Adult attitudes to sustainable dentistry in Trinidad and Tobago and their willingness to accept alternatives

The study investigates adults’ attitudes toward sustainable dentistry and their willingness to accept practice alternatives that reduce the environmental impact of dental care in Trinidad and Tobago. Dentistry contributes substantially to environmental burdens through water and energy use and waste (e.g., mercury, plastics), while healthcare has a responsibility to minimize environmental harm. Global climate pressures underscore the need for sustainable practices guided by principles such as reduce, rethink, recycle, and reuse. Prior work shows substantial portions of dental carbon footprints arise from patient and staff travel, and health systems such as the NHS have net-zero targets. No prior assessment existed in Trinidad and Tobago, where sustainability implementation is at an earlier stage compared to the UK. The research question: What are adults’ attitudes toward sustainable dentistry, and how willing are they to accept alternatives (e.g., longer appointments, higher costs, aesthetic or durability compromises) to reduce environmental impacts? Understanding these attitudes can inform stakeholder engagement and guide feasible changes in dental service delivery.

Background literature highlights: (1) Dentistry’s environmental impacts include energy, water, and hazardous waste; sustainable strategies include waste reduction, energy efficiency, and green procurement. (2) UK data indicate patient/staff travel as a major contributor to dental carbon footprints; the NHS has net-zero goals by 2050. (3) Prior exploratory work in the UK (Baird et al.) found generally positive attitudes to sustainable dentistry with variable willingness to accept trade-offs, particularly around aesthetics and health. (4) Public knowledge of climate change solutions can be inconsistent; stakeholder engagement is needed to translate awareness into behavioral change. This study situates Trinidad and Tobago within this context, aiming to provide baseline, locally relevant evidence to compare with more mature settings like the UK.

Design: Cross-sectional survey using a self-administered questionnaire distributed to a convenience sample of adult patients (≥18 years, residents) attending private and public dental clinics across Trinidad and Tobago. Ethics and consent: Approved by The University of The West Indies ethics committee (CREC-SA.1835/11/2022) and the regional health authority ethics committee. Participation was anonymous and voluntary; proceeding implied consent and confirmation of age eligibility. Instrument development: Adapted from Baird et al. (UK) to the local context; demographics (gender, age, education, ethnicity, employment) followed by items on attitudes to sustainable dentistry and willingness to accept alternatives (e.g., longer appointments, paying more, aesthetics, dental health/durability). The full survey is in Supplementary Material. Data collection: February–May 2023; no incentives. Items used a 5-point Likert scale (1 = strongly agree to 5 = strongly disagree), reverse-coded so higher scores indicate more positive attitudes or greater willingness. Reliability: Cronbach’s alpha—Attitudes 0.90; Time/Convenience (longer appointments) 0.844; Money (willingness to pay more) 0.79; Aesthetics 0.79; Health (sacrifices for dental health) 0.67. The durability/repairing restorations construct had low reliability (alpha 0.48) and was excluded from further analysis. Analytic strategy: Exploratory factor analyses confirmed groupings (Attitude; Time/Convenience; Money; Aesthetics; Health). Average scores were computed per factor per participant. Data visualization assessed distributions; normality and assumptions checked. Missing data handled via pairwise deletion. Descriptive statistics, Pearson correlations, independent samples t-tests, and ANOVA with Bonferroni post hoc tests were performed using IBM SPSS 29.0.0.0 and RStudio. Clinic type (private/public) and demographics were examined as potential correlates of attitudes and willingness.

Sample: N = 1267; predominantly female (65.6%); most aged 26–40 years (37.2%); nearly half African descent (41.3%); education skewed high (undergraduate degree 29.8%); employed 72.6%; majority attended private clinics (93.5%). Descriptives (N ≈ 1265): Attitude toward sustainable dentistry Mean 3.89 (SD 0.80); Willingness for longer appointments (Time/Convenience) Mean 3.47 (SD 0.73); Willingness to pay more (Money) Mean 3.00 (SD 0.87); Willingness to accept alternatives affecting Aesthetics Mean 2.55 (SD 0.83); Willingness to accept alternatives affecting Dental Health Mean 2.16 (SD 0.95). Correlations: Attitude with longer appointments r = 0.658 (p < 0.05); Attitude with paying more r = 0.358 (p < 0.001); Attitude with aesthetics r = −0.042 (ns); Attitude with dental health r = −0.229 (p < 0.001). Longer appointments correlated with paying more r = 0.532 (p < 0.001). No significant correlation between longer appointments and dental health. Group differences: By gender—significant differences for attitude (p < 0.001), longer appointments (p = 0.01), aesthetics (p = 0.016), and dental health (p < 0.001); females had more positive attitudes and were more willing to accept longer appointments, while males were more willing to accept alternatives affecting aesthetics and dental health. By age—significant differences across age groups for all outcomes except dental health (p = 0.197); older participants (41–60 and >60) showed more positive attitudes and greater willingness for longer appointments and paying more. By education—significant for all except aesthetics (p = 0.087). By ethnicity—significant for attitude (p = 0.01), aesthetics (p = 0.02), and dental health (p < 0.001). By employment—no significant differences. By clinic type—significant for Money (p < 0.001) and Health (p < 0.01), with private clinic attendees less willing to pay more.

Adults in Trinidad and Tobago reported very positive attitudes toward sustainable dentistry and moderate willingness to accept feasible practice changes, notably longer appointments and modest additional costs, aligning with findings from the UK. Participants were less willing to accept compromises in aesthetics or dental health, consistent with prior literature emphasizing patient prioritization of personal health outcomes. The strong link between positive attitudes and willingness to accept longer appointments (and moderate association with willingness to pay more) aligns with the theory of planned behavior, suggesting attitudes can predict intentions and behaviors. Demographic patterns indicate females tend to have more positive environmental attitudes and acceptance of scheduling changes, while males showed comparatively greater willingness to compromise aesthetics/health; older age groups expressed stronger pro-sustainability attitudes and willingness to pay more. Ethnic differences likely reflect socio-economic and educational variation in the sample. Private clinic patients’ lower willingness to pay more may reflect existing out-of-pocket payments. These insights identify where stakeholder engagement and targeted education could enhance acceptance of sustainable dental practices without compromising clinical standards.

This pilot study provides baseline evidence from Trinidad and Tobago showing generally positive adult attitudes toward sustainable dentistry and willingness to accept certain alternatives—particularly longer appointments and some additional costs—to reduce the environmental impact of dental care. Acceptance is lower for trade-offs affecting aesthetics or dental health. Findings can guide stakeholder engagement and targeted public education to foster pro-environmental behaviors in dental settings and inform future research comparing settings and testing interventions to increase acceptance of sustainable practices.

Generalizability is limited by sampling biases: overrepresentation of females and Afro-Trinidadians relative to national demographics; a highly educated sample; an unusually high proportion of unemployed participants (~25% vs national ~4.9%); and a strong skew toward private clinic attendees. Socio-economic status and clinic type likely influenced willingness to pay responses. Convenience sampling further limits representativeness. Additionally, one intended construct (accepting durability compromises via repair) demonstrated low reliability and was excluded from analysis.