|Year : 2015 | Volume
| Issue : 3 | Page : 302-306
Prevalence of musculoskeletal pain in dental practitioners in Davangere, Karnataka: A cross-sectional survey
DJ Veeresh1, GY Yunus2, R Deepta1
1 Department of Public Health Dentistry, Bapuji Dental College and Hospital, Davangere, Karnataka, India
2 Department of Public Health Dentistry, Rungta College of Dental Science and Research, Bhilai, Chhattisgarh, India
|Date of Web Publication||14-Sep-2015|
G Y Yunus
Department of Public Health Dentistry, Rungta College of Dental Sciences and Research, Bhilai, Chhattisgarh
Source of Support: None, Conflict of Interest: None
Introduction: Despite numerous advances in dentistry many occupational health problems still persist in modern dentistry, of which the most common is a musculoskeletal disorder (MSD) and pain is the most common symptom of MSD. Aim: To investigate the prevalence of musculoskeletal pain among the dental practitioners in Davangere and the prevalence of pain in different anatomic location. Materials and Methods: A cross-sectional survey was conducted among 70 dental practitioners residing in Davangere city. A self-designed questionnaire containing eight questions was self-administered to all the available dentists at their place of work. The data collected were analyzed using descriptive statistics and Chi- square test. Results: The prevalence of at least one musculoskeletal pain among the dentists was found to be 34.71%, and they reported a higher frequency of pain in the neck region (71%). Conclusions: Among the dentists practicing in Davangere, there was relatively lower prevalence of at least one musculoskeletal pain and the most common site of pain was neck region.
Keywords: Backache, dentists, musculoskeletal, neck pain
|How to cite this article:|
Veeresh D J, Yunus G Y, Deepta R. Prevalence of musculoskeletal pain in dental practitioners in Davangere, Karnataka: A cross-sectional survey. J Indian Assoc Public Health Dent 2015;13:302-6
|How to cite this URL:|
Veeresh D J, Yunus G Y, Deepta R. Prevalence of musculoskeletal pain in dental practitioners in Davangere, Karnataka: A cross-sectional survey. J Indian Assoc Public Health Dent [serial online] 2015 [cited 2019 Aug 25];13:302-6. Available from: http://www.jiaphd.org/text.asp?2015/13/3/302/165280
| Introduction|| |
Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity, which leads to a socially and economically productive life.  Healthy body helps us be more productive. However, in today's world, health takes a backbench due to work stress. 
Dentistry is a highly rewarding profession, but it is a very demanding job with a high degree of concentration and precision in work. Dentists require good visual acuity, hearing, depth perception, psychomotor skills, manual dexterity, and ability to maintain occupational postures over long periods.  Uncomfortable positions frequently adopted by dentists lead to excessive tightening of some tissues and the straining of other tissues. Apart from the physical strain, dental professionals are predisposed to a number of occupational hazards. These include exposure to infections, percutaneous exposure incidence, dental materials, radiation, respiratory disorders, and eye insults. Nevertheless, the most common subtle disorder existing among the dentist is the musculoskeletal disorder (MSD). ,
MSDs are described as disorders of the muscles, nerves, tendons, ligaments, joints, cartilage, or spinal discs.  They result from one or more of these tissues having to work harder than they are designed to.  MSD may be caused due to improper working posture, repeated unidirectional twisting of the trunk, working in one position for prolonged period, operators not knowing how to adjust properly ergonomic equipment, and physiological damage or pain.  Estimates have shown that MSD contributes to about 40% of all costs toward the treatment of work-related injuries.  Pain is the most common symptom associated with MSD. In some cases, there may be joint stiffness, muscle tightness, redness, and swelling of the affected area. Sensations of "pins and needles," numbness, skin color changes, and decreased sweating of the hands may also be experienced. 
Thorough exploration of available literature resources revealed no studies conducted in Davangere to determine the prevalence of musculoskeletal pain among general dental practitioners. Hence, this study was conducted with the aim to determine the prevalence of MSD among general dental practitioners in Davangere city and factors associated with its prevalence. The objectives of this study were to know the prevalence of pain in different anatomic location and to investigate the association between MSD and demographic and clinical details.
| Materials and methods|| |
This study was a cross-sectional survey. Ethical clearance for the study was obtained from the Institutional Review Board. Written, voluntary informed consent was taken from the study participants prior to the beginning of the study. The data were collected from June to July 2013.
The list of practicing dentists was obtained from the Indian Dental Association (IDA), Davangere branch. The list contained totally of 97 dentists who constituted the sampling frame of the study. Of the 97 dentists, 85 dentists participated in the main study and 12 in a pilot study.
