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Four A'S of eco-friendly dentistry.

It is a matter of concern that some dental clinics are not taking into consideration the environmental impact on the general hygiene and safety of their patients and surrounding. Eco-dentistry association defines green dentistry as "a high-tech approach that reduces the environmental impact of dental practices and encompasses a service model for dentistry that supports and maintains wellness". It is especially important as it deals with the oral hygiene of patients. (1)

Eco-friendly dentistry is an attempt made to reduce chemicals detrimental impact on the environment and promote environmental awareness and sustainability to patients. It is an approach in dentistry that encourages sustainable practices by reducing resource consumption and waste. Eco- friendly dentistry also tries to promote the dental life expectancy. (2)

What makes eco-friendly dentistry important?

It is an approach that helps to maintain a balance between the patient and the dentist by creating an eco-friendly environment. According to the Eco-Dentistry Association, (green dentistry) they insist to reduce waste and pollution, save energy, water, and money and to incorporate high tech innovations, focus on wellness, and integrative practices. (3)

It is suggested that a management tool may be developed to ensure the increased promotion of eco-friendly dentistry.

Four A's management protocol: Ask, Assess, Advice and Assist the dentists. This could be a way to ensure its sustainability in dentistry. The 4 A's adapted from the strategies of tobacco cessation (2) may be used in eco-friendly dentistry as described below theoretically:

a. Ask - Gather all the details from the dentist on his routine dental practices;

b. Assess - Assess what all practices can be modified towards promoting eco-friendly dentistry;

c. Advice - A clear set of guidelines that can be followed; and

d. Assist - In preparing a framework as per the environmental conditions at the place of the dental clinic/Hospital.

Dentists play a very vital role in helping to promote and create an ecofriendly environment. This aspect being important may also be taught at a university level as a part of the curriculum in dentistry. Dentists should realize that efforts have to be made towards creating an eco-friendly environment at a clinical level to be community friendly. Continuous dental education programs should be conducted to increase awareness among the dentists to create an eco-friendly environment.

It is not even necessary that some management consultant should come and carry out the above assessment of the existing situation and suggest improvements for meeting the goals of eco-friendly dentistry. Every dentist and in case of a large dental institution the management itself should assess their existing infra structural arrangements, materials used and treatment methodology. After assessing they should improve the existing situation to the recommendations of the eco-friendly association guidelines. The 4 A's management tool may be used by the dentists themselves (4).


(1.) Eco Dentistry Association. About green dentistry. Berkeley: Eco Dentistry Association, 2013 [cited 2013 Nov 11].Available from: about green dentistry

(2.) Passi S, Bhalla S. Go green dentistry. J Educ Ethics Dent. 2012;2(1):10-12.

(3.) Pockrass F, Pockrass I. The four "R's" of Eco-friendly dentistry. Am Dent Hyg Assoc. 2008;22:18-21.

(4.) Tobacco Free RNAO. Brief Intervention: the 4 A's. 2018 [cited 2018 Aug 25]. Avalaible from:

Shanthi VANKA (a) Othman WALI (b) Amit VANKA (a)

(a) IBN Sina National College for Medical Studies, Preventive Dental Sciences, Jeddah, Makkah, Saudi Arabi.

(b) IBN Sina National College for Medical Studies, Oral Basic and Clinical Sciences, Jeddah, Makkah, Saudi Arabi.

Declaration of Interests: The authors certify that they have no commercial or associative interest that represents a conflict of interest in connection with the manuscript.

Corresponding Author: Shanti Vanka


Submitted: September 24, 2018

Accepted for publication: November 05, 2018

Last revision: December 05, 2018
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Title Annotation:SHORT COMMUNICATION Dentistry
Author:Vanka, Shanthi; Wali, Othman; Vanka, Amit
Publication:Brazilian Oral Research
Date:Jan 1, 2019
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