Sea levels are changing, rising due to the melting of large glaciers as a result of the increase in global temperatures caused by greenhouse gases. Like the seas, the natural environment is changing day by day as a result of the high levels of pollution that have been generated. In this regard, and for the same reason, the education provided in institutions that train dentists should be oriented toward the creation of a pro-environmental culture based on sustainable development.

Keywords: culture, dentistry, sustainability

Why is nature changing and dying? Why are flora and fauna disappearing? Why is our world burning away? Possibly because civilization has become a chronic consumer, especially of fossil fuels, and this has been creating a profoundly altered planet where floods, droughts, fires, snowfalls, and climate change in general are increasingly abrupt, atypical, extreme, common, and destructive.

In the last century the earth has warmed by more than half a degree Celsius and sea levels have risen by about 20 centimetres due to the melting of large glaciers due to carbon dioxide and other greenhouse gases that have been released into nature with the consequent rise in temperature and even if the burning of fossil fuels were stopped tomorrow, existing greenhouse gases would continue to warm the planet for many years, so that future generations will be irremediably condemned to live in a warmer world with rising sea levels, with the consequent impact on marine flora and fauna, causing, among other things, flooding and abandonment of coastal cities and towns and famine.¹

If the problem of the environmental crisis is viewed and addressed from the perspective of only dealing with the consequences that pollution and climate change have caused, the situation will only be partially addressed, therefore it is necessary to truly raise awareness about the importance of beginning to truly and correctly correct the consumerist and predatory culture that exists in humanity from the field of education, that is, truly imposing and applying in schools true programs and projects, not only vertical to the curriculum but also primarily transversal, covering almost all strategic parts of the school curriculum, with the intention of generating a new pro-environmental culture, where work is done in all environments of social, professional and work life for sustainable development.

In this sense, culturally, the majority of the world's society considers the concept of sustainability as something that refers exclusively to the consumption of a product that is friendly and respectful of nature in the sense that it is not harmful to it, however the term sustainability is more than that, it implies an integrality that not only includes the environment exclusively, it goes further, it is a way of thinking and acting that entails an attitude of connection with any social and economic challenge and with a perspective towards development.²

A full understanding of this situation involves understanding the problems and consequences of climate change and the critical situation surrounding environmental pollution. It involves starting to change our consumption patterns. If we want to be a green society, we must create green jobs and services. Our current development model is no longer compatible with the reality we are experiencing and threatens the environment and, consequently, life itself.

In today's market economy of supply and demand, the consumer and the generator of a service and/or product must assume a more conscious responsibility and be more proactive in respecting, restoring and caring for the environment. In this sense, we must begin to transform the vision and commitment of the producer and the one who offers a service, as well as changing consumer habits to build a better society based on a greater balance between the present and the future, applying what we have learned from the past.

It hasn't been long since it began to be recognized that globally we are a consumer society and we base practically all of our human and social relationships around consumption, in other words, from the moment we are born we begin to consume indirectly or directly, our economic, social and professional success or failure is based on the logic of consumption, "how much can I buy, how many can buy my services or my products", this situation in this circumstance has become the axis of our life and reason for being.

Nowadays, as several sociologists have suggested (Zygmunt, Bourdieu, Zemelman and Bauman among others) we no longer consume just to live, we do it to identify ourselves and be accepted by a specific social group, to compensate for deficiencies not only vital but also emotional, we do it to have status in the eyes of others, in short, to be more than others, today we consumers are the main promoters of the same product we consume, which is why we simultaneously have the need to be in symbiosis with the other party, with the generators of goods and services; until the middle of the 20th century, products were produced or generated to satisfy needs, today needs are created that are only satisfied with certain products.

Considering the logic that the market has created, this model of economic development is becoming or will become unsustainable. First, natural resources do not allow for unlimited consumption; second, the planet is experiencing overexploitation of its natural resources because we consume more than what is generated and regenerated in nature; third, population growth has already generated unsustainable pressure on these same natural resources. Since 2008, we have reached 7 billion inhabitants, and according to figures from the World Economic Forum, 1.4 billion people will join the ranks with the same consumption habits as of that year.³ The world's population will reach a peak of 10.3 billion in this century, which will mean that, if we all do not begin to take measures and take action to satisfy consumption patterns, sooner rather than later three planet Earths will be needed to supply the demand for products.

To start thinking sustainably, we need to act accordingly and reduce the excessive extraction of natural resources, we must start recycling and efficiently use our products, for example, by 2030 there will be no more copper reserves in the subsoil, an essential resource even for any electronic device and paradoxically at this time there are, according to ALSIMET (a company that sells all kinds of iron and metal products), approximately 225 million tons of this metal wasted inside electronic objects that are thrown in landfills.⁴

Sustainable consumption is environmentally friendly and viable in any social, economic, and labor dimension. Nothing can or should be separated from it. With this consumption, more and better is achieved with less, efficiency and effectiveness are increased in meeting social needs, and consequently, we begin to disengage from environmental and social degradation. In other words, sustainable consumption generates sustainable development and involves meeting the needs of the present without compromising the ability of future generations to meet them.⁵

To create a sustainable society, it is important to consider providing a new pro-environmental education capable of generating a new culture of supply and demand, service and consumption, and for this situation to overlap with the professions and trades. In the case of Dentistry, as a profession that generates specialized medical services and is highly consumerist of technological products, innovative medications, and disposable materials, we must begin to understand that it is a profession (like many others) that is highly polluting to the environment. The use of fluorides, mercury, disclosing and fixing liquids, lead, disposables, connectivity, antiseptic substances, sterilants, technology, etc., places us as a profession with a high negative environmental impact due to the habits and beliefs that exist regarding supply and demand, the practice and consumption of dental services.

