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 Table of Contents  
ORIGINAL ARTICLE
Year : 2015  |  Volume : 3  |  Issue : 2  |  Page : 43-48

Evaluation of occupational musculoskeletal disorders and related risk factors among dentists working in North East India


Department of Conservative Dentistry and Endodontics, Regional Dental College, Guwahati, Assam, India

Date of Web Publication22-Jun-2015

Correspondence Address:
Chandana Kalita
Department of Conservative Dentistry and Endodontics, Regional Dental College, Guwahati - 781 032, Assam
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2348-1471.159182

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  Abstract 

Introduction: Musculoskeletal disorders (MSDs) in a working population are very common, occurring predominantly in the low back, neck, and upper limbs. Dentistry is one of the high-risk professions for developing MSD, because of high visual and skill demanding works resulting in prolonged static, as well as uncomfortable postures. Objectives: The aim of this study is to evaluate the occupational MSDs and related risk factors among dentists working in North East India. Subjects and Methods: In this cross-sectional study, specially designed questionnaires were distributed among 200 randomly selected dental practitioners with a work experience of more than 24 months. Results: According to this study, 70.5% of the surveyed dental practitioners have single or multiple symptoms of MSD, especially in the lower back (48%) and neck (24%). Eighty percent of them work with an assistant and 61.5% treats more than five patients/day, 9% worked without any break, 46% takes break once a day and 28% twice a day, 54.5% does regularly exercise , 4% uses loupes and only 5% had proper training in ergonomics. There was a significant correlation between MSDs and gender (P = 0.029) and number of patient treated per day (P = 0.001). Conclusion: The symptoms of MSDs increase with the number of years of practice and number of patient treated per day and are more common among female.

Keywords: Dental profession, ergonomics, musculoskeletal disorders


How to cite this article:
Tamo T, Kalita C, Bhuyan A C. Evaluation of occupational musculoskeletal disorders and related risk factors among dentists working in North East India. Dent Med Res 2015;3:43-8

How to cite this URL:
Tamo T, Kalita C, Bhuyan A C. Evaluation of occupational musculoskeletal disorders and related risk factors among dentists working in North East India. Dent Med Res [serial online] 2015 [cited 2019 May 25];3:43-8. Available from: http://www.dmrjournal.org/text.asp?2015/3/2/43/159182


  Introduction Top


Dentistry as a profession has seen significant technical and knowledge advancement in recent years. Among the occupational health problems faced by the dental personal, musculoskeletal disorders (MSDs) is most common and frequently reported. [1],[2],[3]

Musculoskeletal disorders, particularly back pain is a biggest threat among dental care workers as indicated in many studies. [4],[5],[6],[7] Studies on musculoskeletal health and pain experienced by the practitioner, [8],[9],[10],[11],[12] even with the advancement from standing to seated four-handed dentistry and ergonomic equipment's, [13],[14],[15],[16],[17] found that MSD persisted. Several studies have characterized different parameters of pain in dentists. [14],[18],[19],[20],[21] This study aimed to determine the prevalence of MSD and its associated factors.

Aims and objectives of this study

The objective of this study was to evaluate and determine the scale of occupational MSDs related to dental work among dentists in North-East States of India and identify the factors associated with it.


  Subjects and Methods Top


A cross-sectional study was conducted from September to November 2014 among dental practitioners who worked in private or Governmental Dental Health Clinics in North-Eastern States of India. The study criteria consisted of work experience of at least 24 months duration, without any significant medical conditions such as congenital MSDs, rheumatoid arthritis, scoliosis or any surgery involving the spine and were not pregnant during data collection. The study was conducted on the basis of the author's own questionnaire-based on the Nordic Musculoskeletal Questionnaire suitable for application in workplaces and for a large number of workers very quickly and cheaply. The survey was anonymous.

The questions concerned demographic factors such as age, sex, body mass index, place of work and specialization. More detailed questions covered such issues as working methods (the position adopted by the dentist, "two-handed" or "four-handed" dentistry), courses taken in ergonomics, the number of breaks taken, and pain in the musculoskeletal system, type of treatment received, as well as health-promoting and health-damaging behavior. Some questions allowed for multiple responses. Out of 200 randomly selected dentists to whom specially designed questionnaires were distributed, 156 dentists participated in the study and returned the filled questionnaire. Data obtained were analyzed by Chi-square test using the Statistical Package for the Social Sciences (SPSS 16, IBM).


