Eco-friendly dentistry in clinical practice: awareness, implementation and factors associated with sustainable dental care

Abstract

Environmental sustainability is increasingly recognised as part of oral healthcare and dental education, but evidence from low-resource and conflict-affected settings remains limited. This study assessed the awareness and implementation of eco-friendly dentistry amongst dental professionals and examined factors associated with awareness and practice scores. An analytical cross-sectional survey was conducted from November 2025 to April 2026 using a proportionate stratified multistage, clinic-based sampling approach among licensed dental professionals working in private clinics in Sana’a, Yemen. A structured questionnaire was utilised to collect demographic data and responses to six awareness items and 18 practice items. Scores were categorised as low, moderate, or high by using predefined cutoffs. Mann–Whitney U and Kruskal–Wallis tests were employed for group comparisons, and multiple linear regression estimated adjusted associations. P < 0.05 was considered statistically significant. Amongst 310 participants, the mean awareness score was 2.93 ± 1.43, and the mean practice score was 9.45 ± 2.65, indicating moderate awareness and implementation. Of participants, only 41.3% were aware of the eco-friendly dentistry concept, and 16.5% were aware of Eco-dentistry Association–endorsed programmes, although 82.6% believed that eco-friendly dental practices should be universally recommended. Implementation was strongest for alternative restorative materials (91.0%) and digital radiography (88.4%) but weak for amalgam separators (24.8%), sealed amalgam disposal (19.7%) and waterless vacuum systems (33.9%). In multivariable models, practice score was positively associated with awareness score (B = 0.18, P < 0.001), and awareness score was positively associated with practice score (B = 0.67, P < 0.001). Female gender and 6–10 years of experience were associated with lower awareness scores, whereas PhD qualification was associated with a higher practice score. Dental professionals in Sana’a City demonstrated moderate awareness and implementation of eco-friendly dentistry, with important gaps in formal sustainability awareness, hazardous waste management and water conservation. The findings support competency-based curricular integration, targeted continuing professional development, and feasible clinic-level policy and infrastructure interventions; longitudinal research is needed before causal effects can be inferred.