Abstract
Objective: To investigate the implementation of eco-friendly dental office strategies by Jordanian dentists. Methods: Self-designed questionnaires were provided to 150 dentists working in private dental practices in the city of Amman, the capital of Jordan. Dentists’ names and addresses were obtained from the Jordanian Dental Association. Results: Overall, the level of knowledge about eco-friendly dental offices strategies was high for amalgam, radiology, paper waste, infection control and energy and water conservation. In terms of implementation, the majority of Jordanian dentists apply few eco-friendly dental offices strategies. The most frequently identified barriers to implementation of eco-friendly dental offices strategies were cost and lack of incentives from the government. Conclusion: Most Jordanian dental practices are not eco-friendly. A continued focus on the impact of dental practices on the environment is needed through formal and continuing dental education. Results of this study can guide policy development to encourage implementation of eco-friendly strategies.
Key words: Jordan, environment, eco-friendly, dental office
INTRODUCTION
Preservation of the environmental is a global issue. Dental professionals have a responsibility, along with other health-care professionals, to conserve natural resources and to reduce the impact on the environment of toxic waste generated from their practices. Common waste products in dental practices are amalgam restorative materials, radiographic chemicals, plastic/paper barriers and disinfectant solutions. Control of these toxic materials that end up in landfills and water supplies will have an impact on personal health and the natural environment. Using materials that have a minimum effect or cause no harm to the environment are known or defined as eco-friendly or environmentally friendly1.
REVIEW OF THE LITERATURE
Dental practices generate a significant amount of waste on a regular basis. Eco-friendly dental offices utilise strategies that minimise toxic waste generated and help reduce the negative impact of global warming. By adopting these strategies, there is decreased harm to overall human health and the environment. This study examined Jordanian dental professionals’ knowledge and implementation of eco-friendly dental office strategies in the following areas: amalgam management, radiographic management, paper waste, infection control, energy management and water conservation.
Amalgam management
Amalgam contains mercury and exposure to high levels of mercury can be detrimental to human health2. The effects of mercury on humans include irritability, memory loss, tremors, poor physical coordination, insomnia, kidney failure and anorexia3., 4.. Disposal of dental amalgam particles in regular trash or down a drain is not a safe disposal practice. Amalgam particles should be collected in well-sealed containers for recycling to protect the environment. Using pre-capsulated alloys and recycling extracted teeth that contain amalgam restorations to reduce the amount of disposed mercury is recommended by the American Dental Association5. Using an amalgam separator – a device used to reduce mercury waste – traps amalgam particles before to disposal. Amalgam particles are generated during preparation, mixing, administration and removal of the restorations from a patient’s mouth6. Amalgam separators can be installed in different locations in the dental office, such as within the vacuum system lines or close to dental chairs, in-line at a central location before the separator or at the exit side of an air/water separator7. Amalgam separators efficiently remove 95% of amalgam particles8. According to the Eco Dentistry Association9, the use of an amalgam separator in every dental office could reduce 3.7 tons of mercury-containing waste each year. Eco-friendly dental offices also use amalgam traps and vacuum filters which catch coarse amalgam particles. Further, using alternative restorative materials (composite, ceramic, gold, porcelain and glass ionomers) reduces the amount of mercury disposed6., 10..
Radiographic management
Using digital radiographic techniques instead of conventional techniques eliminates the paper, plastic and lead waste generated from discarding used film packets, and the disposal of toxic chemical wastes, such as developer and fixer chemicals. In addition, digital radiographs require 50–80% less radiation than conventional images, which reduces the radiation exposure of the patient11.
Paper waste management
Paper waste is significant in the dental office. Converting dental practice management from a paper-based records system to a computer-based records system is eco-friendly. Practice-management software protects the environment by reducing paper waste, organises patient records efficiently and reduces the risk of losing patient records in emergencies, such as fires and floods. Electronic record keeping saves time when updating the patient records and displays the changes using simple easily understood graphs12., 13.. Implementing patient electronic messaging services and using educational videos are another way of being eco-friendly14.
