Strategic Action Framework

A broad strategic action framework has been developed on the basis of the previous elements of this report, which reviews and identifies: our level of awareness of the nature and magnitude of the environmental pollution caused through our activities;the challenges that we need to overcome that will enable real and impactful solutions;the drivers that may facilitate and promote the required changes; and finallythe opportunities that exist or that can be created through this collaborative working partnership.

The impact and effectiveness of this action framework arises from the strength of each of its components and statements, taken individually and as a whole in a truly synergistic manner, with the potential for real and effective outcomes. It should be noted that the strategy presented does not intend to provide detailed granular detail for specific approaches or projects.

There is an acknowledged level of health inequalities across the world, between countries and within countries. This is also particularly pertinent to oral health that presents the challenge of balancing preventive oral healthcare with sustainability goals. This challenge needs to be addressed with ingenuity and use of multiple fit-for-purpose approaches. The strategic action points that are promoted in this document must be considered in the cultural and socio-economic contextual framework of the region in which it they are to be implemented. Essentially, stakeholders must take note that the appropriateness of recommendations, solutions and level of impact will vary significantly according to the country and the ability to effect change within it. A local assessment is essential to consider what is achievable and what will have biggest impact.

Thus, this collaborative and non-partisan strategy needs to operate within a code of practice, embodied by the following principles: a desire to engage in a collaborative and non-partisan manner;real commitment with engagement, actions and funding;consideration of cultural and socio-economic operational frameworks;focusing on impactful solutions;sharing best practice;supporting other stakeholders;reviewing outcomes;establishing a code of good practice;learning best practice from other sectors and reciprocating with translation to other sectors;demonstrating leadership in healthcare.

This stakeholder action framework complements the strategic objectives identified in the Executive Board Report by the Director-General of the WHO (January 2022) [64]: Strategic objective 1: Oral health governance – improve political and resource commitment to oral health, strengthen leadership and create win–win partnerships within and outside the health sector.Strategic objective 2: Oral health promotion and oral disease prevention – enable all people to achieve the best possible oral health and address the social and commercial determinants and risk factors of oral diseases and conditions.Strategic objective 3: Health workforce – develop innovative workforce models and revise and expand competency-based education to respond to population oral health needs.Strategic objective 4: Oral healthcare – integrate essential oral healthcare and ensure related financial protection and essential supplies in public healthcare.Strategic objective 5: Oral health information systems – enhance surveillance and information systems to provide timely and relevant feedback on oral health to decision makers for evidence-based policymaking.Strategic objective 6: Oral health research agendas – create and continuously update context- and needs-specific research that is focused on the public health aspects of oral health.

The strategic action framework that follows is considered in two complementary parts: Enabling success – identification of the role of the different stakeholders in the supply chain and suggestions for optimum operational success.Action through routes to sustainability – specific actions that can be achieved that are specifically focused on the different routes as described.

Enabling success

The strategy is considered in the context of the three key principles that have been identified as core to its effectiveness: Collaboration and leadership.Person-centred oral healthcare.The role of enabling agencies.

1. Collaboration and leadership

Companies to lead the promotion of ethical and sustainable behaviours and practices (attitudes) throughout the whole sector. This is based on a recognition of the strongly embedded social and ethical environmental responsibilities that already exist within a company. The leadership and promotion of these attitudes should be directed initially to the direct sphere of influence working through brands, within the supply chain and also through corporate leadership in the industry sector.

Sustainability in the oral healthcare industry must be addressed as a ‘supply chain’ challenge with all stakeholders working collaboratively. The aim of such individual and combined stakeholder actions is to develop a circular economy.

Companies to provide leadership in the drive for sustainability, working collaboratively across the whole supply chain. Uniting around a mission or target, the oral healthcare industry needs to be able to speak with ‘one voice’ and have a much greater impact, principally via the strong image of competing companies coming together in this purposeful way.

