How to care and thrive through sustainability with Dr Markus Tröltzsch: Coffee Break with Coachman podcast

This transcript has been reviewed by AI and may contain inaccuracies.

Christian Coachman: Being more efficient is very ecological—that’s the conclusion here. When we are more efficient, we are more ecological. And, of course, it’s better for our business, better for the patient. But it’s something we should at least talk about with the team, right? I don’t see many practices talking about that.

Kirk Behrendt: Never, ever. Just keep that in mind.

Christian Coachman: Three, two, one, and we are back with Coffee Break with Coachman. Today, a very important topic—how to care and how to thrive through sustainability—with my dear friend, Markus Tröltzsch, one of the pioneers bringing this topic into dentistry through his project, Greenviu. Very briefly, Markus is an amazing, successful surgeon and dentist, running a very busy practice. He’s also a researcher in surgery, implants, and other areas, and he’s published many articles. He’s on the lecturing circuit as well. But today, I think we need to take advantage of his precious time to talk about something he started that I think is just beautiful. It’s a project called Greenviu, which aims to bring sustainability to dentistry, to help dentists become more environmentally friendly, or at least to increase our awareness of this topic.

So, Markus, thank you so much for being here, but thank you above all for putting energy into a topic that is so important to all humans and to our dear planet. Tell me, how did this start? Why did you start Greenviu, and when did it start?

Dr. Markus Tröltzsch: Friends, thank you so much for inviting me here. And Chris, you’ve been a role model for me in so many aspects, especially with the energy you put into building up whatever you do—pushing things from the start. That was always an amazing inspiration for me, from the first moment I met you. One of the things I took from you is the idea of, "How can I make things better, just where I am?" This is something that always inspired me about you. Wherever you pop in, things turn out better than they were before. And I think it’s very important that we try to improve the little world we can influence—the little piece of our society.

Sustainability was something I was always interested in, and that’s in our times—and you already pointed this out—it's important to note that it was never a political project. It was always a medical project. For me and my brother, both maxillofacial surgeons, it was always a scary sight when we left the operating theater and saw these heaps and heaps of rubbish left behind—whole baskets of rubbish.

So, we started thinking about it, and that’s about eight to ten years ago. We began asking, "How can we avoid that? What can we do differently in our offices, clinics, and surgical theaters to make sure we don’t end up with so much waste?" And that’s always a thought we had in the back of our minds: everything you throw away as a dentist, as a medical professional, is something you paid for at the beginning of the day. All these packages, all these wraps—they don’t come for free; they’re part of the price of the product you use. So, we looked at that and said, "Well, sustainability is very cool. We want to go, from an office structure, to eco-energy." We wanted to have solar panels on the rooftop of our office. We wanted to make sure the light bulbs didn’t burn all day if we didn’t need them and that the AC didn’t run if it was cool outside. Simple things like that.

We started the project in our own office, about eight years ago. And then, after half a year, we gave up because we saw that the change management necessary to turn a highly professional and highly efficient team into a team that would learn new tricks was really, really difficult.

So, we let that sit for a while. After about a year, we thought, "Well, all this effort can’t be in vain," and second, we still loved the idea of practicing eco-friendly medicine and dentistry. A sustainable approach. Then we asked, "What do we need?" So, we started researching. Now, we changed our approach, right? Our first approach was, "Just grab it and do it." That failed. The second approach was, "Sit down and think." So, we sat down, did some literature research, and found…wow, there’s nothing.

We started digging deeper and found amazing data from the UK, for instance, about the footprint of medicine and dentistry in the National Health Service. Because they have a very controlled medical system, they can monitor that. We also have data on climate change and how it actually affects human health. And, Chris, you had that beautiful introduction where you pointed out that we have a different world today than we had eight years ago, right? The climate crisis is still raging every day. We’ve had COVID—that was a time when you and I combined our efforts to convince the world that dentistry is not dangerous and that dentists are not endangered, as we know how to protect ourselves. And we were successful in the end.

Christian Coachman: Remember the podcast we did together? All our predictions came true, one by one.

