Bite magazine – Eco-efficient Dentistry


After much discussion, the dental profession is moving towards more environmentally friendly methods and materials with programs like Dentists for Cleaner Water. But as Rob Johnson discovered, some dentists are taking their own steps towards a greener practice.

When you think about it, the dental profession should be at the forefront of ecologically sustainable business. There are few professions that can tie the wellbeing of clients so directly to tools and processes used in treatment, and tie that to environmental impact. It took years for a pilot program aimed at getting amalgam out of the water supply to get up and running. And some dentists, like Brisbane’s Dr David Cowhig, just went ahead and created a sustainable practice anyway. And he’s attracting patients from all over the country.

“We don’t advertise as such,” he says. “Our patients come to us via complementary and mainstream practitioners’ referrals, word of mouth and internet searches.”

Admittedly, it helps that Dr Cowhig’s been practicing holistic dentistry in Brisbane for just over a decade. After training at Kings College, London, and nine years of practice in the uk, he migrated to Australia in 1998 and opened a practice called Queensland Holistic Dentist in Brisbane. “After migrating to Australia, I did a fellowship with the Australian College of Nutritional & Environmental Medicine (acnem)” he says, “which opened my eyes to the affects of environmental toxins on the body and how subtle changes in a patient’s nutrition and lifestyle had a noticeable positive change in their dental and overall wellbeing.”

Dr Cowhig saw this particular path as an obvious one for him to pursue, as “dentistry has always been at the forefront of preventative medicine”.

“This eventually led to the rebranding of Queensland Holistic Dentist as Dental Wellness™, and set-up of the surgery at a new premises in the leafy suburb of The Gap, only ten minutes out of town.”

The decision to move out of the city was driven by his desire to create a working environment in harmony with its surroundings, and one that rejected the principles and philosophy of the practice.

“It was important for the practice to be established with the health of the staff, patients and environment in mind,” he says. “This was the major design brief when we were at the pre-construction phase. We were to take an old, 1930’s brick building and repurpose it. Aside from the aesthetic considerations at the new practice, foremost was the environmental footprint of the dental surgery.”

Cowhig actively sought out information from around the world on how to achieve those ends, particularly when it came to the issue of amalgam waste disposal.


Water worries

The issue of amalgam contamination and waste disposal are possibly the most significant environmental factors facing any dental practice. Quite aside from any debates on the safety or otherwise of mercury in fillings (and it’s worth noting that the ada’s position is that amalgam fillings are not toxic) — its environmental impact alone is enough to cause concern. According to the World Health Organisation, mercury contained in dental amalgam and in laboratory and medical devices account for about 53 per cent of the total mercury emissions in the UK.

The Australian Dental Association and the Australian Dental Industry Association have long been aware of the issues surrounding amalgam disposal, and began discussing ways of keeping mercury out of the water system in the mid-90s, but talks didn’t lead to any action until early 2002, when the ADA’s Victorian branch decided to get their teeth into the issue. It took a further three years for them to negotiate the maze of the state government, the EPA and water industry.

According to Ian Crawford, project coordinator of Dentists of Cleaner Water, “Fast forward to 2007, in August or September, the state government here in Victoria said ‘yes, we’re happy to run with it’. The EPA and water industry put money into a rebate, which said every private practice has to have a separator put into their waterline to prevent amalgam getting into the system.”

“Two years ago, that happened, and I was approached in November 2007 to be project manager of a three-and-a-half year term to end in June 2011. My task is to make sure each practice conforms and has a separator. Dentists for Cleaner Water was officially launched in August last year by Gavin Jennings, Minister of the Environment, Climate Change and Innovation.”

Examples of amalgam separation (from left to right): Cattani Turbo SMART suction system fitted with Hydrocyclone Amalgam Retention device, and the Cattani Hydrocyclone Amalgam Retention device on its own.


Crawford says the project, which currently runs only in Victoria, has been received extremely positively by the profession, a situation helped by the rebate offered by the EPA and water industry.

“It’s been absolutely a positive response,” he says. “I don’t think I could count the negative responses on one hand. I keep a record here of what I’m doing, and I have filed over 700 phone calls from practices, and I can assure you once it’s explained there’s virtually no negativity. It’s been in Europe for a long time, in the us, and launched in New Zealand a year ago, but we’re the only place in the world that offers a rebate.”

And the early signs have been good—the initial targets set for signing practices up to Dentists for Cleaner Water have been exceeded, with more than 250 of the roughly 900 eligible practices in the state putting in amalgam separators at press time.


Mercury falling

According to David Cowhig, “Waste management, air quality, lighting and water quality are the most pressing environmental issues facing all dental practices. Amalgam waste, photographic chemicals, lead shielding of films and volatile solvents are all potentially hazardous.”

At Dental Wellness™ they installed a CMA Ecocycle mercury filtration system, trapping 99.5 per cent of mercury amalgam waste from going into the waste waterways. CMA states that one gram of amalgam waste can potentially contaminate one billion litres of water to a toxic level. Dr Cowhig also points out that the issue of mercury pollution is becoming an issue for global debate, citing the chair of the White House’s council on environmental quality, who said, “The United States will play a leading role in working with other nations to craft a global, legally binding agreement that will prevent the spread of mercury into the environment”.

As well as the mercury filtration system, Dr Cowhig has installed Swiss Iqair Perfect 16 and Iqair dental series air filters, which clean the air to within 0.003 Microns and remove potentially harmful mercury and solvent vapours while carrying out metal-free dentistry. Non-toxic paint on the walls, altered water and full-spectrum lighting that emulates natural sunlight are also present for the benefit of patients, staff and the dentist.

And the philosophy of a cleaner, more eco-friendly practice may soon be pushed in other states, according to Ian Crawford. He says there’s strong interest in Dentists for Cleaner Water in Queensland and New South Wales, although they’re generally waiting to see the outcome of the Victorian trial before going ahead. “But the water boards are different in those states, and the state ADAs have to get together with those funding agencies to do it,” Crawford explains. “The water boards don’t have the same budgets. There’s been very preliminary talks that have started between those state epas and water boards, but it’s in its infancy.”