By Elizabeth Newman
Green is no longer just a color. In fact, it is a word—rather, a movement—we are hearing almost every day in the news, on the radio, in advertisements, at the grocery store, and in the movies. The term "going green" is quickly becoming part of the world’s lexicon, but it means different things to different people. What does it mean for a general dentist to "go green"? There are many ways in which general dentists can green their dental practices, from simple tweaks in the products they buy to building a completely green building from the ground up. Fortunately, going green is easier—and more profitable—than it has ever been.
From the beginning
The term "going green" may seem relatively new (and almost trendy), but the movement to conserve natural resources can be traced back to the 1800s, when writers and thinkers (including Henry David Thoreau) flew in the face of the industrial revolution by advocating a back-to-nature lifestyle. While certain aspects of environmentalism (such as hybrid cars or sustainable clothing) can be viewed as a response to a trend, the basics of conservation have deep roots (pun intended) in American philosophy. The golden age of American conservation took place during the eight years in which President Teddy Roosevelt was in office at the beginning of the 20th century. Although legislative action taken during his presidency established several national forests and parks, conservationism eventually took a backseat to World Wars I and II and the Great Depression.
The green movement was revived again in American culture with Rachel Carson’s 1962 book Silent Spring, which inspired widespread concern over the effect of pesticides and pollution. Once the country—and the world—joined the movement, food safety and clean air become important causes. The U.S. government responded with several environmentally conscious pieces of legislation, including the National Environmental Policy Act, the Clean Air Act, and the Endangered Species Act. In addition, Earth Day was established in 1970. In the 1980s, several oil spills pushed Congress to pass the Federal Water Pollution Control Act and prohibit the use of dichloro-diphenyl-trichloroethane (DDT), a toxic pesticide used on crops that had infiltrated the nation’s water supply and killed a large number of birds.
In the 1990s, many people in the United States became more vocal about corporations misusing nature and bulldozing green land to build energy-consuming buildings. Young activists chained themselves to trees in opposition to these acts, calling themselves "tree-huggers."
The early 21st century brought the need for conservation to light again, especially in the wake of very noticeable climate changes, the fear of global warming, and the increase in gas and oil prices. Former vice president Al Gore became the unofficial spokesperson for the modern green movement; his film An Inconvenient Truth helped shed an even brighter light on the very serious issue of global warming, causing more people to take action on a wide range of environmental issues, including the presence of chemicals in food and packaging, reduced and sometimes disappearing natural resources, and overflowing landfills that reflect on the country’s wasteful habits.
A green infiltration
The history of the greening of America has very strongly impacted all aspects of life, including business, government, schools, industry, and health care. In the last two years, going green has become a way of life for many parts of the country. According to the State of Green Business 2009¸ from the editors of Greener World Media, Inc, "The notion of a green economy—economic activity by companies and customers in the form of products, services, and business models that promote economic growth, reduced environmental impacts, and improved social well being—gathered steam in 2008." The environmental movement got a huge boost toward mainstream acceptance during the 2008 U.S. presidential campaign, which marked the first time that both major-party candidates addressed environmental issues and ways in which to improve not only the nation but the world. According to Joel Makower, executive editor of Greener World Media, Inc., the combination of a new president and a slowly stabilizing economy "is causing both uncertainty and excitement over the notion of a green economy as a means of national economic and environmental security."
Building a green economy begins with adjusting how companies conduct business, which can involve everything from changing the products they use to the way in which buildings are constructed. According to the State of Green Business 2009, "Green building is on the rise, spurring new technologies that save energy and money while creating more healthful workplaces…. The leading consumer product makers and retailers are starting to rigorously assess the environmental impact of their products…sending signals up the supply chain that tomorrow’s products will need to hew [to] higher levels of environmental responsibility."
