years later, Roosevelt looks pretty prescient
to us. Of course there were other visionaries, and a quote from Black Elk, John
Muir, or Izaak Walton would have suited the purpose just as well. Still, I
don’t think that the environment was getting nearly as much attention then as
it is garnering today — Academy Awards and Nobel Prizes, no less — and they
certainly didn’t know anything about global warming.
difficult to watch the news or open a magazine or newspaper without seeing the
environment dealt with in a serious, if not urgent, fashion. The above quote,
for instance, was pulled from my latest “Smithsonian” magazine. “National
Geographic” had a cover story on recycling, with another article on e-waste
(computers, printers, etc.). The Minnesota DNR journal “Minnesota Conservation
Volunteer” ran a piece on biofuels. “Newsweek” had an article on fuel cells and
another on the revival of the electric car. Even my morning’s “Winona Daily
News” offered a couple of items. Lake Superior
is rebounding a little from record low levels since we had nice rain in October
and nice snow in December. Noted polar explorer Will Steger and Gov. Pawlenty
will be holding forums around the state to bring attention to what scientists
predict global warming has in store for Minnesota’s
forests. And much closer to home for our professional climate, the January 8 ADA web news warned us to brace for a public backlash
is banning amalgam restorations purely on environmental grounds.
this means and will increasingly continue to mean for us is change. Whether for
social, philosophical, economic, religious, or legal reasons, we are all
altering our lifestyles and professional practices in ways intended to lessen
our impact on the environment.
an expert on only one dental practice, mine, and assuming that it is fairly
representative of a typical Minnesota
office, let us use it as an example of how environmental concerns have had an
impact on what we have done. In our office we have:
• weather-stripped and increased insulation when we remodeled and used recyclable
steel construction studs
• converted old T12 fluorescent fixtures to more efficient T-8 tubes with
• installed programmable thermostats
• added reflective glass (low E) windows
• installed mini-fluorescent fixtures
• installed a central vacuum that uses no water and has an amalgam trap
• converted heating and cooling return-air vents from the ceiling return vents in
the summer to the floor return vents during the winter
• installed three high-efficiency heating and ventilating units on the roof
• replaced the old 30-gallon hot water heater with an efficient ten-gallon one
recycled where we can
installed water-saving toilets, and
• I walk to work and drive a gas/electric hybrid
he think he’s fooling?” you might be asking yourselves. “That modest effort is
hardly impressive.” I couldn’t agree with you more! For one thing, I only live
three blocks from my office, and that dinky daily trek is hardly worth
mentioning. “Let he without sin” you might be muttering, and you’d be right
again. No one need fear having to dodge an environmentalist stone coming from
my direction. Just to reassure you, take a look at another list: my
• My office is as big as a tennis court yet only one dentist practices in it.
• I usually use conventional materials (carpet, paint, etc.) instead of recycled
or more sustainable ones.
• I don’t sign up for my energy company’s summer energy savings program.
• Every workday we toss plastic bag after plastic bag of disposable products into
• I use no alternative energy sources (wind, solar, geothermal).
• My showers are too long and hot.
• We still have a mini-van.
• My T.V. is an energy hog plasma, and I have a gazillion electronic components
wasting energy on standby.
• My office has too much and too much of the wrong kind of lighting.
one is my worst addiction. I love lighting. In my office I have sconces,
chandeliers, parabolic reflectors, down-lights, up-lights, and table lamps.
I’ve gone to the trouble of counting them for you. There are 26 four-foot
fluorescent tubes, 36 fluorescent mini-tubes, one metal halide bulb, five
low-voltage halogen bulbs (including patient lights), and a whopping 50 halogen
bulbs. It has been reported that on a clear night my office can be seen from
really should change out all of those incandescents, but I love the quality of
that crisp halogen light. LED lighting is coming on rapidly. Maybe it will come
along soon enough to save me before they take incandescent bulbs off the market
(slated for 2016, I think).
So as you
can see, I still have a lot of work to do. I imagine most of the rest of you do
as well. We all have ample reasons to push forward and reduce our carbon
footprints, and that is why this issue of Northwest Dentistry is entering into
the environmental arena. We asked a number of Minnesota architects and contractors who
have a strong environmental component in what they do to contribute their
experience and expertise to create the following article. It is our intent to
get you thinking both in the here and now and for the future. Dentists are
leaders in so many areas. This should be a genuinely natural fit.
One, Day One
addressing dental offices specifically, the green movement is relatively new,
and its growth will be dependent upon a number of factors, including values and
priorities relating to legal, professional, personal, and business and
financial considerations. While thinking globally is now a given, we need to
recognize that there will always be a financial consideration driving any
decision, and that reality needs to be a clear focus as a project is planned.