Dr. Markus Tröltzsch: Yes, exactly. And then, there came the war in Ukraine—a new thing, right? We thought we had overcome the idea of one country attacking another just to take land. I mean, honestly, look at your biography, where you were born, where you grew up, where you live now. We live in a cosmopolitan world. We live in a world where we want to interact, where we enjoy talking to people from different backgrounds, different cultures—not because we want to say, "I’m better than you," but because we want to see, "What can they do better than I can do?" and learn from them and grow together. That’s the world we thought we lived in, but we found ourselves in a world where that sort of changed.

And the idea of sustainability—it was a pure idea, right? It wasn’t political. It was about behaving in a way where we don’t harm the planet more than we actually have to. And for us, it was always clear that if we practice medicine at a high level, we can never be net-zero. That simply doesn’t exist. For instance, look at DSD. DSD has changed dentistry for the better. The complex mechanisms you installed make dentists get better outcomes, have happier, healthier, and more satisfied patients. But this comes at a price, both financially and in terms of footprint. Advancement causes a footprint.

So, one of the ideas we got very early in that thought process was, "We can’t claim medicine can ever become net-zero." So, we have to learn how to lower our ecological footprint while maintaining or even improving the quality of the care we deliver. At the same time, we look into projects for how we can mitigate the footprint that we will necessarily leave when practicing good dentistry and medicine.

Christian Coachman: Now, Markus, the core idea of Greenviu—let’s start with some of the information you usually share in your lectures about the harm, the footprint we leave as professionals. Because I think many dentists never even thought about it, as I hadn’t before we started focusing on it.

Dr. Markus Tröltzsch: You said something very important, Chris—the word "harm." It’s interesting to see, as you said at the beginning, some political areas in our society start to completely deny that there is a change in climate. And Greenviu, from the research we did, always came to one conclusion: there is climate change, for sure. There’s no point in disagreeing with that, as we have literal proof both in data and in facts that don’t derive from human data.

And here’s an interesting thought. All the data we have can be manipulated, and we see that. For those people saying, "Well, there’s no such thing as climate change," they have a point, you know why? German television—if you look at the weather forecast 10 to 15 years ago, temperatures like 30

Dr. Markus Tröltzsch: Right, today those bright red colors are used for temperatures starting at 25 degrees and up, so it’s signaling more alertness even for lower temperatures. People recognize that. Of course, you can look that up online; you can see there’s some misleading information happening there.

But if we look at the other side—and here’s where the topic of harm comes in—harm is actually one of the best ways to prove that climate change is happening.

Take Lyme disease, for example. Lyme disease, which can be transferred to humans by ticks, is very important in dentistry because it can cause jaw pain and other symptoms we may encounter. We can see how Lyme disease, transmitted by certain ticks, is spreading further north. You can actually map this by looking at where patients suffering from Lyme disease are located, showing how ticks are moving north as temperatures rise on average each year.

North America is one of the best-researched regions for this. In fact, data from 2005 predicted that Lyme disease would reach the Canadian border by 2080. But the data actually showed that it reached the Canadian border in 2017. Climate change sped that up, allowing the ticks to survive longer.

We see many examples of this. For instance, bugs from Africa have now started living in Italy, Spain, and southern Germany, bringing malaria to these regions—diseases that had never been there before. Climate change allows that.

The first data on the harm of climate change on human health goes back to 1979, the year I was born. That was when the first study was published in Nature, showing how climate change—rising temperatures, along with changes in the atmosphere, not just in the stratosphere but in the air around us—actually alters human health. It affects heart disease, diabetes, allergies, asthma. This data is very strong. We know today that people living in areas hit hard by climate change have a much higher risk of developing these diseases than they did 20 years ago in those same areas.

And we’re only talking about heart diseases here. We’re not even talking about the other factors like soil loss, rising sea levels, and the need for people to relocate from areas where they once grew crops to areas where food might be scarce. The whole ecosystem is becoming unbalanced at a very rapid rate.

Christian Coachman: Yeah, and the data is still unclear on exactly how much of this impact is due to human activity, right?

Dr. Markus Tröltzsch: Exactly, we don’t have all the answers. We know there is an influence, definitely, but we also know that climate change has existed far before humans started emitting carbon dioxide. The difference between past climate change events and now is the speed at which it’s happening. All living creatures can adapt to slow changes, but rapid changes pose a significant problem.