Infection control management
About 80% of medical waste can be placed into general trash containers as it is not capable of causing infectious disease. Dental office waste that is considered infectious and requires special disposal comprises only 3% of the waste generated15. According to the Eco Dentistry Association, approximately 680 million plastic and paper chair barriers and 1.7 billion instrument and sterilisation bags are thrown into landfills each year9. An alternative eco-friendly strategy is using reusable cloth fabric instead of single-use paper/plastic barriers in dental offices16. Substituting single-use prophy paste plastic cups with bulk product is another way to go green in the dental office17. Using reusable drinking cups and metal suction tips, which can be sterilised, is more eco-friendly9. Using enzyme-based cleaners that are biodegradable, non-toxic and non-chlorinated18., 19. and delivering disinfectant chemicals to cloth or gauze instead of paper towels will reduce the amount of toxic materials used and protect both human health and the environment19. Another eco-friendly dental office strategy is to use steam sterilisation which does not require toxic chemicals, especially when instruments are wrapped with cloth instead of paper/plastic autoclave bags16.
Energy management
Greenhouse gases responsible for climate change derive from the burning of fossil fuels, such as coals, oils, and natural gas. Electricity generated from coal-burning processes releases pollutants into the atmosphere and thus is the single largest contributor to greenhouse gases20. Electricity generated in this way is unsustainable and therefore reducing its use is another eco-friendly strategy. Moreover, switching to compact fluorescent light (CFL) bulbs instead of incandescent lights reduces heat production and pollution21. Burned-out bulbs, regardless of the bulb type, should be disposed as hazardous waste and not in regular trash, as they contain toxic substances such as mercury and lead22. Automated thermostats in heating/cooling systems, lighting motion detectors, unplugging electronics when in not use and putting computers in ‘sleep mode’ will reduce electricity and thus the emission of greenhouse gases16., 22.. Using sustainable forms of energy, such as wind or solar power will help minimise the impact on the environment.
Water conservation
Jordan has limited water resources and is one of the driest countries in the world. These limited resources are further stressed by rapid population growth, a high number of refugees, industrialisation and contamination of water supplies23. Switching from a standard toilet to a dual-flush toilet conserves water as dual-flush toilets use less water per flush than standard toilets, resulting in a small volume of water waste. Water can be saved when using a standard toilet by placing bricks or other bulky materials inside the toilet cistern. The space needed to fill the tank with water after flushing will be reduced and thus save water22.
Installing motion sensors for water faucets16, using hand sanitisers and turning off water faucets while brushing teeth are eco-friendly strategies that can help reduce waste water. At least 90 glasses of water per person will be saved daily if the water faucet is turned off during tooth brushing9., 24..
Economic consideration
Startup costs for an eco-friendly dental practice are significant. A financial return from changes implemented may not be achieved for years. The initial cost and expenses are limiting factors of implementing an eco-friendly dental practice (see Table 1).
Table 1.
The estimated cost for some eco-friendly strategies
| Item | Estimated Cost |
|---|---|
| Digital radiography without the cost of X-ray machine | $6,000–$16,000 |
| Wireless digital radiography system | $22,000 |
| Digital radiography sensor | $6,000–$ 12,000 |
| Practice management software for single user | $500–$2,242 |
| Practice management software for networkers | $1,799–$3,944 |
| Amalgam Separator for 1–4 chairs | $233–$825 |
| Enzyme-based cleaners per gallon | $62–$74 |
| Solar energy per Kilowatt Hour for solar energy* | $0.40 |
| Automated thermostat | $35–$375 |
| Indoor motion detector | $12–$70 |
| Dual-flush toilets | $61–$598 |
| Water-faucet motion sensor | $70–$320 |
The cost per kilowatt hour for coal, oil, and gas is about $0.01, $0.05 and $0.03, respectively.
To our knowledge, no previous study has been conducted to assess eco-friendly dental office strategies of Jordanian dentists who work in the private sector in Amman. The purpose of this descriptive survey was to determine if Jordanian dentists have knowledge of eco-friendly dental office strategies and if they are using these strategies in their practices.