This invitation to reflection is not intended to turn the dental community into a non-consumerist field, rather, the intention is to generate awareness about what we do, how we do it, to know the consequences of it and to understand that if we look we can find greener, less polluting and more sustainable supply and consumption alternatives, the understanding, acceptance and consequently the application and use of the three "R"s is essential to begin to be a sustainable profession, REDUCE, REUSE and RECYCLE is the way forward; if we also add REPAIR and REDISTRIBUTE what is wasted we will be even more efficient and effective.

Let's consider this and for this, to make Dentistry a more nature-friendly profession and our future, the proposal to practice Ecologically Sustainable Dentistry is not difficult, complicated or very expensive:

1. Use of paint without volatile organic compounds.
2. Lighting with green and energy-efficient energy.
3. Reduction of disposable items.
4. Elimination of conventional X-rays.
5. Use of ecological products for cleaning, disinfection and sterilization.
6. Take care of your water by repairing any leaks and using water-saving faucets.

This proposal involves returning to the reuse of washable cups and mugs instead of paper or Styrofoam cups, using cloth barriers and sterilization instead of disposable ones, using metal suction tips instead of disposable ones, eliminating the use of amalgam fillings, digitizing X-rays, invoices, receipts, and electronic calendars instead of conventional ones, and using motion sensors and energy-efficient light bulbs. All of this will have a positive impact on the accumulation of waste and pollution in landfills, in groundwater or water supply lines, and on climate change by consuming less paper and disposing of fewer toxic chemicals, among many other things. In this regard, it has been found that countries such as Argentina, Brazil, Colombia, Costa Rica, Ecuador, Mexico, Uruguay and Venezuela have legislation for the management of hospital and clinic waste, but in particular they do not have protocols to regulate professional dental practice with respect to environmental care of the planet,^2,6 this situation urgently requires the promotion of a regulatory framework for this professional practice oriented towards respect for environmental sustainability.

To understand and measure the degree of contamination generated, let's think if two patients are treated in one hour, four pairs of gloves and four face masks are required as a minimum (dentist and assistant), two saliva ejectors, two bibs and two disposable rinsing cups, if we calculate that on average a minimum of four patients are treated daily, eight pairs of gloves, eight face masks, four ejectors, four rinsing cups are required; all this multiplied by five days a week, 20 pairs of gloves, 20 face masks, 20 ejectors and 20 cups will be used.

Considering that approximately two and a half million dentists currently work in the world (World Health Organization,⁷ half of which work in Latin America, generating approximately 1.75 kg per day, it has been calculated with this data that Latin American dentistry produces 2.1 million kilograms of waste per day, that is, more than two tons of polluting waste products (toxic and non-toxic). Therefore, correct waste management must be a fundamental part of the actions that need to be implemented, which includes its classification and recycling or replacement by equivalent products that contribute to reducing the environmental impact on the planet.⁸

Even so, and given certain statistical data, the severity and extent of the polluting impact that dental practice has on the environment is still unknown. However, it is important to emphasize the importance of working to implement solutions that promote eco-sustainable dentistry. This situation gives rise to reflection on the importance of practicing dentistry ethically and with the highest standards of quality and biosafety in order to achieve optimal oral health for the population and environmental protection through sustainable practices. Furthermore, the dental profession must strive for and promote institutional public policies related to education, health, and environmental care, and work alongside regulatory bodies that incorporate sustainability without compromising patient safety and the quality of care provided in both public and private settings. It must also encourage undergraduate and graduate programs to integrate the concept of sustainable dentistry into their curricula. Furthermore, national dental associations and other related organizations must ensure that their activities and operations are based on sustainability principles.

The most efficient way to ensure optimal environmental health, with the lowest possible impact on the environment, is to include documents that highlight the importance of sustainability and to be effective communicators in mass media, social networks, and institutional websites to raise awareness of its importance. The industry, companies, and manufacturers of dental products and equipment must develop more sustainable technologies and dental materials that are biodegradable or recyclable, while promoting low consumption and pollution levels through the use of their products by reducing energy, water, and paper consumption to replace, where possible, disposable products with reusable materials that are less harmful to the environment and reduce carbon emissions into the air.

With the above, we are not inviting us to return to an irresponsible dentistry regarding contamination and cross-infections, the invitation is to be more culturally and environmentally responsible, without leaving aside or neglecting the well-being and health of the patient and all the medical staff who provide dental services, keeping the office, the equipment, the instruments in impeccable cleanliness, disinfection and sterilization, along with the use of specific protective barriers, this and more is a culture and practice that should always be present above all else, let us work for a sustainable Dentistry.

None.

The authors declare that there are no conflicts of interest.

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