Creating a Greener Dental Practice

By Dr. Jason and Rebecca McMillan

A Room-by-Room Guide

Not only will your practice benefit from your environmental stewardship, but you will have the personal gratification of knowing you are doing your part to protect the planet for generations to come.

Materials & Furnishings

• Use products and materials that are durable. A product that lasts longer usually requires less maintenance and saves energy.
• Select building materials that will require little maintenance (painting, retreatment, waterproofing, etc.), or whose maintenance will have minimal environmental impact.
• Choose construction materials that are salvaged, have a high-recycled content, are certified wood products, and/or are rapidly renewable resources such as bamboo.
• Give preference to materials manufactured locally to offset the adverse impacts of transportation.
• Create a custom look and conserve resources by furnishing your space with second-hand finds, such as tables and chairs for your waiting room.
• When purchasing new office furniture and fixtures, look for products that follow the "cradle to cradle" design philosophy. These products use environmentally healthy materials and production methods and are designed for the product to be easily recycled at the end of the product's useful life.
• Look for carpet that has no polyvinyl chloride (PVC) in the backing. Consider using carpet tiles that will allow soiled areas to easily be removed and laundered or switched with tiles from other low traffic areas if necessary.
• If possible, select a product that has been certified as Green Label Plus, which means it has been tested by an independent, certified laboratory and meets stringent criteria for low chemical emissions.
• Select materials for your space that do not emit harmful chemicals so that there aren't any issues with "off-gassing." Use low VOC (volatile organic compounds) paints, laminates and adhesives.

Lighting

• Design your office to maximize natural light and minimize energy use with carefully placed windows and/or skylights.
• Install occupancy sensors in rooms that are infrequently used. These sensors will save energy by automatically turning lights on when someone enters a room and turning lights off when they leave.
• Save money and energy by swapping out your incandescent bulbs for compact fluorescents that are four times more efficient and last up to 10 times longer.
• Use daylight dimmers that turn off lights automatically when there is sufficient natural light.
• Control direct sunlight through windows with screens or film.
• Install LED exit signs that last 20 times longer than conventional signs.

Energy Use

• Use high-performance windows, high levels of insulation, and tight construction to conserve energy.
• Design your space to utilize renewable energy such as passive solar heating, daylighting, and natural cooling.
• Purchase renewable energy through your local utility company.

As we all become increasingly concerned about the environment, the demand for sustainable products and services has grown exponentially. From organic produce to hybrid automobiles and green contractors-consumers are demonstrating their commitment to lightening their ecological footprint with their checkbooks.

This trend is beginning to surface in the dental office as well. Many patients are seeking to align themselves with practitioners who show a commitment to improving both their patients' health and the health of the environment. Businesses that have incorporated sustainable features cite numerous benefits, including:

• Recognition by their patients and community as an environmental leader
• Strengthened bottom line through operating efficiencies
• Improved employee health and morale
• Marketing edge over their competition
• More opportunities to further increase productivity and reduce costs

Whether you are renovating, planning ground-up construction, or simply considering ways to be greener in your day to day operations, there are many approaches for creating an office that is more efficient and healthier for you, your staff, your patients and your community. Take a stroll with us through the rooms that populate a typical dental practice and learn both the big and the small steps you can take to reduce your environmental impact and join the growing number of practitioners who are seeing green!

Front Office Save paper, space, and time by investing in practicemanagement software to handle billing; treatment plan tracking; process insurance claims, patient information and consent forms, appointment reminders, and optimize scheduling. Purchase Energy-Star-rated computers, monitors, copy/fax machines, printers, and mailing machines for your office. Equipment with this designation saves you money by using less energy and will last longer because they run at a cooler temperature. Many states also have incentive programs with rebates for selecting these appliances.

• Set your computers to enter system standby or hibernate after 30 to 60 minutes of inactivity. Set monitors to enter sleep mode after five to 20 minutes of inactivity.
• Utilize recycled or Forest Stewardship Council (FSC) certified paper products for your office business cards, letterhead, envelopes, brochures, bags, and copy/fax paper.
• Ask at your print shop about using healthier soy-based inks for printing your business identity materials instead of the standard petroleum-based ink.
• Designate and clearly label recycling containers in accessible areas for both patients and staff to encourage resource reuse and recycling.

Many patients are seeking to align themselves with practitioners who show a commitment to improving both their patients' health and the health of the environment.

• Buy recycled/remanufactured toner and ink-jet cartridges for your office machines.
• Communicate with electronic files rather than paper ones. Use e-mail to correspond with doctors and patients and to send digital X-rays.
• Have notepads and message pads made from the unused side of scratch paper, outdated forms, or old letterhead. Simply staple stacks together for staff use or have larger quantities padded by a copy center.
• Make a commitment to reduce your junk mail by writing to or calling senders directly and requesting removal from their mailing list.

You can also:

• • Reduce pre-approved credit card and insurance offers by calling 888-567-8688 (888-5-OPT-OUT) or visit optoutprescreen.com.
  • Register for the "do not mail me list" at the Direct Marketing Association's Mail Preference Service Site: dmaconsumers.org/cgi/offmailing.
  • Reduce the amount of paper used in your office by utilizing your printer's duplex printing capabilities.
  • Sending faxes electronically. If you are not already sending faxes electronically, try to eliminate fax cover sheets whenever possible.

Rest Rooms

• • • Install low-flow faucets and toilets, which provide the same functionality as conventional fixtures while saving substantial amounts of water.
    • Purchase dual-flush toilets that save water by providing two flush options.
    • Conserve water by using sensored faucets that also stop the spread of germs and bacteria, avoid water overflow, and prevent scalding injury.
    • Reduce paper waste and improve restroom upkeep with an energy-efficient hand dryer.
    • Stock recycled tissue and toilet paper that are whitened without chlorine bleach and free of dyes, inks, and fragrances. Buying products made from recycled paper helps reduce the need for virgin wood pulp.
    • Encourage your team to walk or bicycle to work by providing a shower for staff use.