METHODS
Dentists working in private dental practices in the city of Amman, Jordan were chosen because they determined their office policies and procedures, unlike public sector dentists who do not have this choice. A designated research assistant distributed researcher-designed questionnaires to dentists in Amman whose names and addresses were obtained from the Jordanian Dental Association. Questionnaire distribution occurred from 1 August to 15 September 2010, during normal working hours. The study was conducted in full accordance with the World Medical Association Declaration of Helsinki. Dentists were personally visited and asked to read the cover letter explaining the purpose of the survey. Respondents were informed that they would not be personally identified on the questionnaire and would be anonymous to the principal investigator. If the person voluntarily consented to participate, the questionnaire administrator waited and collected the questionnaire after it had been completed and placed in a sealed envelope by the respondent to preserve anonymity and confidentiality. For inclusion, subjects had to be dentists, 23–65 years of age, working in private dental offices and willing to complete the questionnaire. After 150 questionnaires were collected they were returned by the questionnaire administrator in their sealed envelopes to the principal investigator at Old Dominion University in the USA. As the questionnaire was self-designed, the content validity was established by a panel of health science faculty at Old Dominion University and Jordanian dentists at Jordan University of Science and Technology. The questionnaire was pilot tested using 10 volunteer Jordanian dentists who were asked to answer the questionnaire and provide feedback on content, clarity and format. Once the cover letter and questionnaire were finalised, they were translated by the principal investigator into Arabic, the official Jordanian language. The questionnaire consisted of three sections: demographic information; information about the dentists’ knowledge and implementation of eco-friendly strategies (this section used a four-point Likert scale and the participants were asked to select one answer that applied to his/her dental office management strategies in amalgam, digital radiograph, paper, infection control, energy and water); and information about dentists’ perceived barriers to implementation of eco-friendly strategies (this section contained four closed-ended questions and one open-ended question). This study was approved by the Institutional Human Subjects Review Committee of Old Dominion University in August, 2010. Questionnaire data were analysed using spss package version 7.0.
RESULTS
Given that a non-probability, convenience sample was used, results are limited to populations similar to those represented in this study. Half (50%) of the study participants were between the ages 31 and 40 years. Most of the respondents (67.3%) were male and earned a monthly income of $500–$1,000 (54%); 80.7% held a baccalaureate degree, 11.3% held a master’s degree, 5.3% held specialty degrees and 2.7% held doctoral degrees. The majority of the respondents (82%) had been in dental practice 1–19 years.
An assumption in this study was that implementing a strategy would serve as an indicator of knowledge about the strategy. To assess the knowledge of Jordanian dentists regarding eco-friendly strategies, the responses available were: ‘Fully in Place’, ‘In Progress’ and ‘Aware of Strategy–But not Implemented’. Responses of 70% or higher for ‘Fully in Place’, ‘In Progress’ and ‘Aware of Strategy–But not Implemented’ indicated a high level of knowledge about eco-friendly management strategies among the respondents. The majority of the respondents reported having a high degree of knowledge in each strategy (Table 2).
Table 2.
