Effects of climate change on oral health: sustainable environment and future scope – A Review

@ 2025 | PUBLISHED BY GJR PUBLICATION, INDIA 1 Global Journal of Research in Dental Sciences ISSN: 2583-2840 (Online) Volume 05 | Issue 06 | Nov. – Dec. | 2025 Journal homepage: https://gjrpublication.com/gjrds/ Review Article Effects of climate change on oral health: sustainable environment and future scope – A Review 1Shirin Shakira Mohamed Hanifa, 2Divya Vinayachandran * 1 Undergraduate Student, Department of Oral Medicine and Radiology, SRM Kattankulathur Dental College and Hospital, Faculty of Medicine and Health Sciences, SRM Institute of Science and Technology, Kattankulathur, Chengalpattu, Tamilnadu, India. ORCID ID: 0009-0007-9752-8598 2 Associate Professor, Department of Oral Medicine and Radiology, SRM Kattankulathur Dental College and Hospital, Faculty of Medicine and Health Sciences, SRM Institute of Science and Technology, Kattankulathur, Chengalpattu, Tamilnadu, India. ORCID ID: 0000-0001-7042-6435 *Corresponding author: Divya Vinayachandran Associate Professor, Department of Oral medicine and Radiology, SRM Kattankulathur Dental College and Hospital, Faculty of Medicine and Health Sciences, SRM Institute of Science and Technology, Kattankulathur, Chengalpattu, Tamilnadu, India. Email: ORCID ID: 0000-0001-7042-6435 INTRODUCTION The Ancient Greeks believed health stemmed from the unity of body and soul, with illness arising naturally [1]. Health was seen as equilibrium between individuals and their surroundings [2]. Similarly, the World Health Organization in 1948 defined health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” [3]. Oral health is fundamental to overall wellness and is influenced by environmental changes [4]. Climate change, an outcome of environmental deterioration, alters oral conditions [6] and impacts oral health through factors like global warming. It also affects food availability and nutrition [7]. Environmental decline, poor living conditions, and low economic status lead to compromised oral health [8], further causing malnutrition, anemia, tooth decay, gum disease, and systemic illnesses [9, 10]. Therefore, to protect our oral health, it becomes necessary to protect our environment and prevent climate crisis. Abstract The objective of this review is to assess the impact of climate change on oral health and estimate the sustainability of oral health care practices in the context of environmental change. A comprehensive literature review was conducted to evaluate the relationship between climate change, environmental sustainability and oral health. The study focuses on analyzing how climate-induced changes and health care practices contribute to oral health outcomes. Finding suggest that climate change influences oral health through altered environmental conditions and increased exposure to pollutants and pathogens. Additionally, clinical practices by oral health professionals contribute significantly to resource consumption and environment degradation. Social determinants, such as access to care and education, mediate the effects of climate change on oral health. Climate change poses a growing risk to oral health, emphasizing the need for environmentally sustainable practices in oral health care. Implementing population-level health promotion and preventive strategies can mitigate the impact of climate change on oral health outcomes. Keywords: Climate change, Environmental degradation, Oral health, Sustainability, Future goals. Global J Res Dent Sci. 2025; 5(6), 1-8 @ 2025 | PUBLISHED BY GJR PUBLICATION, INDIA 2 METHODS Search Strategy The systematic search of electronic databases was carried out using the following databases: PubMed, Scopus, Web of Science, Science Direct, Google scholar, Cochrane Library, WHO and FDI websites using keywords which includes “climate change”, “oral health”, “dental sustainability”, “environmental health”, “dental caries and climate”, “periodontal disease and pollution”, “global warming and dentistry”, “sustainable dental practice”, “climate resilient health systems”. Inclusion Criteria • Articles addressing how climate change affects oral or general health • Research on sustainable dental practices • International organization reports on paper (UN, WHO, FDI, etc.) • Publications from 2000 to 2025 • English language articles Exclusion Criteria • Research unrelated to climate change or dentistry • Articles lacking relevance to sustainability in healthcare • Non-peer reviewed blogs or opinion pieces • Non-English language sources without full translation available Data Extraction The following data points were extracted from the selected literature: • Type of environmental impact (e.g., heat, pollution, water scarcity) • Direct or indirect oral health consequences • Identified sustainable dental practices • Health equity considerations and policy responses • Recommendations from global health authorities • Initiatives (e.g., PRUDENT, WHO’s action plan) • Data were organized thematically using a manual matrix to map climate drivers to oral health outcomes and sustainability