Contractor Larry Karkela stated, “It is my firm belief that most good changes
are economically driven, and once the economics become more widely known, the
green movement will accelerate rapidly.” As well as a means to possible
business efficiencies, more dental practices will be using sustainability as a
marketing direction. Thus, selecting architects and contractors with both the
commitment and the experience in this philosophy is essential for success.
i.e., sustainable, design has many levels to consider. Design decisions should
be focused on those aspects that will be most beneficial to the clinic and the
environment. Green design should protect occupant health; improve productivity;
be energy, water, and resource efficient; and minimize impact on the
environment. It is always wise to add an LEED (Leadership in Environmental and
Energy Design/U.S. Green Building Council) consultant to the
architect/contractor team for any new project to explore all options before the
final design. An LEED certified design will give a project of any size
guidelines and goals, and focuses on five key construction areas: sustainable
site development, water savings, energy efficiency, materials selection, and
indoor environmental quality. While LEED certification comes with no tax breaks
or such, it carries the weight of “I did it right”, and can be a positive
community influence and practice builder. Dentists are leaders, and when they
“talk up” a concept, people pay attention. That’s a contribution to green
movement right there.
You Are –
step in evaluating a green project is the building itself. The approach for an
existing dental office will be completely different from that for creating a
new one. Size and location of any existing office create limits on what can be
done. For new, free-standing offices, the possibilities are wide open. One
resource to consider is the Minnesota Energy Challenge, a self-guided energy
audit available at mnenergychallenge.com. It will start you with a solid “you
are here” and offer good, easy suggestions on how to improve.
selection is a high impact topic for both urban and rural areas. In rural
areas, rather than building new on what was good arable land, renovating an old
building, perhaps even a historic one, is very green. When looking for
“location, location, location”, a landmark building can be value added. In the
city, availability and crowding are issues that will have to be looked at in
terms of environmental impact. But town or country, site selection always comes
down to the needs of an individual practice.
amount of heat generated by equipment is always figured into a design
mathematically. If constructing a new building, hire an engineer to do the
heating and electrical calculations. If you hire just at the “design/build”
level, they will most likely build to code and not fine tune beyond that.
Surprisingly, even in Minnesota
most larger office buildings don’t require any extra heating in the winter; the
lights, computers et al are sufficient. The down side is that that same
equation places very heavy loads on air conditioning in the summer. And
“anecdotal evidence” tells us a lot of folks think most offices run too warm
high-efficiency systems will have immediate results in reducing operating
costs. Additional insulation allows systems to be reduced in size and will
provide a more comfortable interior environment. Efficient lighting reduces
heat loads, thereby reducing AC demand.
Lighting, and Energy
analyzing your project with a green approach, find out where your energy comes
from: Is it a new facility or a re-use one? Then think ahead. Buying your
energy from a wind co-op, for instance, will probably (at least currently) cost
the same as other sources, but it is, again, a “right thing to do”. It is a
vote, a step. Dental offices use a lot of power, so “self-generation” is a lot
to ask, but consider solar panels. Do make sure to buy your energy locally. The
further it travels on transmission lines, the more of it is lost. The “carbon
footprint” each of us leaves applies to every category of materials and
supplies, so start thinking in terms of sourcing. Dentists should ask their
suppliers for efficient options in all categories.
A lot of
good light is essential in a dental office, and a dentist can completely
re-lamp any clinic. The quality and variety of energy-efficient light bulbs
have vastly improved over the last 10 years. Virtually all new projects in the
past five to seven years have incorporated energy-efficient fluorescent
lighting. The latest systems incorporate LED lighting with automatic dimming
capability to utilize sunlight more effectively and to maintain a relatively
constant light level.
quality, especially for shade matching, the most natural light is best, and can
be created with fluorescent lamp bulbs. The best option, however, is north
facing windows and natural daylight. North means no direct sun at any time,
just an even, direct light, as opposed to west, for example. Most dentists are
well aware of color-correct lamps and ask for them. They are only needed in the
operatories. And don’t forget classic architectural design: overhangs, windows
shaded from the summer sun, deciduous vegetation.
green means being active in pursuit of environmentally sound options. Find an
energy audit specialist. Xcel or any energy company will come out and audit,
and that is an efficient place to start. They will tell you it is cheaper for
them, especially as major providers, to give rebates for saving energy than to
keep building new plants and using up non-replaceable resources. Anticipating
demand is a huge part of their planning, and right now there is no good answer.