Questions assessing knowledge and implementation of eco-friendly dental office strategies (N = 150)
| Strategy | Implementation | Knowledge | |||
|---|---|---|---|---|---|
| Fully In Place, n (%) | In Progress, n (%) | TOTAL Implementation, n (%) | Aware not Implemented, n (%) | TOTAL Knowledge, n (%) | |
| Amalgam management | |||||
| 1. Use pre-capsulated alloys in different size | 88 (58.7) | 14 (9.3) | 102 (68) | 47 (31.3) | 149 (99.3) |
| 2. Dispose amalgam in means other than regular trash or down drain | 26 (17.3) | 29 (19.3) | 55 (36.6) | 91 (60.7) | 146 (97.3) |
| 3. Keep unused amalgam particles in well-sealed containers | 37 (24.7) | 17 (11.3) | 54 (36) | 90 (60) | 144 (96) |
| 4. Use amalgam separators | 27 (18) | 11 (7.3) | 38 (25.3) | 97 (64.7) | 135 (90) |
| 5. Use amalgam vacuum filters which directs the amalgam particles to amalgam waste water containers | 16 (10.7) | 20 (13.3) | 36 (24) | 95 (63.3) | 131 (87.3) |
| 6. Use alternatives to amalgam filling such as composite, ceramic, gold and porcelain | 114 (76) | 24 (16) | 138 (92) | 12 (8) | 150 (100) |
| Radiographic management | |||||
| 7. Mix and store chemicals according to manufacturer’s recommendations to avoid waste | 109 (72.7) | 18 (12) | 127 (84.7) | 19 (12.7) | 146 (97.4) |
| 8. Purchase chemicals (developer, fixer) in concentrated form. Prepare chemicals as needed to eliminate excess | 74 (49.3) | 20 (13.3) | 94 (62.6) | 52 (34.7) | 146 (97.3) |
| 9. Use waste management programme to dispose of lead foils | 20 (13.3) | 27 (18) | 47 (31.3) | 67 (44.7) | 114 (76) |
| 10. Use waste management program to dispose fixer | 15 (10) | 26 (17.3) | 41 (27) | 66 (44) | 107 (71.3) |
| 11. Use digital radiography | 85 (56.7) | 23 (15.3) | 108 (72) | 34 (22.7) | 142 (94.7) |
| 12. Reuse X-ray mounts for new patients when purging old files | 12 (8) | 16 (10.7) | 28 (18.7) | 93 (62) | 121 (80.7) |
| Paper waste management | |||||
| 13. Recycle dental office paper waste | 6 (4) | 6 (4) | 12 (8) | 117 (78) | 129 (86) |
| 14. Print on both sides of the paper when possible | 49 (32.7) | 12 (8) | 61 (40.7) | 81 (54) | 142 (94.7) |
| 15. Use computer-based records system | 100 (66.7) | 18 (12) | 118 (78.7) | 29 (19.3) | 147 (98) |
| 16. Use practice-management software | 60 (40) | 26 (17.3) | 86 (57.3) | 57 (38) | 143 (95.3) |
| 17. Implement patient electronic messaging services | 10 (6.7) | 17 (11.3) | 27 (18) | 106 (70.7) | 133 (88.7) |
| 18. Use educational videos to explain the recommendations of different dental procedure | 13 (8.7) | 17 (11.3) | 30 (20) | 109 (72.7) | 139 (92.7) |
| 19. Use reusable name badges | 10 (6.7) | 16 (10.7) | 26 (17.4) | 104 (69.3) | 130 (86.7) |
| 20. Use recycled paper products | 21 (14) | 7 (4.7) | 28 (18.7) | 107 (71.3) | 135 (90) |
| 21. Use scrap office/computer paper for scratch pads and internal notes | 75 (50) | 5 (3.3) | 80 (53.3) | 58 (38.7) | 138 (92) |
| 22. Donate old magazines to community centres, public health and other service centres | 49 (32.7) | 19 (12.7) | 68 (45.4) | 73 (48.7) | 141 (94.1) |
| 23. Donate old dental books to libraries, schools or fundraising efforts | 43 (28.7) | 20 (13.3) | 63 (42) | 77 (51.3) | 140 (93.3) |
| Infection control management | |||||
| 24. Purchase supplies in bulk packaging | 120 (80) | 16 (10.7) | 136 (90.7) | 8 (5.3) | 144 (96) |
| 25. Use reusable glass/metal cups instead of paper, plastic or Styrofoam | 7 (4.7) | 13 (8.7) | 20 (13.4) | 109 (72.7) | 129 (86.1) |
| 26. Use reusable metal air/water syringes instead of plastic | 31 (20.7) | 10 (6.7) | 41 (27.4) | 98 (65.3) | 139 (92.7) |
| 27. Use steam sterilisation with cloth instrument wraps vs. paper and plastic autoclave bags | 19 (12.7) | 17 (11.3) | 36 (24) | 96 (64) | 132 (88) |
| 28. Use metal suction tips instead of disposable plastic suction tips | 13 (8.7) | 10 (6.7) | 23 (15.4) | 107 (71.3) | 130 (86.7) |
| 29. Use enzyme-based cleaners that are biodegradable | 42 (28) | 18 (12) | 60 (40) | 81 (54) | 141 (94) |
| 30. Use nontoxic, noncorrosive disinfectant wipes instead of pump spray bottles | 56 (37.3) | 16 (10.7) | 72 (48) | 71 (47.3) | 143 (95.3) |