Company leadership can be achieved through the promotion of the following domains:

1. Education
   1. Engage in dialogue, education and the use of proactive activities to promote wider engagement with stakeholders.
   2. Promote behaviour change through the company workforce and drive engagement through focused training, such as workshops, in order to bring the outside in and make the workforce more aware of the challenges and opportunities.
   3. Promote behaviour change among oral healthcare professionals, making it easy for people to act, and commit to sustained communication over time.
   4. Collaboration with dental professionals in the development of educational materials (both on sustainability and on healthy oral care habits) for patients, the general public and the profession at large.
   5. Use of CEU and CPD credits, engagement incentives and business benefits for sustainable partnerships.
   6. The translation of complex knowledge into multiformat, strategic and international communication actions.
2. Showcase good practice
   1. Work with healthcare providers and the public end-user through brands and an obviously explicit sustainability corporate responsibility.
   2. Collaborative partnerships between private sector oral care product providers and dental practices to develop a collection system to drive circularity.
   3. Share internal good practice from companies (manufacturing, distribution and oral healthcare providers) more widely to educate and promote a ripple effect throughout the supply chain.
   4. Design and promotion of sustainable products and habits through these products.
   5. Tackle the challenges and barriers that exists between the provision and attainment of everyday health and environmental and societal sustainability.
3. Lead industry change
   1. Establish collaborative partnerships with cross-value chain consortiums that work with government. It is important to identify where the largest gain for collaboration is and how the chain is interconnected.
   2. Work with all the stakeholders and the supply chain as a single entity, end to end.
   3. Be a role model with suppliers to set new standards and expectations within the supply chain and with consumers.

There is clear recognition that companies can bring significant resources to collaborative partnerships to drive sustainability; these include: Knowledge, expertise and research.Expert resources, such as human, communication, materials, consumer behaviour; logistical learning/scale.Funding that is appropriate and effective.Partnership and ideas. Companies understand their challenges and can work with other stakeholders to provide new points of view and solutions.Education, communication, engagement, support.Focus on tangible, easy-to-understand messages, such as the preservation of water usage.Establishing centralised, non-partisan, platforms for sharing examples of good practice and data.

2. Person-centred oral healthcare

The pursuit and achievement of oral health, through preventive programmes, good-quality care and effective maintenance, is the mainstay of sustainability.

There is a need to raise awareness and normalise a sustainability culture that sits comfortably alongside the promotion of oral healthcare as a whole ‘provider–recipient’ team effort.

Within the context of dental practices, there is a need to promote the positive financial business model that underpin the provision of sustainable clinical dental practice. There is an opportunity for the development of a multi-faceted, collaborative practical business model for the care provision stakeholders.

Promote a greater use of digital technologies with the manufacturing and distribution industry, which will reduce the need for personal contact and engagement should be sought to reduce unnecessary travel. At the point of clinical patient-centred care, consider and engage with tele-dentistry and remote clinical consultations. The adoption of these technologies needs to be carefully assessed, as they can be very resource intensive in terms of equipment, technical support and energy.

3. Enabling agencies

External organisations (e.g. government, professional institutes, legislative authorities) should support the development of environmental sustainability in the oral health industry. Consider alignment to the action plan of leading organisations such as those identified by Health Care Without Harm – HCWH [25]. Key to this is a need to engage in a mutual, consensual dialogue that seeks to understand the challenges and identify solutions.

Examples of such actions are: Revision and drafting of new and ‘fit for purpose’ legislation and regulations with sustainability as a major driving consideration will be key.Creating policies that are flexible to allow companies to take actions in their own specific areas (e.g. producers responsibility payments could be offset by investment into alternative proven sustainable initiatives).Working with trusted non-partisan leaders to continue to support good practices and drive action, for example RSB, WRI, EMF and others (see Glossary).Creating incentives for responsible sourcing, manufacturing and consumption (e.g. returning specific products creates a discount in future purchase/oral health insurance plans).Education and transparent communication to (oral healthcare) consumers that combines performance, constituent/material transparency and sustainability profile.National dental associations to raise awareness, through the integration of sustainability into national conferences and the promotion of adapted national guidance.

Agencies (e.g. local/national governments) and legislators should work collaboratively to enable sustainable practices at all levels.