While "green" products are sprouting everywhere, sometimes it’s hard to know if an item is really green. A term that may be unfamiliar but is gaining recognition is "ecolabelling." Ecolabelling.org, a Web site that asks the question "Who’s deciding what’s green?", helps companies find products that are truly environmentally friendly. The Web site defines an "ecolabel" as "any consumer-facing logo that claims an added environmental or social benefit." Users can visit Ecolabelling.org and search for certified "labels" that indicate a product is green. If you see produce with the label "certified organic," then the search results can tell you what that label means and how the product received it. According to the Web site, which was created by Big Room, Inc., Ecolabelling.org started because "the increasing number and differing quality of ecolabels around the world was creating confusion amongst business and consumers." The company believes that markets need trustworthy and transparent information in order to grow.
One of the most recognized ecolabels is Energy Star, a joint program of the U.S. Environmental Protection Agency and the U.S. Department of Energy created in 1992 to promote energy-efficient products and practices. Energy Star products are available for everyday consumers to purchase at a growing number of retailers throughout the United States. The Energy Star label can be found on a wide range of products and appliances, ranging from dishwashers and washing machines to water heaters and roofing products.
Another ecolabel that people may recognize but may not completely understand is LEED (Leadership in Energy and Environmental Design). According to the U.S. Green Building Council (USGBC), a non-profit organization whose members advocate the construction of "green buildings," "LEED is a third-party certification and the nationally accepted benchmark for the design, construction, and operation of high performance green buildings. LEED certification offers third-party validation of a project’s green features and verifies that the building is operating in exactly the way in which it was designed." LEED certification can be assigned to any type of building—commercial or residential, newly constructed or renovated. When buildings are assessed for LEED certification, they are rated on a point-based system, earning LEED points for green aspects of the building, including sustainable sites, water efficiency, energy and atmosphere, materials and resources, indoor environmental quality, and innovation in design. As previously stated, LEED certification is something for which any building—even yours—can apply.
Green building isn’t a subject to be treated lightly. According to the USGBC’s fact sheet "Green Building Facts," "Buildings are one of the heaviest consumers of natural resources and account for a significant portion of the greenhouse gas emissions that affect climate change." Building operations represent 72 percent of U.S. electricity consumption and also use 15 trillion gallons of water per year (almost 14 percent of the drinkable water in the United States).
There are several different categories of LEED-certified buildings. For example, LEED certification for New Construction and Major Renovations is "a rating system that can be applied to commercial, institutional, and residential buildings of four or more stories, with a focus on office buildings."
There is also LEED certification for Commercial Interiors, which "addresses the specifics of tenant spaces primarily in office and institutional buildings and is designed for tenants who lease their space or do not occupy the entire building and want to LEED certify their space as a green interior." LEED certification for Existing Buildings is a program that the USGBC calls "a tool for the ongoing operations and maintenance of existing buildings." This program identifies and awards best practices for existing buildings and outlines ways in which building owners and tenants can use less energy, water, and natural resources; improve the outdoor environment; and uncover operating inefficiencies.
The fact sheet indicates that there’s more to improving America’s construction habits than helping the environment; the practice also creates jobs, thus improving the economy. "Green building will support 7.9 million U.S. jobs and pump $554 million into the American economy over the next four years (2009 to 2013.)"
The jobs that accompany any burgeoning industry pump up the economy, but the USGBC maintains that green buildings can save a great amount of money in the long run as well. "Green Building Facts" reports, "An upfront investment of 2 percent in green building design, on average, results in life cycle savings of 20 percent of the total construction costs—more than 10 times the initial investment." And the USGBC offers the following statistics about the cost savings of green buildings: they consume 26 percent less energy; have 13 percent lower maintenance costs; have 27 percent higher occupant satisfaction; and emit 33 percent fewer greenhouse gases. But perhaps most important is the effect that green buildings have on the people who live and work inside them. The Environmental Protection Agency has said that Americans spend about 90 percent of their time indoors, where the concentrations of pollutants are much greater than they are outdoors. Given that scenario, the construction of buildings designed to reduce chemical emissions and the wasting of resources affects not only the world around us but also the personal and professional lives of those who work there.