| 31. Use cloth lab coats that can be laundered rather than disposable ones | 44 (29.3) | 11 (7.3) | 55 (36.6) | 86 (57.3) | 141 (93.9) |
| 32. Use sterilisable instruments, trays and film holding devices, rather than disposable products | 60 (40) | 21 (14) | 81 (54) | 63 (42) | 144 (96) |
| 33. Reuse instrument sterilisation bags. Secure with autoclave tape | 18 (12) | 15 (10) | 33 (22) | 109 (72.7) | 142 (94.7) |
| Energy management | |||||
| 34. Use compact fluorescent light bulbs | 138 (92) | 3 (2) | 141 (94) | 8 (5.3) | 149 (99.3) |
| 35. Dispose the burned bulbs into hazardous waste or recycle it | 27 (18) | 12 (8) | 39 (26) | 101 (67.3) | 140 (93.3) |
| 36. Use renewable energy such as wind or solar power | 8 (5.3) | 4 (2.7) | 12 (8) | 109 (72.7) | 121 (80.7) |
| 37. Use automated thermostats to control heating/cooling systems | 39 (26) | 5 (3.3) | 44 (29.3) | 77 (51.3) | 121 (80.6) |
| 38. Turn off and unplug all the electrical appliances at the end of the day, including computers, printers and copiers | 106 (70.7) | 7 (4.7) | 113 (75.4) | 34 (22.7) | 147 (98.1) |
| 39. Use motion detectors for room lighting | 4 (2.7) | 9 (6) | 13 (8.7) | 94 (62.7) | 107 (71.4) |
| Water conservation | |||||
| 40. Use water faucet sensors | 38 (25.3) | 14 (9.3) | 52 (34.6) | 77 (51.3) | 129 (85.9) |
| 41. Use hand dryers | 75 (50) | 17 (11.3) | 92 (61.3) | 53 (35.3) | 145 (96.6) |
| 42. Use hand sanitiser | 131 (87.3) | 6 (4) | 137 (91.3) | 11 (7.3) | 148 (98.6) |
| 43. Instruct the patients to turn off water faucet during tooth brushing at home | 42 (28) | 11 (7.3) | 53 (35.3) | 92 (61.3) | 145 (96.6) |
| 44. Use dual-flush toilet | 74 (49.3) | 12 (8) | 86 (57.3) | 47 (31.3) | 133 (88.6) |
| 45. Put bricks or other bulky materials inside toilet cisterns | 47 (31.3) | 15 (10) | 62 (41.3) | 64 (42.7) | 126 (84) |
Bold type indicates high knowledge/implementation.
The response choices ‘Fully in Place’ and ‘In Progress’ assessed implementation of eco-friendly strategies by Jordanian dentists. A total of 50% or higher for ‘Fully in Place’ and ‘In Progress’, indicated a high level of implementation of eco-friendly management strategies among the respondents. The majority of the responses in amalgam waste management revealed a low level of implementation. In radiographic management, the responses revealed low implementation in three strategies (questions 9, 10 and 12): use of a waste management programme to dispose of lead foils, use of a waste management programme to dispose of fixer and reuse of X-ray mounts for new patients when purging old files. However, there was a high level of implementation in the three other strategies (questions 7, 8 and 11): mixing and storing chemicals according to manufacturer’s recommendations to avoid waste, purchasing chemicals (developer, fixer) in concentrated form and use of digital radiography. The majority of the responses for paper waste management revealed a low level of implementation except in three strategies (questions 15, 16 and 21): use of a computer-based records system, use of practice-management software and using scrap office/computer paper for scratch pads and internal notes. In infection control management, the responses revealed a level of low implementation except in two strategies (questions 24 and 32): purchasing supplies in bulk packaging and using sterilisable instruments, trays and film-holding devices, rather than disposable products. In energy management, the responses revealed a low level of implementation except in two strategies (questions 34 and 38): use of compact fluorescent light bulbs and turning off and unplugging all the electrical appliances at the end of the day. In water conservation, the responses revealed a low level of implementation in three strategies (questions 40, 43 and 45): use of water faucet sensors, instructing the patients to turn off water faucet during tooth brushing at home and putting bricks or other heavy materials inside the toilet cisterns (see Table 2). The most identifiable barriers to implementation were cost and no rewards or incentives from the government for applying eco-friendly strategies.