measures. Analysis A qualitative synthesis approach was applied. Thematic analysis was used to categorize the data into key areas: • Climate change impacts on oral disease patterns • Contributions of dentistry to environmental degradation • Global and regional mitigation efforts • Sustainable and climate-resilient dental care models • Knowledge gaps and future research directions RESULTS Environmental Factors Affecting Health Environmental health is closely linked to human health [11]. Pollutants and microorganisms released through human activity or natural disasters affect air, water, and food quality, ultimately influencing community livelihoods [12]. Environmental factors such as SHS, PM, and heavy metals have been strongly associated with dental caries, with recent studies reinforcing this connection. Air serves as the main medium for these contaminants, followed by soil and water. PM and SHS are airborne mixtures that contaminate the atmosphere and eventually settle on surfaces, soils, and objects [13]. PM2.5 entering water through precipitation alters its physical, chemical, and biological properties. Heavy metals from pesticides, industrial waste, and vehicle emissions further spread pollution across all environmental media. Although only a limited range of contaminants has been examined regarding dental caries, future research should address emerging pollutants such as ozone, volatile organic compounds, and microplastics [13]. Dental hygienists (DHs) and other oral health care (OHC) workers consume significant resources in daily practice, contributing to pollution and climate change [14]. The OHC sector requires large amounts of supplies, energy, water, and fuel, which through greenhouse gas emissions add to environmental damage [15]. In the UK, OHC contributed 675 kilotons, nearly 3% of the NHS carbon footprint between 2014–2015 [16]. Overall, England’s NHS produces 22.8 million tonnes of carbon emissions (3% of the national total), while similar services in the US and Australia contribute 10% and 7%, respectively [16]. Global J Res Dent Sci. 2025; 5(6), 1-8 @ 2025 | PUBLISHED BY GJR PUBLICATION, INDIA 3 Air pollution significantly impacts human health, with healthcare activities and pollutants such as nitrogen oxide [17], sulfur dioxide, and others contributing to nearly 10% of global emissions. A Yale working group on sustainable healthcare further highlighted that decontamination practices represent a major source of pollution [16]. Climate change is strongly associated with carbon dioxide (CO2) emissions [18]. The buildup of greenhouse gases (GHGs), including CO2, methane (CH4), nitrous oxide (N2O), water vapor (H2O), hydrofluorocarbons (HFCs), perfluorocarbons (PFCs), and sulfur hexafluoride (SF6) is identified as the main driver [19]. From 1750 to 2012, CO2 levels rose from 280 to 395 ppm, CH4 from 715 to 1882 ppb, and N2O from 227 to 323 ppb. Today, GHG emissions remain at historic highs and continue to rise, ensuring persistent climate change impacts [20]. The oral health care sector, through sustainable practices, could reduce CO2 emissions, waste, and plastic use, while improving care quality, workforce well-being, and overall efficiency [22]. Factors Influencing Climate Change Some of the factors responsible for climate change are discussed below: - • Changes in solar radiation caused by the Sun's dynamic processes [22]. • Adjustments to the Earth's orbital parameters according to its movement around the Sun [23]. • Inconsistency in the intensity of galactic cosmic rays that modify the Earth's cloudiness [24]. • Geophysical and geological (tectonic) processes that produce the Earth's internal structure [25]. • Movement of lithospheric plates, the formation of mountain systems, the opening and/or closing of oceans [24]. • The formation of the planet's primary geomorphological features [26]. • The significant influence of human activity, which has grown in significance since the Early Holocene [24]. Climate Crisis Climate change is currently the most significant issue of our time since it is accelerating faster than initially anticipated (National Research Council 2013). The hydrological cycle is being impacted by climate change, and storm frequency and intensity are rising [27]. Weather-water-related events, such as drought and aridification, wildfires, pollution, and floods, account for more than 90% of "natural" disasters [28]. They put a tremendous strain on economies, societies, and the environment and cause death, damage, loss of livelihoods, and displacement [29]. The solar radiation which is trapped in the atmosphere by greenhouse gases (GHG) escapes back into space resulting in rising sea levels [30]. Extreme weather events, higher average global temperatures, and severe precipitation problems (droughts and flooding) result in climate change [31, 32]. As temperatures rise and air quality deteriorates, the ozone layer which filters the sun’s UV rays depletes [33, 34]. Ozone depletion causes an increase in ultraviolet radiation and vice versa [31, 35]. It is anticipated that the global mean surface air temperature (SAT) would