A self-designed close-ended structured questionnaire containing eight questions was developed by modifying the Standardized Nordic Questionnaire.  The modifications were with respect to the answering options and shortening of the questionnaire. The contents of the questionnaire and face validation were carried out among 10 experts in the subject of Public Health Dentistry. The reliability of the questionnaire was assessed by distributing the questionnaire to 12 practitioners who were not included in the study. The data were collected and subjected to analysis. The reliability of the questionnaire was 0.76 (Cronbach's alpha), which was considered good.
The questionnaire was divided into three sections. The first section included demographic details such as age, sex, height, weight, and the qualification of the study participant. The second section included the work experience of the dentists, duration of the working hours, number of patients examined in a day, hand dominance and type of dentistry. The third section contained the details regarding the location and the frequency of pain in each anatomic location. The locations of pain included neck, low back, shoulder, forearm, hand and wrist, elbow, upper back, one or both hip or thighs, one or both ankle or feet, one or both knees. For frequency, the options given here were often, occasionally and never.
Self-administered questionnaire was given to the practitioner at the clinic or college or residence according to the convenience of the practitioner. The questionnaires were distributed in the colleges (Bapuji Dental College and College of Dental Sciences) and in dental clinics. Questionnaires were distributed to 85 practitioners, of which 70 were returned. The questionnaires were collected on the same day. The time taken by each participant to fill the questionnaire was approximately 8-10 min.
The data were analyzed using SPSS version 17.0 (IBM Corporation, SPSS Inc., Chicago, IL, USA). Descriptive statistics was used to represent the data in frequencies and percentages. Chi-square test was done to determine the association among the sociodemographic variables, clinical demographic variables, and the location of pain.
| Results|| |
The response rate for the survey was 82.35%. The sample consisted of totally 70 participants of whom 44 participants were male, 63 participants had a MDS degree, and 57 participants practiced their branch exclusively [Table 1]. The total mean age, height and weight of the participants, were 35.61 ± 6.37 years, 168.83 ± 8.81 cm, and 69.59 ± 10.52 kg, respectively [Table 2]. 56% of dentists were practicing for 5 years or less. Approximately, half of dentists were practicing for 3-6 h/day (53%) and saw < 5 patients per day (50%). About 85% of practicing dentists were associated with dental institutions. Equal number of dentists practiced right and left-handed dentistry, and 51% of dentists practiced fourhanded dentistry [Table 3].
For the analysis of the prevalence of pain according to the anatomic locations, the options often and occasionally were combined together as the percentage of participants who answered the option often was meager. The prevalence of MSDs among the dentists was found to be 34.71%. Low back pain (70%) was found to occur with higher frequency, followed by shoulder pain (44%), and hand and wrist pain (43%) among the dentists [Table 4].
A statistically significant association was found between weight and forearm pain (P = 0.036), weight and upper back pain (P = 0.015), weight and one or both ankle/feet (P = 0.003), years of practices and one or both hip/thighs (P = 0.035) and association to dental institution and elbows pain (P = 0.004). Other associations were not statistically significant though an association between the height of the dentist and upper back pain can be considered to marginally significant (P = 0.052).
| Discussion|| |
To our limited knowledge, this is the first study to assess the prevalence of musculoskeletal pain among the dentists of Davangere, Karnataka. MSD is prevalent worldwide and is one of the commonest causes of long-term pain and disability affecting hundreds of millions of people.  World Health Organization and United Nations have recognized this fact with their endorsement of the Bone and Joint decade 2000-2010.  MSD is characterized by the presence of discomfort, disability or persistent pain in the joints, muscles, tendons, and other soft parts, caused or aggravated by repeated movements and prolonged awkward or forced body postures. 
Dentists frequently assume static postures, which require more than 50% of the body's muscles to contract and hold the body motionless while resisting gravity. The static forces resulting from these postures have been shown much more taxing than dynamic (moving) forces.  When the body is repeatedly subjected to such prolonged static postures, it results in pain, injury, or career ending MSD. MSD has an impact not only on the physical, but also on the psychological and social aspects of the practitioners. Work-related MSD in severe cases results in frequent absences and finally to early retirement.
In this study, 34.71% of the dentists reported at least one musculoskeletal pain which is lower when compared to the studies reported by Rabiei et al. (73%),  Muralidharan et al. (78%),  Kumar et al. (100%),  Saxena et al. (83%),  Leggat and Smith (87%)  and Rehman et al. (46.7%).  The descending order of frequency of pain in the anatomical sites was the neck, lower back, shoulder, and hand/wrist. Neck was the most common site of pain (71%), which is in accordance with studies reported by Rabiei et al. (43%),  Hayes et al. (85%),  Muralidharan et al. (52%)  and Szymańska (56%).
