الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Environmental pollution is the flaming issue today in the world. Directly or indirectly, every individual is responsible for this, and Dentistry is not an exception. Dentistry produces waste materials that cause harm to the soil and to the biosphere, it is also one of the fields that contribute to climate change and pollution of the environment.
Exposures to environmental pollution remain a major source of health risk throughout the world, though risks are generally higher in developing countries, where poverty, lack of investment in modern technology and weak environmental legislation combine to cause high pollution levels.
According to the Eco-dentistry Association, Green Dentistry reduces waste and pollution; saves energy, water, and money; incorporates high-tech innovations, and focuses on wellness and integrative practices within the offices that result in an eco-friendly environment.
The current study was aiming at assessment of the impact of environmental education program on knowledge, attitude, and practices among intern dentists regarding eco-friendly dental office strategies in Alexandria Dental Research Center. The field work was completed in 3 months starting in February 2019.
A pilot study was conducted among a sample of 10 intern dentists from other setting. The pilot study sample was not included in the study sample.
Anobservational check-list regarding the implementation of eco-friendly dental clinic strategies in Alexandria Dental Research center was completed.It was applied for assessment of all dental clinics in the center (twelve clinics).An observational check-list for dentists regarding their eco-friendly practices was completed.
Pre-designed and pre-coded structured self-administered interview questionnaire was used to obtain data from 83 intern dentists to assess their knowledge, attitude, and practices (KAPs) regarding eco-friendly dental office strategies.It consisted of four main parts:
Part I: Back ground information (Q1-Q3)
Part II: Knowledge of intern dentists regarding eco-friendly dentistry (Q4- Q19)
Part III: Attitude of intern dentists towards some concepts about green practices and their role in environmental preservation. (Q20- Q32)
Part IV: self- reported practice of intern dentists regarding eco-friendly dentistry. (Q33-Q38)
The intervention program was pre-designed and modified according to the results of pre-test and was tailored according to their needs. Number of audiences was 83 intern dentists; they were divided into two groups each group received a series of four educational sessions, each session was about an hour.
The same pre-test questionnaire was introduced to the study group, immediately at the end of the program and three months later to re-assess the intervention program impacts on their KAPs regarding eco-friendly dental office strategies.
Results of observational check-list of dental clinics:
According to the observational check list for the clinics, the results of this study revealed poor implementation of eco-friendly strategies in all clinics meaning that none of the 12 clinics were fulfilling all the items.
Results of observational check-list for dentists’ practices:
According to the observational check list for dentists’ practices towards eco-friendly dentistry, the results of this study proved fair practice in 78.3%, and poor practice in 21.7% of intern dentists.
Results regarding intern dentists’ knowledge regarding eco-friendly dentistry:
No one of the intern dentists in ADRC had a good knowledge towards eco-friendly dental strategies in the pre-test which improved to 65.4% in the immediate post-test but it was shown to become 34.6% in the three months post-test. There was high statistically significant difference between pre and immediate post-test, pre and three months post-test and between immediate and three months post-test.
As regards the barriers that prevent application of eco-friendly dentistry half of the participants reported that lack of information was the barrier, about 23% of them chose high cost as a barrier, while about 27% reported that there was lack in polices to regulate such practices.
Results regarding attitude of intern dentists towards eco-friendly dentistry:
Only 19.3% of the participants showed good attitude towards eco-friendly dental practices in the pre-test, the majority of them 80.7% showed fair attitude, while in the immediate post-test there was improvement in their attitude, the percentage of good attitude was raised to be 45.7%, but it was decreased to be 38.3% in the three months post-test.There was statistically significant difference between pre and immediate post-tests.
Results regarding intern dentists’ self-reporting practices regarding eco-friendly dentistry:
Only 38.6% of the intern dentists had good practice towards eco- friendly dentistry, after the educational program an improvement was noticed as the percentage of good practices reached 46.9% and 58% in the immediate and three months post- tests respectively. There was high statistically significant difference between pre and three months post- test. It was noticed that the observational check-list revealed higher percentage of poor practice (in the pre-test stage) than the self-reporting questionnaire by 18%.
