SUSTAINABLE DENTISTRY. TO REDUCE OUR IMPACT ON THE ENVIRONMENT

Aim: The European Parliament has voted In march 2019 for a ban of single-use plastics to come into force by 2021. Dentistry objectives are to diminish its environmental footprint by adopting the 4R’s conceptreduce, reuse, recycle, rethink-and through the switch to eco-friendly home oral hygiene products. Aim of this study was to evaluate the impact of at-home oral hygiene products on environment. Methods: Literature searches of free text and MeSH terms were performed using MedLine (PubMed), Scopus, and the Cochrane Library (from 1950 to March 2020). All searches were conducted using a combination of subject headings and free-text terms; the final search strategy was determined through several pre-searches. Results: The search strategy identified 23 potential articles: 8 from PubMed, 10 from Scopus and 5 from Cochrane. Most of the available studies focused on the environmental impact of toothbrush and on green alternatives. Precise data on Italian market were not available, as only estimates of consumption were found by search. More detailed data were available about the US market, where 1 billion toothbrushes are thrown away every year and this amount is enough to run around the Earth 4 times. Fifty million pounds of toothbrushes end in landfills in the US every year. Toothbrushes are made from propylene plastic and nylon, which are sourced non-renewable fossil fuels. The handle is made of polypropylene plastic, and when discarded isn’t recycled and it doesn't biodegrade. The bristles are made from nylon, and manufacturing it creates nitrous oxide, a greenhouse gas 300 times more potent than carbon dioxide. These plastics may end up in the oceans. It's estimated that by 2050 there will be more plastic than fish in the oceans. The same concept may be used when talking about dental floss, that is 100% nylon made. Eco-friendly alternatives for toothbrushes are: i) wooden toothbrush with pig bristles, 100% biodegradable, not suitable for those with ethical concerns or vegan; ii) wooden toothbrush with nylon bristles, that have to be separated and thrown in the mixed waste; iii) silicone based toothbrushes; iv) plastic handle toothbrushes with changeable bristles. Alternatives for nylon dental floss are: i) silk wax floss, contained in glass and aluminum dispensers with floss- refills on sale; ii) silk and beeswax floss, in a cardboard or bio-plastic box, that are completely biodegradable. Scanty data are available on the efficacy and efficiency of these products on oral hygiene. Further clinical studies are needed to validate the eco-friendly alternatives of traditional toothbrushes and dental flosses. Conclusion: In conclusion, consciousness about the environmental impact of oral hygiene products should increase among stakeholders and decision makers. Further research should concentrate efforts on development and production of sustainable and eco-friendly alternatives with proved clinical efficacy.