Coal pollutes, nuclear energy comes with storage and toxicity issues, wind and
solar power generation fluctuates too much to carry the baseload. We also have
several new metropolitan areas in this state, and their issues will evolve.
electricity loss” describes the electricity we use on a daily basis that we
don’t see or typically think about, such as small transformers for electronics,
instant-on devices like TVs, monitors, computers, surge-protected extension
cords, and electronic phones, and it is something we will be hearing more and
more about. For instance, while some computers do their back-up work at night,
they don’t need the monitor on. These days almost anything may be on standby
power. Rule of thumb: if it has a clock flashing or any red or green light on,
it is using electricity.
it’s hard to unplug. But if you start to think this new way, you will find new
ways. There are devices that calculate the amount of “phantom” electricity a
home or business is using. Use a power strip. Some clinics have master switches
in each operatory. While retrofitting for the latter is difficult, in a new clinic,
ease of closing up at night is optimized. The more you look for things to do,
the more you will see. And don’t run the T.V. in the waiting room if no one is
“materials and methods” have a substantial impact on the “greenness” of any
office, new or existing. Some contractors now use trash dumpsters that are
sorted to recycle up to 60% of the waste, sending much less to landfills. Ask
about that; ask for that. Renewable resources such as cork or bamboo flooring and
recycled materials from floor to ceiling are gaining popularity. Using green
materials with recyclable waste creates both a stabilizing and sustainable cost
and an environmental advantage. Low toxicity materials should be a priority.
it appears we are moving toward more eco-friendly managed forestry. It is
currently comparable to organic farming, but is already a big industry.
Consider the choice between real wood and a petro-based product. Real is better
for a lot of reasons, one of which is “sick building syndrome”. This is very
complicated, even for the professionals, but they will do the research if you
direct them to. A healthier working environment is very green: Medtronic has
found air quality and lighting in a green building is improved and their
employees are more content and productive. Employees in their older buildings
are now asking to move to the green building.
remains a firm fact that there is no more basic cause and effect than the
market directing what is produced. That is where the consumer can make the most
consumption inside a practice is not a major item, although there is much that
can be addressed. Water-saving faucets and appliances, including washing
machines, should be considered. Clinic water does have to be very high quality,
and that issue should be specifically addressed. As for water heating, a lot of
people don’t see Minnesota
as a good place for reliance on solar panels. Not true. Very few snowstorms,
even here, can block a 45 degree solar panel. It will still have several
hundred degrees of temperature in the middle of winter. The sun is strong
enough. Solar water heating augments a system. You will use perhaps half the
energy you otherwise would to heat your water. You can also go to a waterless
hand sanitizer; you can do away with sinks – and a lot of plumbing - in the
operatories. You simply have to evaluate your own willingness to look at the
options and then prioritize.
the exterior, with a freestanding building, the landscaping on the site can
manage the water issues. Native vegetation is already adapted to water
management, and along with mulch and compost can reduce pesticide use as well.
Use roof-collected runoff for any additional watering needed. Rain gardens
reduce pollutants in the storm water stream and help control the amount of
storm water flowing off a property. Savings of 40% inside and 70% outside can
be achieved by selection of fixtures, vegetation, rainwater collection, and
on the Roof
roofs act not only as insulation but as water quality control for runoff. They
are relatively new in the public awareness, and there are more raised eyebrows
than consciousnesses about this option. The greatest drawback to their progress
in the trade is initial cost. Even though green architects and builders
emphasize the “life-cost” of an adaptation, most green adaptations do come with
a greater front-end cost. Green roofs are viable. They do need to be
maintained; they need a watering system, and plants can and do die. Architects
say these issues are very manageable. Installers most often put a maintenance
service into what is usually an annual contract. The practical side here is a
genuinely serious one. In sites both urban and rural, water quality is a big
and growing issue. It is being very regulated, and there is no flexibility in
it. For instance, a one-acre site may require a pond to manage runoff from roof
and parking lot. Replace the pond with a green roof, and you can have more building.
Bottom line: Be aware of what you need from a site. Currently zoning
requirements for parking drives most sites, so plan for greater function from
Monitoring, and Upgrading
building can be challenging, and sometimes the intuitive answer is incorrect.
Example: Adding insulation in the roof can take twice as long to pay back as
investing in a window upgrade. The rule of thumb here is that maintenance and
monitoring will be relatively low for passive components such as insulation and
windows. For active ones such as AC, heating, and lighting, it will be
essential to have a qualified service person conduct periodic tests and
inspections, especially with high efficiency systems.
technology to manage all these options is here, and it is growing rapidly, but
it is operating at different levels of user capability. The good news is that
there is probably someone in the practice who will love to get into all this.