  Results Top


Out of 200 dentists to whom questionnaire were distributed 156 dentists participated in the study and returned the filled questionnaire. Among the 156 dental practitioners, 99 (63%) were male and 57 (37%) were female, with a mean age of 37 ± 6.38 years, mean height of 164.3 ± 28.5 cm and mean Weight 66.8 ± 10.6 kg. Profile of the study participants is described in [Table 1] and [Figure 1].
Table 1: Profile of dentist participated in the study

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Figure 1: Percentage of dentists afflicted by musculoskeletal disorder during last 12 months

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Sixty-nine percent of the studied population were a general practitioner, with the remainder being specialists. As per the current study 110 (70.51%) dentists had at least one kind of occupational MSD symptoms either neck or back or shoulder or combination of it in the past 12 months. Females (78.9%) suffered more compared to males (65.7%). Among those who suffered MSD 3.6% had trouble everyday [Figure 2] and [Figure 3]. It was found that although the majority of dentists work with an assistant, 20% were still practicing two-handed dentistry.
Figure 2: Relationship between gender and symptoms of musculoskeletal disorders

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Figure 3: Percentage of dentists as per the duration of musculoskeletal disorder symptoms in the last 12 months

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Respondents most commonly experienced pain in lower back (48%) followed by pain in neck (24%) [Figure 4]. Out of 110 dentists affected with MSD, 44 had to reduce their activity during the last 12 months due to MSD. Only few dentist remained absent in their clinical work due to pain, of which 34.5% remained absent for 1-7 days, 2.7% for 8-30 days and 2.7% for more than 30 days.
Figure 4: Percentage of specific parts of body afflicted by musculoskeletal disorder in dentists

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According to the study results, the number of dentists reporting pain increased with age and tne number of years of profession [Figure 5] and [Figure 6]. Among the participants, 19.13% just beginning their professional careers (<5), 91% of respondents with 5-10 years of work, 70.87% with 10-20 years of experience and 86.52% of those with more than 20 years of experience suffered from MSD. When asked what break they took 46% reported to have one break during their work while 7% take break after every patient [Figure 7].
Figure 5: Percentage of dentists afflicted by back pain in comparison to age in years

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Figure 6: Percentage of dentists afflicted by back pain in comparison to years of practice

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Figure 7: Frequency of breaks taken by dentists during working hour

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Prolong sitting (39.70%) aggravate pain more while rest (38.40%) relieves it [Figure 8] and [Figure 9]. The survey revealed that most dentists (38.5%) work in a sitting position with a patient in a sitting position. Slightly fewer (32.1%) work in a standing position with a patient in a sitting position, and 29.5% of dentists choose to work in a sitting position and a patient in a supine position, that is, the working model promoted by the European Society of Dental Ergonomics (ESDE).
Figure 8: Aggravating factors and its frequency among dentist with musculoskeletal disorder

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Figure 9: Relieving factors and its frequency among dentist with musculoskeletal disorder

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Among the participants, 33% suffered MSD who treat five patients/day, whereas it is increased to 77% among those who treat more than five patients/day.

A total of 54.5% of the dentists in the survey regularly does exercise (Yoga, aerobics, sports etc.). Out of this 12.9% does exercise for ≤100 min/week, 21.9% exercise for 100-200 min/week and 20% does for more than 200 min in a week.

Medical treatment and physiotherapy play an important role in the management of such musculoskeletal pain (drugs and physiotherapy 17.3%) [Figure 10]. Among the 110 participants with MSD, 33.6% had never taken any treatment of their work-related pain, which revealed ignorance or negligence of the participants.
Figure 10: Percentage of treatment chosen by dentists afflicted by musculoskeletal disorder

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Only 4% of the participant's dentist uses magnifying loupes, and all of them were a specialist. Only 5% knows about and had training in ergonomics. [Figure 11] shows only 23% use adjustable backrest with armrest. All the respondents recognize the importance of education in ergonomics and correct posture and strongly suggest that it should be part of under graduate dental education.
Figure 11: Percentage of type of stool used by dentists

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Statistically, no significant correlation was found between MSDs and age, working with or without an assistant, operator position, exercise and rest breaks (P = 0.052, 0.719). There was a significant correlation between MSDs and gender (P = 0.032), with more female predilection to MSD and the number of patient treated per day (P = 0.001), more patient more MSD. Furthermore, significant correlation (P = 0.034) was found between MSD and the years in the profession with an increase in the prevalence of MSD with an increase in the years of practice and experience.


  Discussion Top


The results obtained in this study indicate that the surveyed dentists demonstrated improper working habits and deficient of basic knowledge of ergonomics. The results of the present study have established that the majority of dentists in the North-Eastern India do suffer from physical musculoskeletal health problems. A similar situation was reported in the Netherlands where one out of 10 dentists indicated having poor general health and three out of ten reported poor physical health. [22] The present study showed that dentists experience musculoskeletal pain very frequently (71%), which is similar to 78% in Thailand [17] and 79.8% in Spain, [10] but higher than 64% of the dentists in New South Wales, 63.6% in Gujarat, [23] 50% in Denmark, [16] 55% in Israel, [24] and 53% in the United States. [25]

[Figure 2] shows that the musculoskeletal disorder is more prevalent among female dentists than male with 78.9% of female affected compared to 66% male (P = 0.029). Female dentists face unique musculoskeletal demands and inherent gender differences that may place them at higher risk for occupational pain and injury than their male counterparts. [26]