• Make it easier to be sustainable than not to do so, e.g. easy, practical and effective waste recovery and recycling schemes and financial penalties (taxes) for non-recycled waste.
• All stakeholders should benefit from the process, e.g. waste recycling with the benefit of financial benefits and social/patient recognition.

Action through the routes to sustainability

Route 1 – Reduce, reuse, recycle and rethink

Reduce and recycle should be the focus of remediation, being the most practical and readily implementable approaches.

Reduction is best achieved through the delivery and maintenance of good oral health, focused on prevention and with the provision of durable interventions, using high-quality products materials and that will last longer and/or require fewer revisions. Every stakeholder in the supply chain, from manufacturing to the clinician and end-user, has a role to play to optimise this reductionist approach, the emphasis being on ensuring high quality, fitness for purpose and durability that is more important than perceived ‘greener’ options of questionable effectiveness and durability.

At the point of delivery of care, reduction is achieved through the provision of good oral healthcare by engaging with good practice, as detailed in the four domains [8]: preventive care, operative care, integrated care and ownership of care.

• Preventive care – the assessment and management of systemic and local risk factors with a practical and patient-centred preventive regime.
• Operative care – the combination of core knowledge, skill sets, experiential learning and team work acting synergistically. The provision of high-quality operative interventions results in durable treatment that will require fewer repairs and replacements.
• Integrated care – the integration of services, patient-centred structured treatments and patient participation as co-creators and co-managers of their care.
• Ownership of care – active participation in core and complementary activities that leads to professional development, a passion to excel and the satisfaction of achievement.

The outcome of this integrated approach for the delivery of oral care is twofold: (i) fewer appointments, with fewer patient journeys and reduced need for professional interventions, resulting in an overall reduction in CO₂ emissions; and (ii) increased longevity of restorations and a reduced need for procurement, which results in an overall reduction in waste generated.

Reduction of packaging should be sought at all levels: primary/container/delivery vehicle; secondary and tertiary packaging.

Recycling opportunities arise from: Engagement with stakeholders in the supply chain to add value to waste plastic packaging.The design and development of plastic items made from single plastics that can be readily recycled.Engagement with end-user consumers and waste management companies to segregate, collect and recycle clinical SUPS as a valuable commodity.

Companies should fully engage with recycling opportunities with other stakeholders in the supply chain. This must be done in a partnership and is an essential component of finding sustainable solutions. A materiality assessment and SWOT or similar analysis will help manufacturing companies understand where this type of activity fits within the overall strategy.

There is need to create socially equitable funding models and appropriate infrastructure that will promote and permit practical recovery and recycling schemes. The social aspect of managing plastic waste is key to achieving a circular economy. The activity from the Flexible Plastics Consortium is a good example of progress in this respect [42].

Stakeholders in the supply chain should use their influence to increase the application of reuse or recycling, through: Education in manufacturing companies – encourage sustainable product design and environmentally conscious changes in consumer behaviour, the latter with a focus on the use of at-home oral care prevention products.Simple, clear communication and marketing to retailers and consumers, supported and enhanced by the oral care professionals.The establishment of partnerships, collaboration and communicating examples of good practice.Speaking with one voice to drive change.Innovation and setting expectations with suppliers and other third parties.Dental professionals, by implementing sustainable practices in the dental practices.

Route 2 – Legislation, policy and guidelines

Policies and public health guidance should promote oral healthcare as the most important and impactful route to environmental sustainability: Public awareness about the triple benefits of preventive regimes:individual disease reductionpublic health cost savingsenvironmental sustainability gains.Screening and health promotion campaignsWater fluoridationIncorporation of environmental considerations into all clinical intervention guidance.

Supply chain stakeholders should seek to engage with legislation at two levels: Legislation (lawfully enforceable) to drive sustainability and in this way catalyse organisations to move in a positive direction. Legislation or regulation can work to level the playing field across the industry to ensure that all stakeholders operate to an accepted minimum common standard.Legislation using incentivisation and as an advocacy tool, to support sustainable practice, rather than limiting it through regulation. Legislation should seek to drive compliance and public advocacy through trade associations, rewarding best practice and informing public policies, but with care not to stifle innovation and other forms of sustainable development. As stakeholders, operating in different world platforms and settings, we need to be mindful of the different regulatory frameworks across countries and seek opportunities to translate good practice, from other arenas, to influence and raise standards as appropriate.