This study concluded that,poor resources and lack of awareness of the concept among the concerned professionals present major barriers to implement strategies of green dentistry. The educational intervention increased the knowledge about eco-friendly dentistry confirming the importance of continuing education. There was a statistically significant gain in knowledge, attitude and practice among the participants after the educational presentation.Although the ADRC was not fulfilling all the items of the check list, the center was found to implement few eco-friendly strategies as; proper protocol for waste segregation and disposal, is equipped with autoclave for clean sterilization, installed
fluorescent lighting, and the clinics were supplied with alcohol hand rub for hand sanitizationand these steps are good strong initial points to start a proper Eco-friendly dentistry in the ADRC.
Eco-friendly dentistry reduces wastage and prevents pollution. Oral health professionals play an important role in protecting the environment
Conclusion:
Based on the results of the present study, the following can be concluded:
• In spite of the fact that the results of ADRC clinics’ check-list revealed poor implementation of eco-friendly dental strategies, it was found that the center implements proper protocol for waste segregation and disposal, uses autoclave for clean sterilization, uses fluorescent energy saving lighting, and the clinics were supplied with alcohol hand rub for hand sanitization.
• Overall knowledge, attitude, and practice of eco-friendly dentistry among intern dentists were inadequate according to the pre-test questionnaire results.
• Eco-friendly dentistry reduces wastage and prevents pollution. Oral health professionals play an important role in protecting the environment.
• Poor resources and lack of awareness of the concept among the concerned professionals presented major barriers to implement strategies of green dentistry.
• The educational intervention increased the knowledge about eco-friendly dentistry. There was a statistically significant gain in knowledge among the participants after the presentation.
• The knowledge and attitude towards eco-friendly dentistrywereremarkably decreased in the three months post-test which indicates the need for continuous education regarding eco-friendly dental practices.
• The practice of the intern dentists was improved in the immediate and three months post-test.
Recommendations:
Based on the results of the current study there are some recommendations to be implemented:
• The future of green dentistry rests in the hands of the younger dental students, therefore information about harmful impact of dental clinic on the environment, and the eco-friendly dental strategies should be integrated in the under-graduate curriculum in dental schools.
• As eco-friendly dentistry is a fresh and emerging concept, workshops, seminars, and conferences must be conducted to the existing dentists in this regard.
• The policy makers should take decisions about financial resources from different sources that could ensure effective implementation of policy, plan, laws, and regulations for the eco-friendly practices.
• The Egyptian government might encourage dentists to implement strategies of eco-friendly dental clinics in their offices by offering reduced taxes and no duties when purchasing and using equipment or materials that have minimum effect on the environment.
• At a local level, it is recommended that the Egyptian Dental Association takes a lead role in training dental professionals to adopt the green dental practices.Implementation of protocols can begin with training and awareness-raising and at a later stage, involve legislative control.
• Encouragement of further researches to assess the awareness and implementation of eco-friendly dental practices among dentists to know the exact magnitude of the problem.
• Development of interventional studies that involve dental staff to evaluate the impact of different training methods on the dental staffs’ knowledge and attitude.
Recommendations to the center:
For waste reduction:
• the center should review purchasing policies to avoid excessive waste; reduction can also be done by product substitution or modification.
• Reusable items should be preferred to disposable items.
• Separation of recyclable waste and selling it to recycling companies, this will yield financial benefit to the center.
• Digital system for patient charting, scheduling, and billing should be implemented.
For energy conservation:
• Whenever choosing electrical appliances for the clinic, consider purchasing star-rated devices.
• Install motion sensors to automatically turn off lights when people leave the area.
• Install solar cells for energy
For water conservation:
• Install water faucets with sensors.
• Convert to a waterless vacuum system.
For pollution prevention:
• Establish an amalgam separator and ensuring that waste is properly recycled, not dumped in residential area, if not possible,avoid amalgam filling and use alternatives as possible.
• Use digital imaging to avoid waste generated from conventional system, or recycle fixer and lead foils from x-ray films if still use conventional x-ray processing system.