One common argument against climate change is, “How can climate change only be happening now when we’ve found Roman ruins under the glaciers in the Alps?” Well, yes, there have been warmer periods in Earth’s history, but using radiocarbon dating, we can show that these warmer periods took at least ten times longer to develop than the changes we’re seeing today. It’s the speed of today’s climate change that’s frightening and dangerous. And, don’t get me wrong, a rapid cooling of the planet would be equally hazardous for agriculture and life on Earth. So, whichever direction it goes, it’s difficult.

Whatever measures we take, we need to do so patiently and with foresight, understanding that the decisions we make today will affect the climate 30 years from now, not tomorrow. That’s something that’s hard for many people to understand. Just because you don’t switch on a light bulb today doesn’t mean tomorrow will be cooler—not at all.

Kirk Behrendt: Hey Christian, can I ask a question here?

Christian Coachman: Yes, go ahead.

Kirk Behrendt: Markus, I love this. You’re shining light on something I think we all feel, whether it’s anecdotally or subjectively. Greenviu, your project, has three core principles: reduce, replace, and compensate. You refer to it as “compensation projects.” That’s great. Can you describe that methodology?

Dr. Markus Tröltzsch: Absolutely. Reducing the footprint is straightforward: just waste less. That’s where economy and ecology go hand in hand. Isn’t it interesting that those two words sound so similar? In many languages with Latin roots, they sound alike because they share the same basis. In old times, sustainability was a necessity. People wasted less so they would have more, which was good for them and for the planet. So, that’s the “reduce” part.

“Replace” is about using more eco-friendly products. Now, “compensate” is about realizing that medicine will always have a significant footprint. We can reduce it, but we have to look into projects where we can mitigate the footprint that we can’t avoid. This is not a carte blanche to waste as much as you want; it’s about wasting less and compensating for what’s left.

We partnered with the United Nations’ “Climate Neutral Now” project. Greenviu is an official partner of this UN movement. We focus on projects they run, primarily energy-related projects, because energy is an area where we can clearly measure impact. For example, in some regions of India, people still burn wood and brown coal to produce energy. Building a hydroelectric plant there would reduce the area’s carbon footprint by a factor of 100, reducing carbon dioxide output per energy unit by 100 times.

These are projects that genuinely reduce humankind’s footprint while improving access to essential resources. There are various types of projects—like reforestation—but we try to focus on what science can measure. The challenge with some other projects is that we can’t always calculate their full impact on humankind’s footprint.

Christian Coachman: And we can’t forget that medicine, if it were a country, would be the fifth-largest emitter on the planet. Only China, the US, and Brazil are bigger.

Dr. Markus Tröltzsch: Exactly, which shows how huge our footprint as medical professionals really is. So, when we aim to reduce our footprint, finding good partners is essential. There are many partners offering solutions, but we have to be careful, as not all of them provide the best outcomes. For us, it was clear from the start that we wanted to work directly with the United Nations.

Eco-friendly products and companies became a big trend in marketing more than 10 years ago. It was a positive investment for companies to be able to claim that. But, as you know, it’s not always true.

Christian Coachman: Right. How do you see dental companies actually caring about this or trying to develop solutions to help us all be more eco-friendly?

Dr. Markus Tröltzsch: You’ve pointed out something important. Look at advertising today—is eco-friendly really a big focus for large companies now? Look at car companies, computers, cosmetics. In 2024, do you see big marketing campaigns focusing on brands being eco-friendly? I don’t see it anymore. Ten years ago, it was a big thing. Look at VW; all these big companies were doing it.

Christian Coachman: So, what’s happening now?

Dr. Markus Tröltzsch: In the automotive industry, for example, VW is on the brink of bankruptcy because they misinvested in e-mobility.

Markus Tröltzsch: ...because they didn’t sell. And here’s the bad news—the market is adapting to sustainable practices a lot slower than we expected. We thought that by now there would be a higher demand for sustainable products in medicine, especially in dentistry, but it’s just not there yet.

Christian Coachman: Right. And we can see how that connects to what I was saying before we went live. This shift in attitudes, it’s connected to how, around seven or eight years ago, sustainability was a cool, positive topic that everyone could agree on. It was obvious that we needed to be mindful about it, and everyone wanted to take action. Back then, we didn’t know a lot about the science, but people were optimistic, and it was a forward-thinking conversation.