Practical Practice Builder
of larger multi-tenant buildings are recognizing the marketing benefits of
green in their new properties, according to the Minnesota Commercial
Association of Realtors (MNCAR), and that will rapidly drive the design of new
multi-tenant buildings to green.
energy use statistics presented at the MNCAR seminar for a typical multi-tenant
office building are useful in making decisions about investing in green.
Receptacles (phantom): 29%
numbers are for standard office use, and a clinic will probably differ. In new
building construction, the owner has control over all of the above. However, as
a tenant in a multi-tenant building, one has diminished control (if any) over
heating and cooling system design.
selecting dental and data processing equipment for a practice, energy
consumption should rank after performance.
of you building, green construction can increase the cost of a building of
50,000sf or larger by 1.5-4%, and payback time can range from four to seven
years. For those who are going to be tenants, remember you are being marketed
to, and there will be a lot of opportunity to make exaggerated claims as the
green movement becomes more prevalent.
aspect of a dental practice can serve as a practice builder as the green
philosophy expands. For instance, while there would be no difference in the
basic design of an office from place to place in our state, a dentist in the
southern part could put a windmill on his or her property. It is a good
investment, and it makes a strong statement. Dentists as a group have the
wherewithal to make these changes a reality more than the general population
does. They can appear symbolic, but practically speaking, seeing is believing.
Thing Right Now
people do now? A lot. Relamp; put in programmable thermostats or occupancy
sensors for light switches. It all adds up. Don’t overlook the simple things.
That old refrigerator in the break room is very energy hungry. A new energy-star
frig would pay for itself in a few years and pay it forward for even more.
existing practice in a leased building, energy consumption vs. cost increment
evaluation of any new dental equipment, computers, and fixture purchases will
be beneficial. If the lessee is responsible for all heating and cooling costs,
be sure to have programmable thermostats properly set to save energy during
non-business hours, and set temps near the most economical end of the comfort
intangible is that any of these actions spark ideas, even if it’s a kid who
walks into a bathroom, the light comes on for him, and he says, “Cool.” You
never know who is watching, and what imagination will be ignited.
it is the contractor’s job to get a client into a building for the best price
and in the best time, and it is really competitive out there. Time is money,
but time is essential. Look at lead times. If you don’t give the contractor
time to order the right materials, things are going to get compromised. Dental
offices are very time sensitive, and it can be a big concern to relocate a
practice. Be flexible, and understand that necessity. Build the time into the
planning. Be honest with contractors up front about your values and priorities.
Haven’t We Thought Of?
most often overlooked elements in planning a green project is flexibility in
dollar efficiencies. For instance, three partners in an LLC putting up their
own building will find cost per square foot much lower than doing three individual
sites. Such things as combined parking and site setback for efficient land use
are where green and practice management meet.
and staging – both are essential. Work with the designer. Plan for things later
that you feel you can’t afford now. You may have a slab on grade now, but put
the plastic tubing in and hook it up to a boiler or boiler/solar panel later.
areas see sustainability more directly because of the closeness of people,
buildings, vehicles, and the barrage of information about the “movement”. Rural
areas may consider green design an urban concept, and the awareness may be
vague at first. While we still need to get past the mindset against sustainable
practices as everything from “hippie” or “goofy” to “elitist”, cost is always
the biggest roadblock. Payback is still five to ten years on average before any
profit from an adaptation is shown. The frustrations for all parties come with
the rising costs during the entire process, often resulting in cost (i.e.,
quality) cutting measures no one wants to make. That’s where the solar panels
or heat exchangers or green roofs just disappear. But if you don’t do it when
you’re building, odds are against it happening later. Architect Carl Robertson
told us, “My first warning to any dentist is always this: Whatever you’re
thinking, it’s going to cost more than you think, it’s going to take longer
than you think it will, and it’s going to be a bigger headache than you think
it’s going to be. But when you’re done, you’ll be glad you did it. You won’t
want to do it again soon, but you’ll be glad you did it.”
what we know:
1. Sustainability shouldn’t be considered a trend, it should be a way of life.
2. It is always wise to be a good steward of our resources, both energy and
3. Employing materials and systems to save energy and to minimize waste is good.
4. Thinking green will advance an enlightened professional’s personal and
professional understanding of how things work.
5. The dentist benefits from lower operating costs and has the option of putting
that saving to use in other good avenues.
6. Green choices have longevity, are the right thing to do, and they are never
going to get less costly.
homework; make good decisions. And don’t forget to switch off the light when
Carroll is a pediatric dentist in private practice in Winona, Minnesota.