The present study shows that the more years of age and practice and more patient per day may lead to more MSD (19.13% [<5 years experience], 43.91% [5-10 years], 70.87% [10-20 years] and 86.52% [>20 years]). According to some report, the occurrence of pain is not dependent on age, [10] whereas Marshall et al. found that musculoskeletal problems peaked among the dentists in their sixth decade of life. [27] On the other hand, Valachi's study indicates that young dentists suffer most intense pain. [26] There seems to be a correlation between years of professional experience and the percentage of dentists reporting pain.[2]

[Figure 4] shows that the most commonly reported source of pain is in the lower region of the back (48%), followed by the neck (24%) and upper back (23%). Similar incidence of lower back pain of 46% were found in a Greek study [28] and 53.7% in an Australian study, [29] whereas in a Polish studies incidence of MSD was found to be higher in lumbosacral and neck regions (60.1% and 56.3%, respectively). [2]

The survey revealed that only 29.5% of dentists choose to work in a sitting position with the patient in a supine position, that is, the working model promoted by the ESDE. This indicates the lack of knowledge and awareness from participant side regarding ergonomic as well as their health. According to the results of Szymanska's study, 27.6% of dentists worked in a standing position with the patient in sitting position, 22.8% adopted both dentist and patient sitting position, 39.2% alternated between both these positions, 1.1% always worked in sitting position with patient in supine position and 9.3% sometimes did so. [2] In the present study, 20% of the dentists still perform two-handed dentistry without an assistant, whereas Kierklo et al. found 63.6% of dentists work without an assistant and 3.64% practice "four-handed dentistry." [30]

Though in the present study [Figure 7] no significant difference was found among the number of breaks taken (P = 0.233). This could be because of the limitation of the understanding of the questionnaire. Numerous studies have pointed the positive influence of short breaks could have on the effectiveness and quality of work. At the same time, they stress that it is more effective to take more frequent short breaks than one longer break. [30],[31] The amount of rest that dentists gain when taking breaks depends not only on the duration of those breaks but most importantly on their frequency. [32] According to a study by Kierklo et al., 32.73% of dentists work without any break, 36.37% take one break a day, 16.36% have two breaks a day, and 8.18% rest after each patient. [30]

One factor that affects the dentist's ability to tolerate physical loading (both dynamic and static) is physical fitness. The present study found only 54.5% of the studied population exercise regularly. Whereas Hille et al. in his survey found 80.08% of the dentists in the regularly practice sports. [32] Regular exercise was found to be effective in preventing and relieving dental work-related pain. [33] Aerobic exercises are necessary to strengthen muscles and in this way prevent the occurrence of pain, while stretching can be helpful in softening pain in muscles and joints. [31]

[Figure 8] shows 39.70% of the dentist with MSD reported that pain is aggravated by prolong sitting, 35.90% by lifting heavy object others by driving, standing, rotation and weather. Pain is relieved by rest (38.40%), exercise (21.20%) and other relaxing methods [Figure 9].

Medical treatment and physiotherapy exercise play an important role in the management of musculoskeletal pain. Among the dentist with MSD, 33.6% had never taken any treatment of their work-related pain, which revealed negligence of the participants. Ignorance of pain in early stage and continuous exposure to aggravating factor ultimately convert mild and moderate pain into sever disabling pain. [32]

Present study found most frequently chosen method for combating pain is physiotherapy (19%) and pharmacological treatment (19%), followed by exercise and massage (17% and 18%), whereas in Szymanska's reported in his study that 64.6% of the dentists underwent treatment. The most frequently chosen method for combating pain in his study was physiotherapy (77.5%), followed by pharmacological treatment (67.1%). Another 20.2% chose other forms of treatment from among massage, treatment in a sanatorium, manual therapy and gymnastics. [2]

Only 5% of the surveyed dentist in the study had training on ergonomics. Kierklo et al. also reported that more than 90% of dentists do not know and do not observe the basic rules of ergonomics in the workplace. [29] To avoid the dangers of health-related problem dentists should constantly educate themselves all aspects of dental ergonomics to prevent MSDs. [32] Students should begin learning about ergonomics during their undergraduate coursework and continue to do so throughout their entire professional careers. [31]

The present study revealed that dentists pay insufficient attention to the ergonomic aspects of dental work. Therefore, dental students must be made aware of the need not only for ergonomic working conditions, but also the necessity of taking regular exercise. Hundred percent of the respondents feels the importance of education of ergonomics and education of correct posture and strongly suggest that it should be part of undergraduate dental education.

This study was a questionnaire-based cross-sectional study, and one of the limitations of questionnaire-based studies is that what people report may differ from their real situation. This study could only evaluate the association between variables, but not cause-effect relationship due to cross-sectional design. While the results of the present study have given some interesting findings, further research, in this case, is still required.


  Conclusion Top


Limited ergonomics in the work environment of the dentist's results in MSDs and its prevalence is very high. The symptoms of MSDs increase with the number of years of practice and age and have a gender predilection toward female.

Short breaks in between patient and regular exercise, especially relaxation exercise during their practice is recommended.

The prevention and reduction of MSDs among dentists should include their education in dental ergonomics and awareness regarding the importance of work-related risk factors. Education of correct posture should be part of undergraduate dental education.

 
  References Top

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