Legislation should be derived from a fact-based decision-making process. Based on knowledge ascertained through the development of a standardised robust LCA that considers the broad array of variables and their interaction to improve sustainability.

Stakeholders in the oral healthcare supply chain should work with legislators to influence and improve the manner in which laws and rules assist sustainable practice, through: Better stakeholder engagement with legislators/policy regulators, through forums that enable discussions and engagement with policy regulatory bodies, end-users and other stakeholders up- and downstream.Active and regular input into the sustainability debate, to ensure consistent and contemporaneous messages across the industry.Working together and identifying challenges and potential solutions that would be good for the environment but without compromising patients’ and consumers’ oral health.Incentives and support for sustainable business practices that demonstrate sustainable outcomes, rather than limiting it through regulation.Collaboration and sharing good examples and speaking with one voice to drive change.

Route 3 – Waste management

Educate the profession and the public about the merits, usefulness and indispensability of plastic in the healthcare sector. Improve knowledge and attitudes towards the generation and management of biomedical waste across the world and in particular in developing economies.

Promote and support research into recovery and recycling of all forms of plastics used by the industry. Do so in collaboration with supply chain stakeholders up and down the supply chain to achieve a coordinated and impactful solution to the challenge. This should include effective communication and education of end-users about the ability to recycle waste plastic so that it can be repurposed as valuable feedstock in a circular economy.

Focus research on a life cycle perspective of products/materials that considers the whole picture of the environmental impact in the context of the intended purpose of the device, its durability and its management as eventual waste.

Unlock the barriers that exist at each point of the supply chain, changing systems and behaviours at a local and systemic level, and coupling waste management to innovative solutions for reprocessing. The supply chain, acting as a single entity, can help to manage the waste generated by end-users (general public or the oral healthcare profession), with a focus on materials reduction, optimised transport and distribution logistics and recycling packaging materials.

Promote and support research into recovery and recycling of all plastics used by the industry. Do so in collaboration with supply chain stakeholders up and down the supply chain to achieve a coordinated and impactful solution to the challenge. Need to view plastic waste as a resource that can be recycled as part of a circular economy.

R&D collaboration between the oral healthcare manufacturing industry and the plastic synthesis suppliers to design feedstocks (from sustainable sources) and materials that meet safety, quality and durability requirements and can be accepted by recyclers. Further down the supply chain, the oral healthcare manufacturers should work with recyclers on technologies that enable and drive effective recycling.

Management of plastic (SUPs) by means of: Establishment of partnerships and effective communication channels with peers, NGOs and other stakeholders that will drive and enable innovation, new designs, build infrastructure and secure quality recycled feedstock plastic.Pursuit of a more desirable SUP circular economy that focuses on a reduced consumption of finite resources (such as oil-derived plastics) and that designs ‘plastic waste’ out of the systems.Identification of strategies that address single-use plastics at three key stages: (i) packaging, (ii) pre-clinical or pre-use and (iii) clinical or end-user products.Identification of practical and pragmatic approaches that are appropriate for the setting.

Pre-clinical and pre-consumer SUPs (e.g. packaging)

Work towards a circular economy through a reduction of packaging waste by ensuring that this is both recyclable and that there are systems in place to provide recovery and recycling opportunities further down the supply chain.

Establish a business culture that identifies the value of all plastic packaging (including product delivery sundries, e.g. materials compules), setting it as a valued commodity/resource that can be recovered and recycled, rather than the current status of a zero-value waste product at the point of manufacturing and throughout the supply chain.