The different shades of green
On an individual level, there are many ways in which dentists can change the way they practice, from the subtle to the extreme, from the building they occupy to the products they use. Steven Koos, DDS, MD, of the ORA Oral Surgery and Implant Studio in Chicago, Ill., built the first green oral surgery office in the United States. When Dr. Koos started the project in 2008, he admits that the task was quite a bit more difficult than he expected. "Since I was the first oral surgeon in the country to pursue building and operating an eco-friendly green office, I had to do extensive research, planning, and preparation," he says. "There was no template or specific guidelines that I could apply directly."
Fred Pockrass, DDS, co-founder of Transcendentist (located in Berkley, Calif.), the first green dental office in the United States, and cofounder of the Eco-Dentistry Association™ (EDA), can sympathize with Dr. Koos. "When we created Transcendentist back in 2003, we were definitely lone wolves," he recalls. "We experienced a gradual, growing interest in green dentistry over the years, but in the last two years, there has been a veritable explosion of interest. Green dentistry is now a hot topic in dentistry."
Dr. Koos started by sticking to an unwavering commitment to environmentally conscious design and operations; he says that he was determined not to compromise regardless of cost, commitment, or challenge. After that, he hit the books. "I enrolled in a Leadership in Green Healthcare curriculum to gain a knowledge base and also to begin networking with already established medical organizations involved in sustainability, like the WHO [World Health Organization], HCWH [Health Care Without Harm], the Teleosis Institute, and Practice Greenhealth." To learn more about constructing his oral surgery office, Dr. Koos became a member of the USGBC and worked with the Green Guide for Health Care (GGHC), an organization that produces a guide for healthy and sustainable building design, construction, and operations for the health care industry. "Through LEED and, more specifically, GGHC benchmarks, I was able to have clear construction and operational goals and objectives for my project," he says.
In an interview with the Teleosis Institute ("Green Health Care Spotlight," available online at http://www.teleosis.org/spotlight-koos.php), Dr. Koos says that neither he nor his contractor had any experience in the construction of green buildings. Dr. Koos started by consulting the HCWH list of environmentally-friendly products and materials. Eventually, he retrofitted a former automobile parts distribution center built in the 1930s into an elegant, unique space. As Dr. Koos has demonstrated, using eco-friendly materials doesn’t mean that the structure looks cheap.
Dr. Koos utilized green interior design, finishes, and textiles, including interior elements that are free of persistent bioaccumulative toxins (e.g., mercury and lead) and volatile organic compounds (e.g., formaldehyde). The materials he used are made from post-industrial or post-consumer waste or they come from sustainable resources.
Now that the project is finished, Dr. Koos can offer some words of wisdom: "What I can recommend to practitioners building, redesigning, or wanting to green their offices is to work with a LEED-accredited professional, either in the capacity of an architect, project manager, or interior designer, for proper guidance and possible certification. I would also stress becoming a member of the EDA and utilizing its information and resources for specific dental industry guidelines and eventual certification, if attainable." By doing his homework and never losing sight of his vision, Dr. Koos’ ORA Oral Surgery and Implant Studio earned a number of green accolades, including the Green Health Care Program Gold Star Award; EDA Charter Certified Practice; LEED certification; and the EDA GreenDOC™ Dental Office Certification Program’s highest award, the GreenDOC Gold.
It’s been a little more than a year since Dr. Koos opened the doors at ORA, but he maintains that all of the work was worth it. "Building, designing, and operating a sustainable green oral surgery practice has been an endeavor well worth the time, effort, and monetary investment," he says. "I am proudly fulfilling my duty as a health care provider to extend the Hippocratic Oath from ‘Above all, do not do harm’ to ‘Above all, do no harm to the environment as well.’"