Unfortunately, after the pandemic and the rise in global political conflicts—right versus left, left versus right—one side took sustainability as their primary cause, while the other side labeled it a hoax or a lie. That conflict polarized the topic, which shifted from being universally positive to divisive. Both extremes have damaged the momentum we once had for working together to protect the planet.

Extremism is always a problem, whether it's people aggressively pushing their perspective or others aggressively denying reality. It doesn’t matter what side you're on; extreme approaches don’t work.

What’s crazy is that you started Greenviu during a time when sustainability was on everyone’s mind. You and others thought this would grow quickly and that the support would be immense. And it did grow initially, with a lot of opinion leaders supporting it. But because of this politicization, it isn’t growing as much as it should.

Dr. Markus Tröltzsch: Exactly, absolutely. Greenviu has grown, but not at the scale we hoped for. We’re not doubling our membership every year, nowhere near that. When you look at business growth data, you know that new customer acquisition rates are often a significant indicator of a company’s health and potential value. With Greenviu, if you looked only at those numbers, it would seem like it wasn’t worth much because the growth has slowed so dramatically.

Christian Coachman: Right, and you even mentioned that you’re getting backlash for talking about Greenviu. Some people are even calling you a communist for advocating sustainability.

Dr. Markus Tröltzsch: Exactly! Just because I’m promoting sustainability, people associate it with the climate change narrative. If I’m supporting sustainability, I’m supposedly supporting climate change, and if I’m supporting climate change, I must be aligned with the left politically. And if I’m supporting the left, then I’m against the right—and so, I must be a communist.

Christian Coachman: It’s absurd!

Dr. Markus Tröltzsch: Absolutely. It would be funny if it weren’t so sad. But, yes, I get called a communist for wanting sustainability, which is ridiculous because behaving sustainably is actually a smart economic choice—it’s about resource management, not politics. Every time there’s extreme activism, like blocking highways or damaging property in the name of climate action, it makes people even more hesitant about sustainability. And they shouldn’t be, because at its core, sustainability has a huge economic basis. By behaving sustainably, you’re actually setting up for long-term profitability.

But that’s difficult to communicate in today’s climate. And it’s not just Greenviu; we’re seeing this resistance globally. Thankfully, in medicine and dentistry, we’re talking to professionals who tend to be more logical, so we can often bring them back to a reasonable discussion. But, outside of Greenviu, some offices are making overly ambitious promises about their sustainability that we haven’t. We’re not promising to make our members carbon-neutral overnight, for example.

Christian Coachman: Right. You mentioned earlier that some practices have tried to make big sustainability claims—saying they’re net zero or super eco-friendly—and using that as a marketing point. But now, those claims aren’t as effective.

Dr. Markus Tröltzsch: Exactly. Patients cared a lot about eco-friendly practices two years ago, but now they’re indifferent. In fact, claiming to be “sustainable” can even backfire. Patients might think, “Oh, if you’re sustainable, you must be expensive.” It’s ironic. And to top it off, they might think you’re a communist for it.

Christian Coachman: It’s like we’re caught in a paradox, where what used to be a virtue is now a liability.

Dr. Markus Tröltzsch: Right, exactly. And here’s the dilemma. On the one hand, this is the only window we have to reduce humanity’s impact on climate change, whatever proportion of it may be human-caused. While we don’t have 100% certainty on the extent of human influence, we do know that less pollution is good. It’s that simple. Reducing pollution can only bring positive changes, even if we’re not around to see the full benefits. As medical professionals, our guiding principle is “Do no harm.” That rule doesn’t only apply to our patients but extends to the environment, which affects human health as well.

Christian Coachman: Yes, the rule is “Do no harm,” and that must apply to our surroundings, given how interconnected everything is.

Dr. Markus Tröltzsch: Exactly. If we take that approach seriously, we realize that climate change impacts so many serious diseases. And as professionals, we have an obligation to act.

Kirk Behrendt: I love where this conversation is going, Markus. I always want our listeners to have some tangible steps they can take after listening. Greenviu has done great work creating a community and support network. But let’s break it down for listeners. What can a dentist do on three levels: first, for their immediate world; second, to contribute to the bigger picture; and third, how can Greenviu support them?

Dr. Markus Tröltzsch: Great questions, Kirk. This is actually connected to what Christian asked earlier about the role of companies in the dental field. We’re seeing some of the bigger players in dentistry taking this seriously. For example, Straumann has been one of our partners from the start. They, along with other partners listed on our website, have shown commitment to sustainability in a tangible way. We only accept partnerships where we can see the internal sustainability processes, so we know they’re committed.