rise quickly to 1.5℃ by the year 2030s and 2℃ by the year 2050s, having already risen to 1℃ above pre-industrial levels in 2015 [36]. India's National Communications Report to the United Nations Framework Convention on Climate Change (UNFCCC) indicates that climate change is projected to influence all-natural ecosystems [37]. According to Hadley Center projections using the Regional Climate modeling system known as PRECIS, the annual mean surface temperature in India is expected to rise by up to 3 to 5℃ under the A2 scenario and 2.5 to 4℃ under the B2 scenario by the end of the century, especially in the country's northern regions [37]. Oral Diseases and The Changing Environment In 2010, oral diseases affected 3.9 billion people worldwide, with untreated dental caries as the most common and periodontal disease ranked sixth [23]. Climate change factors, including elevated body temperature and high relative humidity, can increase the risk of dental caries by promoting bacterial growth [38]. Shifts in temperature and humidity induced by climate change may negatively influence oral health [39]. Rising global temperatures also favor arbovirus transmission and expand their geographic distribution [40, 41]. Several vector-borne diseases present oral manifestations [42]. For example, Zika virus can cause petechiae, aphthous ulcers, intraoral ecchymosis, and other mucosal inflammations [43]. The consequences of heat stress are more likely to affect dental patients receiving medical treatment with diuretics or selective serotonin reuptake inhibitors [44]. Heat reduces the effectiveness of common medications used to treat allergic responses (epinephrine) [45] or asthma attacks (albuterol). Another factor contributing to the rise in antibiotic resistance is heat stress [46] Chronic lung disease is closely connected to periodontal disease and climate change through the same parameters that impact air quality [31]. Oxidative stress in allergic reactions is also brought on by climate change [47]. In addition to inflammation, environmental exposure to cigarette smoke and air pollution can also cause oxidative stress [37]. The availability of water may also be impacted by changes in precipitation patterns, which could affect the growth of oral bacteria [10,48]. High fluoride levels found in groundwater from deep aquifers and geothermal springs have been attributed in part to geothermal temperature. People with low socioeconomic level who reside in rural areas are the ones Global J Res Dent Sci. 2025; 5(6), 1-8 @ 2025 | PUBLISHED BY GJR PUBLICATION, INDIA 4 who are most impacted by drinking water. The two most frequent fluorosis conditions linked to drinking water containing fluoride [49] are dental and skeletal fluorosis. Although there have been reports of fluoride consumption through other routes, such as drinking tea or eating vegetables, the predominant way that fluoride enters the human body is still through drinking water that contains fluoride [50]. Dental erosion may result from changes in the quality of the water. In addition to other dental issues, dental erosion can cause tooth sensitivity and discoloration [10]. Climate change–induced water scarcity reduces crop growth and nutritional availability, leading to malnutrition. Early signs of malnutrition include gingivitis and inflammatory periodontal lesions associated with NOMA (Cancrum oris). Malnutrition is also linked to delayed tooth eruption, dental cavities, and enamel hypoplasia [23]. Migrants facing nutritional deficiencies are particularly vulnerable, with over 20 million displaced in 2008 due to climate-related causes, a number that continues to rise [31]. Oral health practitioners should also recognize climate-related diseases like Lyme disease, which shows orofacial symptoms, enabling earlier diagnosis and care [51, 52]. The herpes group of viruses, human papillomavirus, CMV, and other viruses have become more common because of climate change. A mutation in the p53 gene is believed to be the origin of the DNA damage brought on by UV light, which ultimately results in cancer. [37] The risk of lip and skin cancers of the face, head and neck is increased by UV radiation exposure. Additionally, oral clefts are linked to heat and sunlight. UV rays from sun are one of the major factors for oral cancer [48]. Additionally, monsoon weather and traffic accidents have been found to be major factors in the prevalence of maxillofacial injuries. To help lower their incidence, it's critical to comprehend the epidemiology of maxillofacial injuries and spot any underlying patterns or trends that may exist, especially in light of the rising frequency of traffic accidents and erratic weather patterns. Monsoon season is associated with a higher rate of facial fractures in some areas, which may be caused by electrical lines, fallen objects, damaged and slick roads and pavements, poor sight, and more traffic. This may result in more traffic accidents and facial injuries. Intervention and Implementation of Sustainability in Oral Health Beyond simply treating oral illnesses, dental professionals play a key role in