Is Sustainability Part of the Drill? Examining Knowledge and Awareness Among Dental Students in Bucharest, Romania

<b>Background.</b> Despite dentistry's alarmingly high energy use, plastic waste, and travel emissions, research on Romanian dental students' sustainability awareness is absent. This study aimed to assess their knowledge of the environmental impact of dental materials and practices, hypothesizing that early exposure to sustainability education would benefit preclinical students most. <b>Materials and Methods.</b> A cross-sectional survey using a form questionnaire with 15 items was conducted on 1800 dental students at Carol Davila University of Medicine and Pharmacy, Bucharest, Romania, for one week in March 2022. The questionnaire, consisting of socio-demographics, students' perspectives on sustainability in dentistry, and personal sustainability, was analyzed using SPSS 26. Data analysis included the Shapiro-Wilk test for normality, Fisher's exact test for categorical variables, the Mann-Whitney U test for non-parametric quantitative comparisons, and Z-tests with Bonferroni correction for contingency tables. <b>Results.</b> A response rate of 26.06% was achieved, with 469 participants. The majority (51.1%), particularly males (66.1%), perceived sustainability as promoting durability. The most common definition of sustainability (33.8%) was related to environmental protection, with significantly higher agreement among female students (39.4%) (<i>p</i> = 0.001). While 49.3% of participants identified single-use plastics in patient care as having the greatest environmental impact in dental practices, 39.2% of female students, primarily from clinical study years (50%), ranked patient paperwork and records as the most significant factor (<i>p</i> = 0.031). The highest-carbon-footprint dental procedures were considered to be amalgam and composite fillings (50.7%), with clinical year students indicating this as the most relevant issue (62.8% vs. 47.7%) (<i>p</i> = 0.011). Students aged 25-30 were more actively engaged in sustainability initiatives compared to the younger group (<i>p</i> = 0.005), while all students over 30 identified scaling and polishing as the most impactful procedure (<i>p</i> < 0.001). A majority of students supported future university sustainability initiatives (62.7%) and an elective course on sustainability in dentistry (65%). Female students showed significantly greater interest than male students in both initiatives (66.3% vs. 52.7%, <i>p</i> = 0.003 and 70.8% vs. 49.6%, <i>p</i> < 0.001, respectively). <b>Conclusions.</b> Greater awareness of sustainability was found in preclinical-year dental students and among female students, with knowledge gaps in clinical-year students, particularly regarding the environmental impact of dental practices and materials. Introducing sustainability courses could better prepare future dentists for sustainable practices in dentistry. Research collaborations and curriculum reforms to further promote sustainability would also be beneficial.