Straumann has taken sustainability seriously; it’s built into their company DNA, regardless of the economic outcome. Camlog and Henry Schein are also making significant efforts. But on the other hand, some products that were developed to be more sustainable in dentistry didn’t last in the market simply because they didn’t sell.

Christian Coachman: So, the market’s readiness for sustainable options is lagging?

Dr. Markus Tröltzsch: Yes, exactly. The market has been slower to adopt sustainable solutions than we anticipated. We had hoped that demand for eco-friendly products would grow faster, but it hasn’t quite caught up yet.

Dr. Markus Tröltzsch: The market is a lot slower than we all thought in adapting all those steps that could be made. And number one, of course, is looking into companies—what can I do tomorrow to become more sustainable? Christian, as I said, we have lots of lectures. If you become a member of Greenviu right now, not a lot is happening, to be very honest with you, because we are basically re-sorting what we’re doing. The market changed so much in the last, let’s say, eight to nine months that we are re-evaluating so many products that, right now, we’re telling our members, “Hold your foot. It’s going to be about a quarter, a year, and then we’ll come out with new information.” So there is a free membership version of Greenviu. Becoming a friend of Greenviu is just about registering yourself on the website. Then you’ll receive the newsletter, and we’ll keep you updated on what’s new in true sustainability in the medical industry.

Dr. Markus Tröltzsch: Second, when you register for this, we have a guide—“11 Steps for Tomorrow”—that all offices can take that cost absolutely nothing, but save you money in running your office and make you more sustainable. And at the top of this, of course, is controlling your use of consumables and energy output. This is a priority, and it’s the easiest step. For example, in my office—Germany is one of the most expensive places for energy, thanks to our green government—well, it’s one of the most expensive places to buy energy. We pay about $15,000 to $20,000 just for electricity each year. And here’s the funny thing: We’re fighting with our local authorities for more than four years now to be able to install solar panels on our office building. We’re not allowed yet. We’re just going to do that now, without the official permission.

But on one side, it saves me heaps of money, and on the other side, it makes me a lot more sustainable in my office. So these are the basic things that everybody can do. Second is to train your team to watch out for these things because if we look into the footprint of dentistry—and, Christian, this is something we discussed in the webinar we did together; it was the first time I ever presented this data—we can prove that about 60% of the footprint of a dental office comes from the commuting and the traveling of workers and patients. Sixty percent of our footprint comes from that.

Dr. Markus Tröltzsch: So if you have a smart appointment management system, for instance, if you use digital tools to make as much diagnostics in one step as possible—from scans to x-rays to imaging to DSD—you end up with the patient needing to come back to your office a lot less. If you need ten appointments to finish a treatment versus five appointments, that makes the biggest impact on your eco-footprint. These are the steps you can take to make a big difference without changing the quality of the treatment.

Christian Coachman: I was surprised when you first mentioned this to me, Markus, because, of course, it brings extra value to the digital workflow that I was already teaching, but I hadn’t thought about it from an ecological perspective. If you’re able to do most of your devices digitally, you don’t have to ship these devices; you’re sending digital files and manufacturing them locally. Chairside milling and chairside printing are extremely ecological in that regard because it allows us to avoid shipping materials around and moving them with regular transportation.

Also, by becoming more efficient through digital means, you need fewer appointments. Monitoring treatments digitally also allows you to treat patients in less time with fewer unnecessary appointments. Being more precise with digital tools helps reduce repetition, redoings, adjustments, back and forth, and more appointments. So that makes us more effective and more efficient. And being more efficient is very ecological—that’s the conclusion here. When we are more efficient, we are more ecological. And, of course, it’s better for our business, it’s better for the patient, but it’s also something that we should at least talk to the team about. I don’t see many practices talking about this—never, ever.

Kirk Behrendt: Just keep that in mind. Every time I think about sustainability, immediately, in the next one or two hours after I’ve thought about it, I see myself doing little things that make me more eco-friendly, right? Not throwing away a piece of paper that can still be reused, not wasting plastic on unnecessary things. Just talking about it already brings huge benefits. And I think we should all bring up that topic more often with the team. Just a little reminder to everybody, “Let’s be more sustainable.”

