Sustainable dentistry aims to minimize the environmental impact of dental treatments while adhering to national standards. Dentistry significantly impacts the environment due to high water and electricity consumption, mercury and plastic waste generation, and the environmental footprint of biomaterials. Given the close link between environmental and human health, the healthcare sector bears a responsibility to mitigate its environmental effects. The urgency to reduce the environmental impact of dentistry is amplified by the rising global temperatures and greenhouse gas levels. Key principles for "going green" include reduce, rethink, recycle, and reuse. Dental practices need to focus on waste reduction, energy conservation, water conservation, and the use of eco-friendly products. While there's growing interest in sustainable dentistry, understanding the problem's scope, contributing factors, and potential solutions remains unclear. A 2014 UK study found that patient and staff travel accounted for 60% of the national dental carbon footprint, highlighting the importance of reducing travel emissions. The NHS in the UK is legally mandated to reach net-zero greenhouse gas emissions by 2050, which reflects a more advanced commitment to sustainability measures compared to Trinidad and Tobago. This study, the first of its kind in Trinidad and Tobago, aimed to investigate adult attitudes towards sustainable dentistry and their willingness to adopt alternatives to reduce the environmental impact of dental care. Engaging the public is crucial for driving change through public pressure, hence the need for this research to gauge public acceptance of potential changes.

Several studies have explored attitudes towards sustainable practices in dentistry, notably Baird et al.'s work in the UK, a society with more advanced sustainability initiatives. Their exploratory study, similar to this one, provided valuable insights into public perceptions. Multi-stakeholder engagement, involving dentists, patients, manufacturers, suppliers, and policymakers, is critical for effective change in sustainable dental services. This engagement is necessary to understand current opinions and encourage deliberate consideration of sustainable dentistry practices. Market research assists in understanding public behavior and views, facilitating change through public pressure. The study considered various aspects of introducing sustainability into dental practices, such as staff and patient travel (often accounting for 65% of CO2 emissions), efficient time management, waste reduction, and energy efficiency. Strategies to reduce carbon footprint might involve preventative care, combined appointments, remote consultations, and digital technologies for record-keeping and improved efficiency. Energy efficiency measures such as LED lighting, low-energy equipment, and the use of renewable energy can also significantly reduce environmental impact. The study also investigated patients’ willingness to consider repair rather than replacement of restorations (while acknowledging potential durability concerns) and the acceptance of less aesthetically ideal options for the sake of environmental sustainability.

This cross-sectional study utilized a self-administered questionnaire to measure attitudes toward sustainable dentistry and willingness to accept environmentally friendly alternatives. A convenience sample of patients from both private and public dental clinics across Trinidad and Tobago was recruited. Dentists were contacted via email to obtain their participation. Participants had to be 18 years or older and residents of Trinidad and Tobago. The University of the West Indies ethics committee and the regional health authority ethics committee approved the study. Informed consent was obtained from participants. The questionnaire, adapted from Baird et al.'s UK study, included demographic questions (gender, age, education, ethnicity, employment status) and questions assessing attitudes towards sustainable dentistry and willingness to accept various alternatives. Responses were recorded on a 5-point Likert scale (1 = strongly agree, 5 = strongly disagree). Reverse coding was used for specific questions. Cronbach's alpha was used to assess the reliability of the scales. Items with low reliability were removed (willingness to accept alternatives affecting durability of dental treatments). Factor analysis was used to group variables based on theoretical considerations. Descriptive statistics (mean, standard deviation) and Pearson correlation analysis were conducted. Independent samples t-tests and ANOVA tests, followed by the Bonferroni multiple comparison test, were used to analyze differences in mean scores based on demographic factors. IBM SPSS Statistics 29.0.0.0 and RStudio were used for data analysis.

The study involved 1267 participants, predominantly female (65.6%), aged 26-40 (37.2%), mainly of African descent (41.3%), with a majority possessing undergraduate degrees (29.8%) and employed (72.6%). Most participants attended private clinics (93.5%). Factor analysis confirmed the grouping of variables into "Attitude," "Time and Convenience," "Money," and "Aesthetics." Participants demonstrated a very positive attitude towards sustainable dentistry (Mean = 3.89, SD = 0.8), and moderate willingness to accept longer appointment times (Mean = 3.47, SD = 0.73) and pay more (Mean = 3.00, SD = 0.87). Willingness to compromise aesthetics (Mean = 2.55, SD = 0.83) and dental health (Mean = 2.16, SD = 0.95) was lower. A strong positive correlation was observed between attitudes toward sustainable dentistry and willingness to accept longer appointments (r = 0.658, p < 0.05). A moderate positive correlation existed between willingness to accept longer appointments and paying more (r = 0.532, p < 0.001). A significant negative correlation was found between attitudes towards sustainable dentistry and willingness to compromise dental health (r = -0.229, p < 0.001). Significant differences in mean scores across demographic variables were observed for most study variables. Older participants (41-60 and >60 years) displayed more positive attitudes and greater willingness to accept longer appointments and pay more. Females had more positive attitudes and were more willing to accept longer appointments, while males showed greater willingness to compromise aesthetics and dental health. Differences were found between Indo-Trinidadian and Afro-Trinidadian participants in terms of attitudes and willingness to compromise aesthetics and health. No significant differences were found across employment status, except for willingness to pay more (private clinic patients less willing).

This study's findings are consistent with other research showing a generally positive attitude towards sustainable dentistry and willingness to accept alternatives such as longer appointments and paying more for treatment, particularly among more affluent participants who primarily attended private clinics. This aligns with the Theory of Planned Behavior, where positive attitudes predict behavior. The observed differences across demographics highlight the importance of targeted educational campaigns. Older participants showed greater willingness to pay more for sustainable practices which contrasts with studies that report younger generations as more environmentally conscious. The gender differences might be explained by the ecofeminism concept, with women generally showing stronger pro-environmental behavior. Differences between ethnic groups may reflect socio-economic factors, and the high proportion of unemployed participants in the sample might influence the generalizability of results. Private clinic patients showed less willingness to pay more, potentially because they already bear higher dental care costs. Future strategies for promoting sustainable dentistry should include targeted educational campaigns to address the identified demographic variations.

This pilot study reveals a generally positive attitude towards sustainable dentistry and a willingness to accept certain alternatives among adults in Trinidad and Tobago. The findings highlight demographic variations in attitudes and preferences, which can inform future targeted educational interventions to improve acceptance and adoption of sustainable practices. Further research with larger, more representative samples is needed to confirm these findings and explore the long-term impact of interventions.

The study's limitations include a non-representative sample biased towards females, Afro-Trinidadians, and those with higher education levels and a high percentage of unemployed participants. The overrepresentation of private clinic patients might also limit the generalizability of the findings. The convenience sampling method introduces potential biases. Future studies should use larger, more diverse samples to enhance the generalizability of the results and address the identified limitations.