness like knowing what sustainability is when ordering supplies. Arming everyone with important information is what we’re trying to do, so they can make informed decisions. Sometimes it seems like the focus is on the dentist, but we are trying to be much more inclusive because everyone plays a part. The site, www.dentsplysirona.com/sustainability, gives concrete actions for protecting the planet and participating in the sustainability effort at all levels of oral healthcare.

Mulligan: One way that hygienists and dentists can work together is by consolidating appointments. Commuting adds to the carbon footprint so aligning appointments reduces patient travel back and forth to the practice. This not only offers convenience to the patient but an environmentally sustainable option for care. When this type of care is explained to patients it is usually well received.

Rethman: Do you think most dental offices understand what sustainability means?

Mulligan: That’s a great question! I think most people are aware of sustainability in their daily lives. They recycle and have home based activities but sometimes those things are difficult to translate into clinical practice. For example, maybe they don’t recycle their lunch trash at work but do so at home. It’s that transferrable mindset that people often don’t have. But I think as the awareness of sustainability in the world increases, decision making on the clinical side has changed and people want to do what’s good for the environment. It’s important to understand that sustainability ultimately is not just what’s good for the environment now but to try and change things so that what we are doing is good for the future. In that way, we are helping the generations to come. We are trying to change the mindset that this is just a matter of incorporating processes into what you are already doing. For example, sustainability is using the best materials available when placing a restoration so it will last a long time, thus reducing trips to the office. It’s a difficult thing to change the whole system. We don’t want to do that; we just want to incorporate sustainability into what clinicians are already doing. It’s about having good quality dentistry…that is sustainable! There are practitioners who are very aware of sustainability even now and are passionate about making changes, such as going amalgam-free and completely digital. There are others who really want to change but don’t know how. And that’s how we hope to help with the toolkits and education programs. And then there are some who think it’s not their thing … they don’t think it’s going to make a difference what they do. But when they see what the rest of the profession starts to do, they will be brought along and will become a part of the effort. Sustainability is not going away, it’s something we need to embrace and adapt to. My colleagues and I did a study that addressed what patients will and will not sacrifice to achieve sustainability. The results are interesting – they will not sacrifice quality, but they will sacrifice their time and will pay more. Patients are very positive about sustainability and want their dentistry to be sustainable because it makes them feel good.

Rethman: How is the Smile Train organization involved in sustainability?

Schaefer: I am loving this discussion and talk of sustainability! It’s what we are as a global cleft organization. Our goal is to have a sustainable long-term system to treat clefts. Initially, our founder was introduced to a mission-based model to treat clefts where doctors are flown in to low- and middle-income countries to operate only for a few days and then leave. While this helped individuals in the short term, our thought was “who is taking care of those kids who are left behind?” If they didn’t make it into the surgical rotation on that mission, they had to wait … what if they could never get the care they needed? If there were already medical professionals in these countries, why were missions flying in when we could utilize those professionals for both immediate and longer-term care? In Smile Train’s early days, the surgical component was the focus to cure the cleft patient, but in the 23 years since we began, we have progressed by listening and working with our partners. We have realized the importance of providing full level comprehensive care. So, we have shifted our model – while surgery is still the main component of what we do, there is subsequent care needed for all those patients. That care includes oral hygiene, orthodontics, and more. We are now able to provide that level of care with the help of our partners, and the support of the FDI and Dentsply Sirona. The patients we treat, and their families, need education—they typically don’t realize that there are other medical complications that can be the result of poor oral health. Since cleft patients have a much greater chance for tooth decay and periodontal problems, that can lead to a greater chance for overall health problems as well.

Mulligan: If I might add, improving the quality of life is part of sustainability!

Rethman: Smile Train has been in existence for 23 years now. What has changed since the organization first began?

Schaefer: We now focus on comprehensive care and a holistic approach to cleft care. A big part of our work is not only advocating for cleft patients but also advocating for those professionals who treat patients in low- and middle-income countries. For example, education about pre-surgical nutritional support for mothers who don’t know how to feed their babies optimally is a big issue. So, we need to be able to support our partners with all the educational materials they need. That way, our partners can provide training for all the professionals who are on the cleft team We work with surgeons here in the US to develop materials that we can provide to our international partners so the same level of care can be delivered across the globe. This is what we are ultimately striving for, and while it’s going to take us a very long time to get there we continue to work for that goal. Part of that is working with and educating governments on the severity of clefts. There is a tendency to look at clefts as a cosmetic problem and not a medical one.

Rethman: For each of you, what is one message you would like to leave for dental hygienists?

Johnson: Hygienists play a critical role in increasing patient awareness globally. Therefore, it’s important to spread the message of oral health and how it connects to sustainability.

Mulligan: Good oral healthcare is good for the patient, good for the practice, and good for the planet.

Schaefer: Good oral hygiene for cleft patients is vitally important. Providing access to good oral hygiene and care to low- and middle-income countries can help achieve better oral and overall health and can contribute to sustainability.

Rethman: Thank you all! This has been a wonderful discussion. It has opened my eyes to what sustainability in our profession truly is, and I know our readers will benefit as well.

The “Consensus on Environmentally Sustainable Oral Healthcare: A Joint Stakeholder Statement” can be found here: https://www.fdiworlddental.org/sites/default/files/2022-04/Consensus%20Statement%20-%20FDI.pdf

The “Pledge for Sustainable Dentistry” can be found here: https://www.fdiworlddental.org/pledge-sustainable-dentistry

The “Sustainability for the Dental Industry Educational Curriculum” can be found here: https://www.dentsplysirona.com/en-us/academy/sustainability-curriculum.html

Information about Smile Train can be found here: www.smiletrain.org

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