Impact of a novel environmental health module on dental students’ knowledge and attitudes

Climate change poses an immense threat to public health.1 Rising temperatures contribute to heat exhaustion, air pollution exacerbates respiratory illnesses, and water and food scarcity cause malnutrition.2 Climate change increases the disease burden managed by the healthcare system, which itself is a major contributor to greenhouse gas emissions.3 Dentistry is not currently environmentally sustainable. Approximately 65% of the dental carbon footprint is from patient and staff travel and a minority is from energy consumption, non-recyclable waste, and nitrous oxide.1 The dental sector is working towards reducing its carbon footprint by creating consensus and developing evidence-based practice guidelines, as demonstrated by American and European Dental Education Associations (ADEA/ADEE). During the 2019 ADEE conference, an advocate group emphasized incorporating sustainability in dental education.3 A survey of all 3200 United States dental students found that 83% of participants rated environmental sustainability as important, but only 5% had sustainability-related content in their curricula.4 The survey respondents comprised 17 US dental schools, one of which is the school now attended by this study's participants.4 To address the problem of dental students not having a learning resource exploring sustainability, a novel module was added to the Global Health Starter Kit (GHSK),5 an open-access curricular resource designed for dental faculty and students. The module explores environmental oral health, climate change, and related topics. A convenience sample of 36 second-year dental students at a United States dental school were invited to participate. Participants completed pre-readings including peer-reviewed publications related to dentistry and environmental sustainability and attended an interactive, discussion-based learning session. The session followed the Environmental Health module of the GHSK and provided an overview of climate change, environmental justice, exposure pathways, and case studies evaluating how environmental changes can affect oral health outcomes. Students then met in small peer groups to respond to the case by designing potential initiatives and interventions to address these environmental concerns. A voluntary online Qualtrics survey was administered to participants before and after the session to evaluate changes in knowledge and attitudes. The methodology was approved for exemption by the IRB (IRB23-1423). The survey included five knowledge and five attitude Likert questions. Data from these questions were analyzed using Chi-square tests, and statistical significance was considered if p-value < 0.05 (Figure 1). Pre- and post-course survey response rates were 55.6% (20/36) and 47.2% (17/36), respectively. A significantly greater percentage of participants rated their knowledge of environmental health, environmental justice, one health, the three-box model, and the impact of climate change on human health as “good” or “excellent” in the post-course survey compared to the pre-course survey (Figure 2). There were no significant differences between pre- and post-course survey data regarding attitudes about whether dentistry is perceived as currently sustainable, the importance of promoting sustainability, interest in sustainability content, and willingness to participate in sustainable initiatives (Figure 3). One explanation could be that participants were already environmentally conscious, as shown in Figure 3 where the pre-course attitudes were already heavily shifted towards viewing sustainability as important. The small sample size limits generalizability. However, despite the limited number of respondents, the data showed statistically significant improvement in students’ knowledge of environmental sustainability. New iterations of this survey should be run on larger samples to allow for more precision and accuracy. In addition, 75.0% of participants reported interest in learning this content. Future studies should explore ways to integrate sustainability content into pre-clinical and clinical curricula. The inclusion of environmental sustainability content in dental curricula is an important first step in educating the next generation of environmentally conscious dentists and providing them with the knowledge and tools necessary to implement sustainable initiatives. The authors are very grateful for the advice from Dr. Brittany Seymour, Associate Dean for Faculty Affairs and Associate Professor and Global Health Discipline Director at the Harvard School of Dental Medicine. The authors would also like to thank Dr. Michael Reddy, Editor in Chief, Journal of Dental Education, for his valuable comments throughout the peer review process.