DISCUSSION
Dental professionals share global responsibility for elimination or reduction of toxic wastes that could harm human health and the environment. Amalgam restoration materials, plastic covers, radiographic chemicals, lead foils and disinfectant solutions are waste materials from dental settings that eventually end up in landfills and water supplies. Using eco-friendly strategies in dental offices can improve public health through minimising waste and hence reducing pollution.
In the present study, the majority of the respondents had a good level of knowledge about appropriate handling procedures for amalgam and used other restorative materials such as ceramic, gold and porcelain. Unfortunately, our results revealed a low level of implementation of amalgam management strategies; this could result from the high use of alternative restoration materials and therefore represents a low need for amalgam waste management. The use of pre-capsulated alloys in different sizes was high among the participants. This finding is similar to that of Sawair et al.25 who found that about 76% of Jordanian general dental practitioners use amalgam capsules of different sizes.
The majority of the respondents had a high level of knowledge about the strategies regarding radiographic waste management but showed a low level of implementation. This could reflect a high use of digital radiography and therefore a low need to dispose of chemicals. Because the dental digital images are computerised and stored electronically instead of a paper chart, X-ray mounts are not needed. The high use of ‘purchasing, mixing and storing radiographic chemicals’ might be explained as an alternative to the use of digital radiography when needed in the event of equipment failure. Respondents might also have misread the questions and were in fact referring to chemical usage other than radiographic chemicals. Further research is needed to validate this high use of chemicals.
The majority of respondents had a high level of knowledge of waste paper management strategies. This result might be explained by information disseminated by public media. Awareness about recycling may have been heightened by events in Jordan such as Clean Planet Day or Earth Day. Results from this study revealed that the Jordanian dentists surveyed have a high level of knowledge about paper waste management compared with a low level of implementation of these strategies. Our results revealed that dentists are using computer-based records systems and practice-management software, and therefore might not be printing documents as frequently as with paper-management systems. The high use technology might be influenced by the location of the study population who worked in the private sector in Amman, the capital of Jordan, where advanced technology is readily available. The study’s results also revealed a high frequency of using scrap office/computer paper for scratch pads and internal notes. This result might explain the dentists’ low use of recycled paper waste or printing on both sides. The majority of the respondents (92%) did little recycling of dental office paper waste, which correlates with the limited availability of recycling programmes in Jordan. Our results revealed a low use of patient electronic messaging services, which might be explained by limited access to the Internet by most Jordanian citizens. The majority of the respondents did not use reusable name badges and educational videos but this might be because respondents did not use name badges anyway or did not have educational videos. The finding that the Jordanian dentists did not donate their old books and magazines is difficult to explain. Further research in recycling is needed to validate these findings.
Our results revealed that Jordanian dentists are knowledgeable about infection control management but have low level of implementation of the strategies. Using disposable items might be preferred by Jordanian dentists for the prevention of disease transmission. However, our results revealed low use of reusable cups, air/water syringes, suction tips, lab coats, and sterilisation bags, which might be explained by the great care that is needed to properly clean and sterilise all reusable items. Low use also might occur because of the need for extra equipment such as a dishwasher with a special sanitiser cycle for reusable cups. The uses of reusable products in dental offices requires additional staff responsibility to meet health code requirements and universal standards. The low use of some products, such as enzyme-based cleaners and disinfectant wipes, might result from lack of product availability or lack of product marketing to dentists. These measures might represent a higher cost for infection control measures to the dental practice. The majority of Jordanian dentists purchase supplies in bulk packaging, but this could be an economic choice that reduces expense compared with the single-use supplies.