While building from the ground up is probably the best way to ensure that a building is completely green, not all dentists will share the ambitions of Drs. Koos and Pockrass. Academy of General Dentistry (AGD) member Tina Heil, DMD, FAGD, owner of Suwanee Family Dentistry in Suwanee, Ga., has made smaller-scale changes to make her office greener. She has eliminated paper charts and installed energy-efficient appliances in the office’s kitchen; in addition, her practice recycles all of the paper used in the office; uses digital X-rays, which do not require processing chemicals; and recycles old office equipment and batteries. Everyone in the office is also very energy-conscious. "It’s amazing how many computers and other electronic items are left on when they are not being used," Dr. Heil says. "We make a conscious effort to turn them off." She found that making changes was very easy—and inexpensive. "Our shredding service recycles office paper, so we just put all of the paper in the shred bin, and they pick it up once a month. The shredding is good for protecting patient information, and we feel good about recycling at the same time," she notes.
Dr. Koos employs some practical, easy-to-implement ideas in his office as well. He uses paperless charting and registration on tablet personal computers, purchases recycled products when he can, reuses ink cartridges, submits insurance claims electronically, and sends electronic patient reminders.
The Missouri Environmental Assistance Center (EAC) offers other recommendations for dentists. To reduce energy consumption, the EAC suggests replacing halogen and incandescent lighting with compact fluorescent lights, energy-efficient fluorescent lights, or light-emitting diode (LED) bulbs, all of which can be found at home improvement stores. Remembering to turn lights off when they are not in use and opening the blinds or shades on sunny days can help to reduce energy consumption. The EAC suggests replacing cathode computer monitors with liquid crystal display (LCD) monitors to cut back on energy usage. When it’s time to replace your old appliances, the EAC says that replacing them with Energy Star appliances can cut energy costs by 30 percent. And if you don’t need to start all of your equipment at once, try to avoid doing so. Turning on equipment on an as-needed basis will lower your office’s energy consumption.
Many dental offices are already implementing these practices (electronic charts, digital imaging, recycling paper, and so forth.). As Dr. Pockrass notes, "What many of our dental colleagues may not realize is that they are already ‘greener’ than they think. If you have digital imaging, digital practice management, and an amalgam separator, you’re far along the green continuum. Tweaking a few things, like setting up office recycling, switching to energy-efficient light bulbs, and reusable infection control and sterilization, can yield huge dividends."
Those "dividends" were illustrated when the EDA employed the consulting firm Natural Logic to analyze how much money dentists could save by implementing small, eco-friendly changes. For example, by switching to cloth operatory and sterilization methods instead of disposables, the EDA projects that a general dentist could save almost $2,500 per year. And, by converting to digital billing, charting, and X-rays, the EDA estimates an annual savings of almost $9,000 per year.
Patients are becoming more aware of the ways in which health care providers can become greener, and some are seeking those physicians and dentists who are actively changing their impact on the environment. Dr. Koos says, "Many patients seek out my practice independently, not only because of my experience, but also now because of my proactive environmental stance. As a result, I have seen my oral surgery practice grow at an amazing rate despite a declined economy."
So how can dentists get the word out about their green changes? Christine Hovliaras, RDH, MBA, CDE, president of Professional Savvy, LLC, is an independent oral care/marketing and wellness consultant in the dental industry. According to Ms. Hovliaras, the term "green marketing" refers to "a process in which dentists actively incorporate eco-friendly practices that are environmentally beneficial in their dental office." Ms. Hovliaras suggests that there are several ways for dentists to promote their green changes to their patients. "Dentists can advertise their eco-friendly changes in their practice to patients by sending out a letter or newsletter—through e-mail or through a blog—announcing their new environmentally safe practices." In addition, she notes, dentists can use their Web sites and their Facebook and Twitter accounts to announce their environmentally safe practices. For patients who don’t have e-mail access, Ms. Hovliaras recommends a personal letter from the practice announcing these new changes, adding that all correspondence should be sent on recycled paper.