Focus on the use of recycled plastic waste arising from manufacturing and distribution as feedstock for new products, devices and packaging. This is considered a less challenging route to circularity than the use of clinical or consumer contaminated plastic and end-user contamination, through a combination of established mechanical (shredding) and innovative chemical (polymer breakdown) recovery methods. In this context, all supply chain stakeholders to collaborate with equal responsibility in recycling schemes: All stakeholders must take responsibility and collaborate to find sustainable solutions.Shared rules/specifications are key for all to participate.Requirement for a ‘supply chain lead’ in this process with sufficient resources and funding to manage and maintain the model.Requirement to gain core knowledge on plastic, its forms and recycling opportunities. To enable stakeholders to make more sustainable choices when using it (e.g. to select bio-based over fossil-based).Need to create a level of baseline knowledge through the conduct of robust life cycle analysis, with the engagement of suppliers, distributors and end-users.

Biomedical SUP waste (clinical and consumer)

Undertake an effective assessment to show varying materiality between aspects in different areas of the supply chain. Focus the assessment on each individual area that identifies the most common key aspects.

Stakeholders (manufacturers, legislative authorities, end-users and waste handlers) need to review opportunities for effective recovery and recycling of clinical and consumer plastic items. Some plastic items (e.g. packaging) used in the oral healthcare sector, do not need to be considered medical waste if they not in direct contact with clinical environments. In addition, other plastics such as dental sundries, primary containers (e.g. composite compules, micro-brushes and dispensing pots), waste sterilised autoclave pouches and even uncontaminated gloves present further opportunities for recovery and recycling, if safely and effectively placed in the correct waste stream.

Route 4 – Procurement and logistics

The supply chain should unite to work as a single entity to develop less cumbersome systems and processes with improved logistics capacity with sustainability as a key driver, which will result in an improved circular economy.

All stakeholders should engage in effective and shared auditing practice of sustainability processes and outcomes, within their own sphere of activity and across the whole supply chain to establish a clear baseline and progression toward a gold standard.

Companies should continue to engage and provide environmental leadership across supply chains, extending reach across the value chain, upstream to suppliers and downstream to consumers.

Establish more efficient logistics within the supply chain at manufacturer/distribution and end-user levels: the creation of efficient manufacturing, distribution and procurement logistics with shared facilities. At the point of care delivery, patient-centred clinical care plans need to be managed in an effective manner.

Procurement summits are an opportunity for sector leadership, stakeholder collaboration and sharing best practice. This creates an opportunity for supplier engagement: identifying an opportunity to work with suppliers and improve their awareness, understanding and level of engagement.

Consider the opportunity to include a ‘sustainability index’ as a means to inform purchasers on the sustainability credentials of a product. To include information on environmental sourcing, ethical manufacturing, supply chain distribution and procurement.

Identify mechanisms for the redistribution of equipment and materials to LMICs and educational institutions: products nearing their use-by date and equipment that is nearing the end of its ‘legislation-driven’ useful life in a particular market.

Route 5 – Research and education

Research

Establish research and innovation partnerships, in the manner of formal alliances, to jointly tackle sustainability projects: effective recycling; the development of sustainable practices across industries; new material introduction (development of more sustainable ethically sourced alternatives to currently used materials); shared logistics; working with dental professionals to develop educational materials for patients; and sponsoring relevant and impactful scientific studies [65].

Undertake effective scoping and mapping studies to identify fundamental research gaps. This needs to be a continuous and live project that can respond and adapt to new emerging challenges.

Obtain reliable and independent research data to enable prioritisation and collective action. Circularity is viewed as a key priority area with comparative industrywide LCAs in healthcare to help identify or exclude options that will engage significant opportunities.

Conduct combined health–economic–sustainability impact analyses as a priority in oral healthcare. It is important to consider the intended purpose and effect of the material or product on the end-user and how this may impact on the overall sustainability impact of that individual over the course of their life.

Engagement of national dental associations and governments to support and actively influence oral healthcare professionals with achievable and practical solutions.

Explore, through quality research, the effectiveness of existing and alternative service delivery models that focus on effective and equitable (understanding the challenges of different settings) oral healthcare and sustainability as core aims.

Education

Promote behaviour change by raising awareness among all stakeholders with a focus on end-users (clinical and consumers) and undergraduate dental students as the future clinicians.