Operatories

• • • Invest in digital radiography and save space, eliminate the need for film processing, and expose patients to up to 90% less radiation than a standard X-ray system.
    • Consider purchasing a CAD/CAM milling machine. This technology reduces material use in the office and it reduces transportation and fuel consumption by patients and laboratories.

• • • Utilize comprehensive practice-management software to save space and increase efficiency by electronically storing charting, progress notes, treatment plans, and X-rays.
    • Select cabinetry constructed with a 100% pre-consumer recycled wood fiber particleboard, that has no urea formaldehyde added during the manufacturing process. This reduces "off-gassing" of harmful chemicals and improves air quality in your dental practice.
    • Reduce the discharge of mercury-containing products, such as dental amalgam waste, into the environment by purchasing or upgrading your amalgam separator.
    • Revisit your local dental association chapter's best practice guidelines to make sure your practice is meeting or exceeding guidelines for managing hazardous and mercurycontaining waste products.
    • Minimize water use by installing medical-grade hand sanitizer dispensers in your operatories. This alternative to hand washing is more effective than soap and water in killing bacteria and viruses, helps prevent dry skin, and saves your office time and resources.
    • Find an alternative to latex gloves. Latex sensitivity is a growing problem for both patients and staff. Be mindful of latex in other products such as rubber dams and prophy cups.
    • Purchase barriers manufactured with recycled materials.

Supply Closet

• • • Use biodegradable, non-toxic cleaners that have limited environmental and health impacts.
    • Stock natural oral-care products for patients.
    • Purchase recycled or corn-based trash bags for waste products.
    • Order sealants, adhesives, and other restorative materials in package sizes that will result in all the contents being used in a timely manner. This will minimize waste from expired inventory and save you money and product.
    • Consolidate your supply orders to prevent unnecessary shipping and packaging waste.

Laboratory/Sterilization Room

• Switch to instrument sterilization via a steam autoclave or dry heat oven. If medically appropriate for your practice, switch your cold sterilant from a solution containing glutaraldehyde to something less toxic, such as hydrogen peroxide.
• Utilize cassettes for instrument processing. This is safer for staff members and reduces the use of sterilization bags.
• Install a good ventilation system to address chemical and airborne particulates.
• Research laundering garments in-house to reduce fuel consumption and overhead costs.

Staff Lounge

• Provide an Energy-Star-rated refrigerator and microwave or toaster oven to encourage employees to bring healthy food from home.
• Purchase reusable dishes, silverware, cups, and glasses for staff and patients and equip your lounge with an Energy- Star-rated dishwasher to encourage employees to wash and reuse tableware.
• Promote carpooling and provide special parking spaces for those who carpool.
• Encourage alternative transportation with public transit maps and discount passes.
• Install convenient, safe places for bike parking.

Mechanical Room

• Select an oil-free compressor. Oil-lubricated compressors can add oil to the compressed air stream and compromise the quality of air for patients as well as having a damaging impact on handpieces.
• Choose a dry, oil-free vacuum system for your practice. This newer technology uses no water compared to a traditional system that consumes approximately a gallon a minute.

HVAC System

• Purchase high-efficiency heating and cooling equipment. This will save money, and produce less pollution during operation.
• Integrate a heat recovery feature into your HVAC system, which can be used to pre-heat or pre-cool outside air by using the exhaust air as the source. This will reduce energy consumption during wintertime and during extreme summer conditions.
• Install programmable thermostats that automatically adjust temperature settings based on the time of day and day of the week.
• Regularly change your HVAC filters and tune up your units.
• Consider installing locking devices on thermostats to maintain desired temperature settings. Water Heater
• Install an energy-efficient water heater. Consult with your project team or visit the U.S. Department of Energy's Web site for their Consumer Guide to Energy Efficiency and Renewable Energy (eere.energy.gov/consumer) to determine what type of water heater is most appropriate for your practice.
• Insulate your existing water heater tank for energy savings. A tank that's warm to the touch needs additional insulation.

Outside Your Building

• Implement storm-water-management strategies to help reduce the discharge of sediment, oil, and chemicals into storm drains, surface water, and groundwater.
• Select a light color for your building and roofing material. This will reflect light and reduce your energy use.
• Landscape with drought-resistant and native plants to minimize irrigation needs.
• Look into the feasibility of using gray water, which is water from sinks, showers, or clothes washers that is recycled for irrigation and to water plants and land.
• Consider a rainwater collection system to provide an alternate water source for garden irrigation while reducing runoff.
• Ask your landscape maintenance team to compost clippings to reduce waste.
• Limit the amount of synthetic fertilizers and pesticides used for landscaping.

Overall Office Strategies: Design & Construction

• Select an architect and builder that are LEED (Leadership in Energy and Environmental Design) accredited or have experience working on green projects. A good place to start is by visiting usgbc.org for contact information for your local U.S. Green Building Council chapter.
• Evaluate the feasibility of pursuing LEED certification for new practice construction and tenant improvements.
• Ask your contractor to develop a waste management plan to facilitate recycling and insure proper disposal of nonrecyclable materials during construction and/or renovation of your practice.
• Select a location that fully utilizes your region's existing characteristics. Work with your design team to weigh the benefits and drawbacks of a potential site's sun, soil, water, and wind conditions.
• Consider a high-density location when constructing a new practice. Density reduces automobile use and creates healthier communities. Look for nearby access to public transportation and other vital services.
• Renovate an existing building for your new practice to preserve more resources than construction that is built from the ground up.

Some of the services or references mentioned apply to U.S. practitioners only.