As Dr. Koos has noted, patients who appreciate such things will definitely take notice when a dental practice shows support for the environment. "More and more consumers are beginning to preferentially choose environmentally conscious products and businesses," he says. "They realize that every dollar spent is essentially a vote for or against the environment."
Some dentists may hesitate to make changes in their practices for a number of reasons, possibly because they see green dentistry as just another trend. Dr. Koos disagrees, saying, "This is truly a paradigm shift happening within the entire health care industry. It is not a fad, a gimmick, or trend like spa dentistry; [green dentistry] actually has substance and merit behind it. Dentists, as part of the health care provider team, should follow their colleagues in other health care fields and realize that it is their direct responsibility as clinicians to protect the health of their team, their patients, and the environment."
Show me the money
Going green in the dental office not only saves money in the long run; it can also provide extra monetary perks at tax time. The Emergency Economic Stabilization Act of 2008 was enacted "to immediately provide authority and facilities that the Secretary of the Treasury can use to restore liquidity and stability to the financial system of the United States." In particular, the Extension of Energy-Efficient Buildings Deduction allows taxpayers to "deduct the cost of energy-efficient property installed in commercial buildings. The amount [that is] deductible is up to $1.80 per square foot of building floor area for buildings achieving a 50 percent energy savings target." This deduction is available through December 31, 2013. Another deduction, the Extension and Modification of Qualified Green Building and Sustainable Design Project Bond, is able to "issue qualified green building and sustainable design project bonds through October 1, 2012."
If a general dentist isn’t sure where to look for tax information, Dr. Koos recommends www.business.gov. By visiting the site’s Environmental Grants, Loans, and Incentives section, he says, "I have been able to take advantage of some of the state and federal incentives. Several possibilities are available for dentists and other small business owners, and it is well worth investigating."
"There are definitely tax incentives, like those under section 179 of the Internal Revenue Code, that are a big help to dentists who recognize that now is the time to upgrade their technology," Dr. Pockrass says. "These tax incentives can help to defray the costs of integrating technology by providing dentists with tax credits for big-ticket items like digital imaging and computers."
Energy Star also has a very comprehensive tax deduction program for consumers. The Energy Policy Act of 2005 includes a tax deduction "for investments in ‘energy-efficient commercial building property’ designed to significantly reduce the heating, cooling, water heating, and interior lighting energy cost of new or existing commercial buildings" (www.energystar.gov). While the person or the company that pays for the construction is usually the recipient of the tax deduction, tenants can sometimes receive tax deductions as well. The Energy Star Web site’s "Federal Tax Credits for Consumer Energy Efficiency" section provides a user-friendly list of the deductions that taxpayers can receive. Tax accountants are becoming more familiar with the deductions for which business owners are eligible. It’s best to speak with a tax professional if you have made green changes or are thinking about making them.
The emergence of new green products and practices has made it easier for dentists to join the eco-movement. As a result, Dr. Pockrass says, "We’ve seen green dental offices popping up all over the country. The Eco-Dentistry Association, which we founded about two years ago, now has almost 500 members." Dr. Pockrass only sees the numbers increasing as more dentists realize that green dentistry is not a fad or a trend, but rather a way in which to improve the health of their patients and the planet. "In terms of the future, we see tremendous growth in green dentistry as our colleagues come to understand the environmental impact of dentistry, what we can do about it, and the significant bottom line benefits that come from going green," he says.
Whether you choose to make large-scale changes (such as building an entirely new practice that is green to the core) or you opt for easier-to-implement modifications to an existing practice, all signs indicate that going green is the way to go. Not only will it save you some greenbacks, it will draw more clients to your office and will be another way for you to help the environment. "Any change, whether you perceive it to be small or not, can make a significant difference," says Dr. Koos.
Ms. Hovliaras agrees. "We know that these measures cannot be accomplished overnight," she says. "However, if each dental practice does its part, it makes a huge impact in the dental industry."