Promotion of effective oral healthcare as the most important route to sustainability, with primary positive outcomes on individual health, public health resources and the environment – achieved through a reduced need for interventions.

Drive sustainable practice throughout the supply chain through education, the promotion of sustainability conversations and leading by example.

Educational messages should focus on:

• Disease prevention and maintenance regimes with sustainable oral hygiene practices at home.
• A requirement for accountability in the clinical environment.
• Alternative, more clinically cost-effective service models that can deliver optimum and sustainable oral healthcare. Consideration should be given to implementing impactful prevention and screening services in population hotspots, such as schools, care homes and shopping precincts.

Design of products and services that enable consumers to reduce their oral health carbon footprint, principally through the avoidance of preventable diseases, following validated oral healthcare messages.

Promote sustainability policies and support behaviour change…

• within companies. This is vital to embedding sustainability across all business and a key building block in business growth strategies. This education and embedding of practices/policies extends beyond supply chains to all functions within company business, helping all to build this mindset into their objectives.
• among the entire dental practice team, to include reception, nurses, clinicians and patients – the latter as active co-participants of their care. Focus on preventive regimes that will deliver healthy oral health with low environmental impacts (low use of resources, low carbon footprint and low waste). Sustainability becomes a welcome unintended consequence of good-quality oral healthcare.
• among oral healthcare professionals and the worldwide consumer public. Do so with a focus on prevention, delivery of high-quality optimised operative care, integrated patient-centred care logistics and joint collaborative ownership of care [8].
• among national dental associations, which have a unique opportunity and responsibility to raise awareness and proactively engage with the oral healthcare profession and allied industries.

Integrate sustainability in the undergraduate oral healthcare curricula. This should make use of the expertise and resources of the oral healthcare industry (e.g. communication, educational programmes and good practice), educational providers and the students themselves as co-participants of their education.

Route 6 – Materials for clinical use

Products and materials (e.g. oral hygiene aids and dental restorative materials) need to be ‘fit for purpose’, with sustainability as a core driver (i.e. during manufacturing, distribution, use and disposal). Labelling materials and products as ‘sustainable’ if they are made from sustainably sourced constituents +/− recycled, is overly simplistic. Products and materials need to be: (i) fit for purpose (effectively and predictably achieve their intended purpose), (ii) built from sustainably sourced materials, and (iii) durable, so that they can perform for a very long time and require reduced revisions and/or replacements. In the context of restorative materials, for example, these should provide a lifetime service for the patient. A product or material that is not durable will require replacement, with the consequent environmental impacts associated with the iterative repetition of the greenhouse emissions (throughout the supply chain, including patient commutes) and pollution associated with the manufacturing, supply and provision of restorative materials or other products.

Research focus on a simple, effective, comparable LCA process that can be used cross-industry to support effective R&D strategies and material choice.

Requirement for a direct partnership with waste management companies to encourage collection, sorting and recycling of waste materials.

Integrate environmental sustainability as an intrinsic element of the ISO standards. To include detail of the process that a manufacturer undertakes to choose the most sustainable raw materials, to create the product, and to produce products that will use minimum amounts of energy and water to function, under the auspices of ISO TC (Technical Committee) 106 Dentistry.

Strategic action – Synopsis

Climate change and environmental pollution represent two of the greatest problems facing humanity and the planet. The whole oral healthcare sector recognises the value and positive impact of further improving environmental sustainability throughout the supply chain. To address these challenges, the FDI World Dental Federation assembled a coalition that included leading manufacturers, health professionals, academic experts, and legislative authorities to reach a consensus and prepare this Joint Stakeholder Statement for the Provision of Environmentally Sustainable Oral Healthcare. This endeavour was driven by a collective ambition to reduce the environmental impact that arises from the wide range of activities associated with the global delivery of improved oral health.

This statement identifies the state of awareness of the impact of oral health activities on the environment: the major challenges facing oral healthcare; the complex drivers that underpin current behaviours and practices; and the opportunities to improve and deliver sustainable oral healthcare for people and the planet. As a result of this collaborative programme, a strategic action framework has been identified that is based on defined opportunities to improve sustainability. This framework is based on the evidential and experiential knowledge alongside insights and expert opinions from the diverse stakeholder community engaged by the FDI. Furthermore, actions need to be implemented with due regard to the cultural and socio-economic contextual framework of the regions where they will be deployed. A code of practice for the implementation of these strategies has therefore also been defined, and this is considered core to effective, collaborative action.

