operate in a sterile body cavity and we do not deal routinely with severely ill patients. Beyond this, we can easily wash our bottles before refill. In fact, I would suggest that in terms of perceived risk to the end-consumer, there is little difference between spraying a dental surgery surface and spraying a restaurant table. My dental nurses spend at least an hour a day, on top of normal surgery hours, sterilising, packaging and resterilising instruments as well as covering all equipment with plastic. They then must throw away all this plastic as well as the plastic impression trays and other items that previously we could sterilise or disinfect. All this goes into clinical waste, for which we have to pay a premium – not to mention the cost to the environment, which is huge. The need for change It’s time to task an organisation with expertise and authority, like the National Institute for Health and Clinical Care Excellence – or NICE – to thoroughly review all the clinical evidence and the cost of all these recommendations against the risk they pose to patients and the environment. Some years ago, a similar exercise resulted in a reversal of a previous recommendation to give prophylactic antibiotics to patients at risk of bacterial endocarditis before any procedure. The reasoning was that there was more risk to the patient from taking the antibiotics than from the bacteraemia – bacteria forced into the blood stream from the oral cavity – and that in any case a bacteraemia was caused every time someone eats or brushes their teeth. Our media constantly feed the public with misleading statistical analysis, causing fear and uninformed decisions.
A sustainable dental surgery
One perfect example is the increased risk of breast cancer caused by hormone replacement therapy. Many women were denied this drug and suffered years of misery when the added risk is actually only 0.5 per cent. My profession is being encouraged to cause unnecessary damage to the environment, and this is not evidence- based practice. We now have to put the environment as a priority consideration when considering relative risks in healthcare and make pragmatic decisions to reduce “one use” items in particular. The benefit of this could huge: millions of pounds saved in our NHS as well as a positive impact on our target to meet carbon emission targets and reduce the amount of plastic polluting our planet.