In contrast to their low implementation of appropriate strategies Jordanian dentists appear to be very knowledgeable about energy waste management. The low use of automated thermostats and motion detectors for lighting might be explained by the need for building renovation and the added costs of this. Jordanian dentists demonstrated a high use of fluorescent light bulbs and the majority turn off all electrical appliances when not in use. These results might be explained by the no, or low cost needed to implement these strategies. Research revealed a low use of renewable energy, which is similar to the findings by Abdulla et al.26, who stated that about 2% of the total energy consumption in Jordan is from renewable energy sources.
The results of our study revealed a high use of hand dryers and sanitiser gels and therefore represented a low need for water faucet sensors. Jordanian dentists showed a high use of dual-flush toilets, which might explain why adjustments did not need to be made to the toilet cistern water level. The result that most of the Jordanian dentists do not instruct their patients to turn off water faucets during tooth brushing is difficult to explain as most Jordanians should be highly aware of their severe water crises. Nevertheless, these observations highlight a need for educational programmes for better water conservation and to take any extra steps to conserve water.
Our results revealed the that majority of respondents chose ‘the cost’ and ‘no advantages from the government for applying eco-friendly strategies’ most often as barriers to implementation. This finding correlates with the knowledge that the majority of Jordanian dentists earn middle incomes and therefore may not have the resources to implement what they perceive as costly strategies. The Jordanian government might encourage dentists to implement eco-friendly strategies in their offices by providing tax incentives and no duties on purchases and use of equipment or materials that have minimum effect on the environment. Further research is needed to examine if there are other influencing variables affecting the implementation of eco-friendly dental office strategies.
LIMITATIONS
Some of the limitations of this study that might have influenced the results include the design of the questionnaire, which disallowed the use of parametric statistical tests. In addition, one question under radiographic management combined two strategies, which might have confounded the results. Also, some eco-friendly strategies identified in the study were not accessible to Jordanian dentists, such as lead foil recycling, which is not available in Jordan. Literature is also limited regarding eco-friendly strategies in the dental office and thus restricts validation of the results.
CONCLUSION
Jordanian dentists are adequately informed and but scantily implement eco-friendly dental office management strategies regarding dental amalgam, radiography, paper, infection control, energy, and water.
The curricula of dental schools should be augmented to ensure that students are competent in safe handling of dental amalgam and wastes. Further, dental school curricula should encourage the application of eco-friendly strategies. Implementing these strategies in dental school serve as a good example of how oral health professionals can be involved in protecting the environment. The awareness of practising Jordanian dentists about environmental problems and solutions related to dentistry should be increased during annual meetings and through continuing education courses. A report based on the outcomes of this survey, along with the recommendations, will be sent to relevant departments at the Jordanian Ministry of Environment and Ministry of Education to encourage implementation of new regulations that enhance the application of these strategies. Considering the results of this study, future studies should focus on the attitude of Jordanian dentists toward environmental problems and the value of eco-friendly dental office strategies. Other important future research areas include improving knowledge of and implementation of eco-friendly strategies by dentists who work in the public sector, or who work in cities other than Amman, and in-depth examination of costs and market influences of using eco-friendly strategies in Jordanian dental practice. This study represents the first known attempt to document the knowledge and implementation of eco-friendly dental office strategies among Jordanian dentists working in the private sector. The study examined the role of dentists but the role of dental hygienists and dental assistants in the implementation of eco-friendly dental strategies may also be important. Recycling is in its infancy in Jordan. Until the availability of recycling industries is addressed, limited participation in recycling efforts is anticipated.
Acknowledgements
The authors thank all participants who responded to this survey.
Conflict of interest
None declared.
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