It was concluded that sustainability in the oral healthcare industry must be addressed as a ‘supply chain’ challenge, with all stakeholders working collaboratively wherever possible. The primary objective of these individual and combined stakeholder actions should be to develop a circular economy. Industry recognises that, by providing leadership, the potential for positive impact will be substantially enhanced throughout the whole supply chain. This partnership is also committed to sharing best practice to maximise benefits throughout the sector. This consensus statement acknowledges the need to work with the supply chain to fix the supply chain, and in time the goal must be to more closely coordinate our actions in order to further optimise efficient systems and processes alongside logistics capacity. Reduce and recycle should be the main focus of an improvement strategy as being the most practical and readily implementable approach, that is, a reduction of packaging, pre-clinical, and clinical/end-user plastic products and engagement with recycling as the next best strategy of waste management. Reduction of treatment needs represents a significant opportunity to improve sustainability, and can be achieved with a combination of effective preventive programmes and the provision of high-quality consumer health products with effective/durable clinical interventions when needed.

External organisations (including national governments, professional bodies and legislative authorities, including regulators) are strongly encouraged to support this development of even greater environmental sustainability across the oral health sector. This recognition and active support need to be extended to the provision of sustainable clinical dental practice. End-user consumer stakeholders should also be engaged in sustainable practice by raising their awareness and engaging in the design of products and services that enable them to reduce their personal oral health-related carbon footprint.

This consensus statement recognises the value of promoting research into the recovery and recycling of all plastics used across the sector, including in packaging. The reduction generation of associated waste streams requires ‘sustainability’ to be embedded in the earliest stages of product design. Reduction may also be improved through adoption of the best technological solutions (including in distribution, logistics, tele-dentistry and remote clinical consultations). Related to this, research programmes that have the potential to provide innovations in recycling or waste reduction should be given a high priority by governments and their agencies. High-quality and impactful research are a fundamental enabler of any effective sustainability action in the sector. There is a need to obtain reliable and independent research data to enable prioritisation and collective action at all levels. This should include a combined health–economic–sustainability impact analysis. Clinical materials and products require robust life cycle analysis research, to enable effective comparisons to be made. Sustainability through improved recycling requires that companies engage with other stakeholders in the supply chain. There may be specific benefits in creating socially equitable funding models and appropriate infrastructure, which will promote and permit practical recovery and recycling schemes. Stakeholders in the supply chain should use their position to increase the application of reuse or recycling.

There is distinct requirement to engage with legislation to drive sustainability and use incentivisation as an advocacy tool. Legislation should be derived from a fact-based decision-making process. Stakeholders in the oral healthcare supply chain should work with legislators to influence and improve the manner in which laws and rules assist sustainable practice. This statement also recognises the benefits of improving education within the professions at all levels and more widely among the public. Behaviour changes at individual and organisation level, through targeted educational programmes, are key to increasing awareness and driving sustainable practices throughout the supply chain. This should include development of sustainability polices and education of company workforces, oral healthcare professionals, whole dental practice teams, and the global public. A particular focus for educational programmes is the oral healthcare profession, which represents a key link between the dental industry and patient education. This can be enhanced through the integration of sustainability into undergraduate dental curricula with the engagement of national dental associations and governments to support and actively promote sustainability throughout oral healthcare.

In conclusion, all elements of our complex oral healthcare sector undoubtedly make a significant contribution to oral health, which improves quality of life for millions of people worldwide. While sustainability has advanced in recent years by both individual businesses and clinical professionals, this consensus statement demonstrates clearly the potential for far greater future impact as a direct result of improved coordination and collaboration between diverse stakeholders. Further engagement by governments and their agencies to improve legislation and provide support for research leading to the translation of new technologies will further accelerate the transition to a sustainable, circular economy and improved oral health.