Center for Earth Systems Engineering and Management

Healthcare infection control has led to increased utilization of disposable medical devices, which has subsequently led to increased adverse environmental effects attributed to healthcare and its supply chain. In dental practice, the dental bur is a commonly used instrument that can either be reused or used once and then disposed. To evaluate the disparities in environmental impacts of disposable and reusable dental burs, a comparative life cycle assessment (LCA) was performed. The comparative LCA evaluated a reusable dental bur (specifically, a 2.00mm Internal Irrigation Pilot Drill) reused 30 instances versus 30 identical burs used as disposables.

The LCA methodology was performed using framework described by the International Organization for Standardization (ISO) 14040 series. Sensitivity analyses were performed with respect to ultrasonic and autoclave loading. Findings from this research showed that when the ultrasonic and autoclave are loaded optimally, reusable burs had 40% less of an environmental impact than burs used on a disposable basis. When the ultrasonic and autoclave were loaded to 66% capacity, there was an environmental breakeven point between disposable and reusable burs. Eutrophication, carcinogenic impacts, non-carcinogenic impacts, and acidification were limited when cleaning equipment (i.e., ultrasonic and autoclave) were optimally loaded. Additionally, the bur’s packaging materials contributed more negative environmental impacts than the production and use of the bur itself. Therefore, less materially-intensive packaging should be used. Specifically, the glass fiber reinforced plastic casing should be substituted for a material with a reduced environmental footprint.

While the definition of sustainability remains open for all to contribute to and participate in, there do seem to be some notions it has come to embody that should not be neglected as the definition coalesces. Among these are the ethical and social dimensions of sustainability. Whether or not it is appropriate, required, or even desirable, concepts like social equity, human rights, ethical sharing of commons, etc. have increasingly come under the umbrella of the sustainability discourse. Even if “sustainability” as a bare word doesn’t imply those things, the concept of sustainable development certainly has taken on those dimensions. That sustainability might be redefined or re-scoped to be a purely environmental or a rigidly scientific endeavor, is not an immediate concern of this paper, though if that were to occur (whether for the sake of simplicity or pragmatics), it should be done explicitly so the ethical sub-discourse can be maintained (indeed, sustained) by some other movement.

This paper proposes a mechanism by which such a migration in terms can be prevented. First, in reviewing the work of Denis Goulet, it shows the solid basis for including an ethical aspect in the sustainability discourse. Second, it points out that Karl-Henrik Robèrt’s highly-lauded and broadly-employed sustainability framework, The Natural Step, is deficient in this area. This deficiency provides the impetus for, finally, proposing a mechanism by which The Natural Step can be extended to include the important social and ethical dimensions of sustainability. This mechanism is based on the capabilities approaches that, in many respects, evolved out of Goulet’s early work. Augmented accordingly, TNS can continue to be used without fear of overlooking the social and ethical aspects of the sustainability discourse.