The second most frequently occurring site of pain was found to be lower back, which was, reported 70% in our study. Similar prevalence rate was reported by Hayes et al. (68%)  and Kumar et al. (72%).  Conflicting prevalence rates were reported by Muralidharan et al. (41%),  Leggat and Smith (53.7%),  Rehman et al. (57.8%),  Saxena et al. (57.5%),  Szymańska (60%) and Shaik et al. (83.3%).  Back pain is one of the most common and troublesome of complaints. It has been stated that the most common site of pain among dentists and dental auxiliaries are in the areas of cervical and lumbar vertebrae.  The shape of a vertebral column, aging, changes, weak muscles, postural practice, movements, lifting techniques and mechanical stress have been identified as factors that can contribute to the neck and back pain in general. , According to Walters,  stress, postural practices (bending and twisting trying to gain better access and visibility within the oral cavity) as well as prolonged working time lead to fatigue. Various other investigators have pointed out the common postural faults among dentists and dental auxiliary personal, such as craning, excessive bending and twisting of neck, bending forward from the waist, elevation of the shoulders and general bending and twisting of neck and back. ,,,
The frequency of shoulder pain in our study was found to be 44% which contrasting when compared to Rabiei et al. (25%),  Hayes et al. (70%),  Muralidharan et al. (29%),  Shaik et al. (6.6%),  Kumar et al. (69.4%),  Leggat and Smith (53.3%)  and Rehman et al. (29.6%).  Hand and wrist pain was found in 42.85% of dentists in this study which is more when compared with studies reported by Rabiei et al. (25%),  Muralidharan et al. (26%),  Saxena et al. (17.8%)  and less when compared to study reported by Kumar et al. (73.13%).  The reasons for conflicting reasons could be that most of the dentists in the present study were practicing for the lesser duration of 3-6 h and on an average treating only 5 patients per day. Our study results are in agreement with wrist and hand pain as reported by 44% of Polish dentists, Swedish dentists and 33.7% of dentists in Queensland, Australia. ,, A recent literature review regarding the general health of dentists stated that dentals experience a high prevalence of hand or wrist pain. 
The authors attribute the high frequency of symptoms of neck, shoulders and upper extremities among the dentists to be probably connected with their difficult work positions - cervical flexion and rotation, elevated arms, and repetitive precision-demanding handgrips.  Literature has revealed that experienced dentists are probably better at adjusting their working position and techniques in order to avoid musculoskeletal problems compared to their less experienced counterparts, or they simply developed coping strategies to deal with the pain. Another more likely explanation, however, is simply that those dentists with severe musculoskeletal problems would have discontinued practicing, and would thus not have been captured in this cross-sectional survey. ,, This hypothesis is partially supported by a 5-year follow-up study of dentists in Sweden. 
In this study, a significant association between musculoskeletal pain and weight was observed, which is not in agreement with the findings of Soriano et al.  and Akesson et al.,  where no association was found between weight and musculoskeletal pain among dentists, whereas Al Wazzan et al.  have found a minor effect of weight on neck and back pain. One study from Sweden, which compared 6328 obese individuals with 1135 individuals from the general population of both genders, found that pain in the neck, lumbar region, hip, knee, and ankle was more common in obese people than in the general population (odds ratio ranging from 1.7 to 9.9, P < 0.001).  However, given the multifactorial nature of musculoskeletal pain among dentists, it is likely that weight may act as a predisposing factor and thereby interacting and enhancing the effects of other important risk factors for the occurrence of musculoskeletal pain. 
Limitations of the study
Only the dentists registered with IDA were part of this study, which may not be a representative sample and the total sample size of the study (n = 70) lacked the power to show true differences. The personal experiences of study participants who complete the questionnaire may affect the results. The reporting of pain was a self-reported measure, which is subjective. The study participants who have faced serious and current musculoskeletal disorders are more likely to remember as compared to older and less grave ones. An objective measure of validating the pain would have been better. Therefore, there might be over or underestimation of the prevalence. Further studies must be conducted by overcoming the limitations of the study.
| Conclusions|| |
Prevalence of MSD among the dentists practicing in Davangere was found to be low. However, the majority of the dentists reported a higher frequency of neck pain when compared to other anatomical locations. To prevent the occurrence of pain in future dentists, more emphasis must be placed on prevention strategies and proper work positioning in the undergraduate and postgraduate curriculum. Continuing dental education programs can be conducted for practicing dentists to update their knowledge.
We are grateful to Dr. Bhagyajyothi and Dr. Nagesh L for their support in framing the questionnaire. We thank all the dentists who participated in our study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Preamble to the Constitution of the World Health Organization as Adopted by the International Health Conference, New York, 19-22 June 1946; Signed on 22 July 1946 by the Representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and Entered into Force on 7 April, 1948.