addressing emerging global diseases by understanding the complex relationship between oral health and the environment. The Oral Health Care (OHC) sector consumes high levels of energy, water, and resources, placing a heavy burden on the planet. To counter this, OHC practice must adopt a collaborative, high-tech, and diverse approach to successfully integrate Environmental Sustainability (ES) programs that reduce pollution and greenhouse gas emissions. However, significant barriers remain at institutional, educational, personal, and infrastructure levels, hindering ES adoption in daily practice. This highlights the need for further international research, collaboration, and policy development to design protocols, infrastructure, and educational frameworks that will equip OHC professionals with the tools needed to advance ES initiatives [48]. Several major initiatives are paving the way forward. The PRUDENT project sought to enhance access to essential dental services while promoting universal health coverage and advancing long-term sustainable oral health strategies [4]. The Paris Agreement also provides a global framework for carbon reduction and expanding renewable energy, though the United States remains the only country that has not signed [53]. Worryingly, healthcare services and supply chains account for 8.5% of U.S. greenhouse gas emissions [52]. To support sustainable implementation, guidelines such as the Scottish Dental Clinical Effectiveness Programme (SDCEP) and Public Health England (PHE) provide evidencebased approaches for OHC professionals [54]. Ultimately, a transdisciplinary, planet-centric model is required, aligning OHC sustainability efforts with the WHO Global Oral Health Action Plan [55]. The WHO Action Plan recommends ecologically responsible use of consumables, safe application of oral care supplies, and efficient consumption of natural resources like water and energy. Additionally, it advocates evidence-based use of essential medicines and support for minimally invasive, eco-friendly dentistry. Such measures will help build sustainable, low-carbon, and climate-resilient oral health systems worldwide [55]. Safety Measures to Maintain Sustainable Environment The Sustainable Development Goal 13 (SDG 13) calls for immediate action to mitigate the effects of climate change [36, 14]. Any effective and equitable health promotion approach must also consider larger disease risk factors including pollution and climate change, as well as more general socioeconomic determinants of health like economics, social policy, education and unequal resource distribution [31]. Since the 1800s, nitrous oxide (N2O) has been utilized in dental care delivery as a safe and efficient means of treating dental pain and anxiety. Nitrous is a powerful greenhouse gas with about 270 times the potential for global warming as carbon dioxide, according to a 2007 American Dental Association survey that estimated 70% of dentists used it in their offices more recently, and 97% of respondents to a survey by the American Academy of Paediatric Dentistry [52]. Careful case selection, effective intraoperative time management, shortened nitrous use duration, and routine system leak monitoring can all help prevent the generation of excess nitrous oxide waste [52]. Global J Res Dent Sci. 2025; 5(6), 1-8 @ 2025 | PUBLISHED BY GJR PUBLICATION, INDIA 5 Protecting patients’ health and creating robust healthcare delivery systems that can endure difficulties brought on by climatic disasters are the responsibilities of medical practitioners. This idea is easily applied to dentistry, as oral health care professionals are essential to the provider-patient-climate trinity [31]. Innovative waste management techniques include the introduction of public-private partnership organizational and economic mechanisms and suitable financing models, economic modelling of resource production relations in the area of secondary resource use, and consistent application of the subsidiarity principle in public policy will further help to create a sustainable environment [56]. In addition to the above safety measures , environmental pollution control and monitoring, including biotechnology; treatment facilities that lower the amount of pollution from both stationary and mobile sources; resource-saving and environmentally friendly: the newest production techniques that use natural resources more effectively or reduce air pollution; and the introduction of cutting-edge machinery for the capture and disposal of hazardous emissions into the atmosphere might support to build a sustainable environment [56]. Sustainable Oral Health Improving disease prevention techniques not only lowers the incidence of oral disease but also reduces the environmental impact of dental care delivery. Oral health care systems must become resilient in facing severe weather events and pandemics, such as COVID-19 [57], while ensuring continued patient care [31]. The pandemic further emphasized the environmental burden of Personnel Protective Equipment (PPE) and the widespread use of Single Use Plastics (SUP), requiring proper