March 2021

Introduction: Designed to Smile (D2S) is a national oral health improvement programme, aimed to reduce the prevalence of dental caries in young children in Wales. D2S has a responsibility to consider the environmental impact of the service it provides and demonstrate adherence to the sustainable development principle legislated within the Wellbeing of Future Generations (Wales) Act. Objective: To review the environmental impact of D2S by estimating the carbon footprint of the programme and identify carbon hotspots for future targeted action. Research design: Process mapping identified the steps to deliver the supervised toothbrushing and fluoride varnish elements of D2S. Annual estimates of business travel mileage, financial spend on procurement, total number of plastic consumables and waste disposal were made. An online survey enabled calculation of staff commuting behaviour. These contributors were converted to carbon emissions using established carbon conversion factors. Results: The annual carbon footprint of D2S was estimated at 388 tonnes of CO2e (tCO2e) with 31% attributed to staff travel, 23% to business travel and 46% to procurement. An estimated 1 million plastic items were distributed. Conclusion: By promoting good oral care and preventing the need for future carbon intensive restorative dental treatments, D2S exemplifies a sustainable model of healthcare. Adopting reduce, reuse, recycle principles for plastic consumables and introducing sustainable procurement procedures could lead to further decarbonisation and reduction in plastic waste. Keywords: Environmental impact, carbon footprint, social responsibility, toothbrushing, programme evaluation, child oral health