Publish date: 17 October 2023

A sustainability project in dentistry has led to a significant reduction in carbon emissions at the Eastman Dental Hospital. 

Having seen the impact of change across other areas of anaesthesia in the NHS, UCLH’s dentistry team realised that guidance did not currently exist within their specialism to make similar strides. The team took action and has made progress in adopting new practices that support UCLH’s net zero programme.  

“Back in October 2022, we decided to benchmark our carbon footprint at the Eastman Dental Hospital, to really understand what we were using nitrous oxide for,” explained paediatric dentistry consultant Lexy Lyne. “When we assessed activity using nitrous gas across the hospital over a period of one month, it was clear that the bulk of use was coming from paediatric dentistry, so that was where we really needed to focus our energies.” 

After the initial stages of their project, the team, led by dental sedation-trained nurses Monika Ozdoba and Petra Vassell, discovered that the procedures associated with the highest nitrous usage were the ones that took the longest, for example, root canal treatment.  

By training dentists and dental nurses on how to deliver nitrous oxide effectively, and encouraging the use of minimally invasive dentistry which does not require sedation, the dental hospital has reduced the carbon footprint from nitrous oxide by over 20 per cent within just a few months.

“We found that most patients that started dental treatment using nitrous oxide continued it for all their treatment visits, even if it was not always clinically necessary” explained Lexy. “So part of our training for the dentists and nurses in the dental hospital has been to really consider when it is clinically useful for patients, and when patients can be ‘weaned off’. We also began to reduce the volume of gas we were administering, which was not being noticed by the patients themselves, but was positively impacting our carbon footprint significantly. 

“We also looked at delivering different treatment options. For example, when inserting a crown on a baby tooth, you would normally do an injection to numb the tooth, drill the tooth to prepare it, and then fit the crown on top. As an alternative, we can offer a ‘hall crown’, which is a successful technique where the crown is placed over the tooth without the need for injections or drilling. This is less anxiety provoking for the children and doesn’t require sedation with nitrous oxide.” 

Postgraduate student, Sarah Ahmad, has been monitoring nitrous use on a quarterly basis since the initial benchmark, and the latest report shows a 23 per cent drop in nitrous per patient since the start of the project.  

Mrs Anand, another consultant in paediatric dentistry, has been piloting a new service at the Eastman Dental Hospital, to provide a different form of sedation to children aged 8 and above, which may offer an alternative to nitrous oxide for some children. However, there is no like-for-like alternative to nitrous oxide sedation in dentistry. 

In the future, the hope is that nitrous oxide capture technology improves for dentistry, and this would allow the team to reduce their carbon footprint even further. As the Eastman is a new building, the amount of gas currently being lost through the gas piping system is less than one percent, but as it ages, we expect this to increase. Dentistry would be the ideal service for capture technology, once this becomes evidence-based and reliable for use in the service. 

The team is now in the process of expanding this project nationally, in partnership with the British Society of Paediatric Dentistry (BSPD), with the long-term aim of producing practical guidance for other dental practices in the UK, covering everything from hospitals with a piped supply of nitrous to community and dental practice settings using individual cylinders. 

“My hope is that that all this work will ultimately feed into the next set of national guidance about nitrous oxide in anaesthesia and we can have a separate section for dentistry,” said Lexy. “It will make a real difference.”