management beyond landfill disposal and incineration [58]. Sustainable dentistry involves minimizing the use of SUP, reducing energy and water consumption, and limiting waste production [52]. Additionally, the environmental impacts of dental restorative materials, their packaging, transportation, and patient and staff commuting should be addressed. As recyclable plastics, paper, glass, and metals constitute 75% of landfill waste, better segregation can significantly reduce its volume [52]. Enhanced waste management also supports oral health equity, protecting vulnerable populations disproportionately affected by pollution and climate crises [31]. Future Scope Long-term studies, including prospective research, are essential to evaluate the effects of climate change and its longlasting impact on oral health. Both public and private healthcare sectors can utilize Metaverse software to deliver digital oral health education and community-focused discussions, thereby improving awareness among the general population [59]. Future research should focus on understanding the complex relationship between oxidant-mediated aerodigestive tract illnesses and gene–environment interactions. The identification of biomarkers and trace elements in oral precancer and cancer will help explain molecular mechanisms, ultimately contributing to high-quality treatment for patients at risk of climate-sensitive diseases [36]. International dental health organizations should support eco-friendly recommendations while promoting green dentistry practices [60]. Globally, communities would benefit from designing educational curricula and programs centered on sustainable dentistry [36]. The efficiency of global mitigation and adaptation strategies will shape the pace of climate change. Ultimately, collaboration between civil society and environmental health efforts, supported by innovative technologies, is necessary for sustained development. A longterm commitment to protect public health requires communityand individual-level engagement in mitigating climaterelated risks [37]. DISCUSSION This review emphasizes the strong interconnection between oral health and climate change, highlighting the importance of adopting a planetary health perspective within dentistry. Environmental challenges such as pollution [61], water scarcity, global warming, and ozone depletion increasingly impact not only systemic health but also oral health outcomes [62]. The recurring theme is that oral health cannot be separated from broader ecological and social determinants. As environmental degradation accelerates, oral disorders are expected to rise in prevalence and severity, particularly among vulnerable and marginalized groups. Climate change influences oral conditions in multiple ways. Fluctuations in temperature and humidity foster bacterial growth, elevating risks of periodontal disease and dental caries [63]. Additionally, the oral manifestations of climate-sensitive vector-borne diseases, such as Zika virus–induced petechiae or ulcers, necessitate expanded diagnostic and preventive roles for dentists. Malnutrition linked to food insecurity further impacts oral development, contributing to enamel hypoplasia, delayed eruption, and increased caries risk [64]. Moreover, environmental exposures like air pollution and UV radiation complicate oral health outcomes, linking oxidative stress to periodontal disease and UV exposure to lip malignancies. The article emphasizes that increasing exposure to environmental contaminants and variations in water quality can contribute to dental erosion and damage to the oral mucosa. From both preventive and systemic perspectives, the promotion of sustainability in oral health care delivery is essential. Dentistry, being a highly resource-intensive field, contributes substantially to greenhouse gas emissions, waste production, and material consumption. Therefore, integrating sustainable practices such as reducing single-use plastics, improving waste segregation, and minimizing the carbon footprint of clinical operations is crucial. Initiatives like WHO’s Global Oral Health Action Plan and the PRUDENT project provide practical frameworks to align dentistry with broader sustainability goals. This review also Global J Res Dent Sci. 2025; 5(6), 1-8 @ 2025 | PUBLISHED BY GJR PUBLICATION, INDIA 6 underscores the importance of an anticipatory and transdisciplinary approach to oral health care. Training professionals in sustainable practices and enhancing climate awareness enable the industry to support mitigation and adaptation efforts. Addressing inequities in oral health caused by climate change requires legislative reform, education, and international collaboration. Ultimately, incorporating environmental considerations into dental care ensures improved outcomes, fosters resilience, and strengthens sustainability for future generations facing climate-related challenges. CONCLUSION To conclude, advancing global oral health can help address the triple planetary crisis of pollution, biodiversity loss, and climate change. 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