Dr. Markus Tröltzsch: Couldn’t agree more.

Christian Coachman: So, how do you see the project moving forward, Markus? How do you see us pushing the industry a little bit more or bringing more dentists on board? How can we help you?

Dr. Markus Tröltzsch: Well, that’s very kind. I think the most important thing is to just spread the word that sustainability has nothing to do with green politics. It’s a totally different ballpark, even though sometimes the results might align. The idea behind sustainability is, of course, about being easier on our environment while also being better for business.

What we’re planning for Greenviu, starting probably in January, is to offer different approaches tailored to different offices. Right now, we offer a comprehensive membership with in-depth assessments that analyze your office and recommend long-term improvements—an ecological and economic audit. We’ll keep offering that, but we’re also going to introduce smaller, more focused options, especially for offices that understand sustainability will continue to be a major topic. Sustainability isn’t just a trend; it’s called a “mega-trend.” It may sometimes get overshadowed by other trends, but it will always come back.

Dr. Markus Tröltzsch: There are two reasons for that. First, every year, the climate problem is getting bigger. It’s getting slowly bigger and becoming impossible to ignore, so the amount of denial will shrink over time. And as humans, when a crisis becomes undeniable, more people start asking, “Why didn’t anyone do something?” even if they themselves had been neglecting it. So, the offices focusing on sustainability—even if they’re doing so quietly—will be well-positioned. Some offices were very vocal about being eco-friendly a few years ago, but we’ve encouraged our members to stay understated. Just be sustainable and let some low-key ads do the talking; don’t overdo it. That’s probably the right approach for now.

And then, there are climate protocols that many governments around the world have signed. Over 75 countries within the United Nations have agreed on these climate protocols, which means that by the end of next year, or by 2025, they will have to enact laws to reduce the footprint of their societies. Part of this will involve monitoring and incentivizing reductions in various industries, including healthcare and dentistry. Some of these regulations might involve new taxes, so offices that can already demonstrate a history of reducing their footprint—and prove it with documentation verified by a neutral organization like Greenviu—will have a big advantage.

Christian Coachman: You’re positioning Greenviu to support dental practices now and in the future, as sustainability continues to be prioritized globally.

Dr. Markus Tröltzsch: Absolutely. We’ll keep adapting Greenviu to make it as effective and practical as possible for our members. For us, it’s all about helping practices be ready for both current demands and the future.

Kirk Behrendt: Love it. I love this. This has been a great conversation already, and Christian, I love that you brought Markus here to the forum. I know a lot of people will want to find out more, so if you're listening, we’re going to put links down in the show notes. It’s Greenviu—G-R-E-N-V-I-U dot com—and you can check out more.

Let’s do this: can we get some final thoughts? Markus, maybe your final thoughts, and then, Christian, your final thoughts before we say goodbye to everyone?

Dr. Markus Tröltzsch: Thank you so much. Christian said some very smart things in the beginning about the battle of politics in the world right now. Brilliant minds like Christian and other opinion leaders, who rightfully rose to those positions through constant work and development, know there’s no absolute right and left, no strict good or bad in politics. We have to follow real politics, which is about making decisions that are beneficial to people.

So, let’s aim to help our immediate worlds, the little communities around us, get better. We need to understand that ecological thinking and sustainability have nothing to do with divisive politics; it’s beneficial for everyone, in the end.

Christian Coachman: Well said. From my side, I just want to say that I hope we’ll all listen to what is obvious. We need to stop finding excuses because it’s more comfortable to ignore the truth. We must understand that it’s in our hands; we can’t keep blaming governments and leaders. It’s in our hands, and we need to do our part. Even if it sounds a bit cliché or political, it’s really not about that. This is about our near future. Things are moving fast, and it’s very sad to see how many people don’t even think about it.

Kirk Behrendt: I love this conversation for so many reasons. It’s been enlightening to understand and know that there’s a resource for this. Markus, I’m just going to encourage you to keep giving a voice to what you’re already doing. I think we have a responsibility not only to leave the world in a better place but also to leave our profession in a better place.

And if you’re listening to the podcast, make sure you reach out to Greenviu and follow along. We’ll add all these links to the show notes. Thank you both for being here—this was an awesome episode. Really appreciate it.