Muralidharan D, Fareed N, Shanthi M. Musculoskeletal disorders among dental practitioners: Does it affect practice? Epidemiol Res Int 2013;2013:6.
Hayes MJ, Smith DR, Taylor JA. Musculoskeletal disorders and symptom severity among Australian dental hygienists. BMC Res Notes 2013;6:250.
Kierklo A, Kobus A, Jaworska M, Botulinski B. Work-related musculoskeletal disorders among dentists - A questionnaire survey. Ann Agric Environ Med 2011;18:79-84.
Kuorinka I, Jonsson B, Kilbom A, Vinterberg H, Biering-Sørensen F, Andersson G, et al.
Standardised Nordic questionnaires for the analysis of musculoskeletal symptoms. Appl Ergon 1987;18:233-7.
Valachi B, Valachi K. Preventing musculoskeletal disorders in clinical dentistry: Strategies to address the mechanisms leading to musculoskeletal disorders. J Am Dent Assoc 2003;134:1604-12.
Rundcrantz BL, Johnsson B, Moritz U, Roxendal G. Occupational cervico-brachial disorders among dentists. Psychosocial work environment, personal harmony and life-satisfaction. Scand J Soc Med 1991;19:174-80.
Rabiei M, Shakiba M, Shahreza HD, Talebzadeh M. Musculoskeletal disorders in dentists. Int J Occup Hyg 2012;4:36-40.
Kumar VK, Kumar SP, Baliga MR. Prevalence of work-related musculoskeletal complaints among dentists in India: A national cross-sectional survey. Indian J Dent Res 2013;24:428-38.
Saxena P, Gupta SK, Jain S, Jain D. Work-related musculoskeletal pain among dentists in Madhya Pradesh, India: Prevalence, associated risk factors, and preventive measures. Asia Pac J Public Health 2014;26:304-9.
Leggat PA, Smith DR. Musculoskeletal disorders self-reported by dentists in Queensland, Australia. Aust Dent J 2006;51:324-7.
Rehman K, Ayaz H, Urooj W, Shah R. Work-related musculoskeletal disorders among dental practitioners in Khyber Pakhtunkhwa. Pak Oral Dent J 2013;33:531-4.
Szymañska J. Occupational hazards of dentistry. Ann Agric Environ Med 1999;6:13-9.
Shaik AR, Rao SB, Husain A, D′sa J. Work-related musculoskeletal disorders among dental surgeons: A pilot study. Contemp Clin Dent 2011;2:308-12.
Marshall ED, Duncombe LM, Robinson RQ, Kilbreath SL. Musculoskeletal symptoms in New South Wales dentists. Aust Dent J 1997;42:240-6.
Bassett S. Back problems among dentists. J Can Dent Assoc 1983;49:251-6.
Walters E. How to live with failure and stress. Dent Manage 1976;16:20-4.
Fox JG, Jones JM. Occupational stress in dental practice. Br Dent J 1967;123:465-73.
Paul E. The technique of seated dentistry. Qunt Int Dent Diag 1979;10:19.
Puriene A, Janulyte V, Musteikyte M, Bendinskaite R. General health of dentists. Literature review. Stomatologija 2007;9:10-20.
Willee AW. How to avoid the occupational hazards of dentistry. Aust Dent J 1967;12:348-59.
Akesson I, Johnsson B, Rylander L, Moritz U, Skerfving S. Musculoskeletal disorders among female dental personnel - Clinical examination and a 5-year follow-up study of symptoms. Int Arch Occup Environ Health 1999;72:395-403.
Soriano EP, Carvalho MV, Araújo AV, Vidal HG, Carvalho KM, Mendoza CC. Cumulative trauma disorders, overweight and obesity among Brazilian dentists. Braz J Oral Sci 2011;10:130-5.
Akesson I, Schütz A, Horstmann V, Skerfving S, Moritz U. Musculoskeletal symptoms among dental personnel; lack of association with mercury and selenium status, overweight and smoking. Swed Dent J 2000;24:23-38.
Al Wazzan KA, Almas K, Al Shethri SE, Al-Qahtani MQ. Back and neck problems among dentists and dental auxiliaries. J Contemp Dent Pract 2001;2:17-30.
Peltonen M, Lindroos AK, Torgerson JS. Musculoskeletal pain in the obese: A comparison with a general population and long-term changes after conventional and surgical obesity treatment. Pain 2003;104:549-57.
Wearing SC, Hennig EM, Byrne NM, Steele JR, Hills AP. Musculoskeletal disorders associated with obesity: A biomechanical perspective. Obes Rev 2006;7:239-50.
[Table 1], [Table 2], [Table 3], [Table 4]