|Year : 2015 | Volume
| Issue : 3 | Page : 307-312
Prevalence of musculoskeletal disorders among dentists: A pilot cross-sectional survey
Deepsikha Sahu1, Shourya Tandon1, Sonal Dhingra1, BR Chinmaya1, Sumanth Prasad1, Esha Bali1, Abhishek Ghosh2
1 Department of Public Health Dentistry, Faculty of Dental Sciences, SGT University, Gurgaon, Haryana, India
2 Department of Public Health Dentistry, KM Shah Dental College, Baroda, Gujarat, India
|Date of Web Publication||14-Sep-2015|
Flat No. 302 b, Metro Residency, Behera Sahi, Nayapalli, Bhubaneswar, Orissa
Source of Support: None, Conflict of Interest: None
Introduction: Musculoskeletal symptoms are of major concern among dental practitioners. Work Related Musculoskeletal Disorders (WRMSD) has been reported to have a high prevalence among dentists in different parts of the world. Aim: To assess the prevalence of self-reported WRMSD among dental professionals in Gurgaon, one particular region of Delhi National Capital Region (NCR). Materials and Methods: A pilot cross-sectional survey of 250 dentists (response 81%) was done using a self-administered questionnaire, which consisted of 21 items based on the Nordic questionnaire for screening WRMSDs. Participants work related physical load characteristics, musculoskeletal symptom characteristics, etc., were evaluated. Results: A total of 206 dentists participated in the study, of which 106 were male, and 100 were female. The study yielded a prevalence of 81.06% (167 dentists) of which 79 males and 88 females were affected with MSD. There were 104 dentists who were young aged 20-29 years, 41 were 30-39 aged, 11 were above 40-49, and > 50 years suffered from MSDs. Around 59.2% young dentists aged 20-29 years, 24.2% were 30-39 years, 4.8% were 40-49 years, and 5.8% were above 50 years who were right handed, 2.9% dentists of 20-29 years age, 1.94% were 30-39 years, and 0.97% were 40-49 years who were left handed. Conclusion: This study found an overall prevalence rate of 81% among dentists with WRMSD in Delhi NCR. The measures for improving education and ergonomic evaluations are indicated on a large scale to prevent a decline in work performance and the incidence of WRMSDs among Delhi NCR dentists.
Keywords: Delhi National Capital Region, ergonomics, musculoskeletal disorders
|How to cite this article:|
Sahu D, Tandon S, Dhingra S, Chinmaya B R, Prasad S, Bali E, Ghosh A. Prevalence of musculoskeletal disorders among dentists: A pilot cross-sectional survey. J Indian Assoc Public Health Dent 2015;13:307-12
|How to cite this URL:|
Sahu D, Tandon S, Dhingra S, Chinmaya B R, Prasad S, Bali E, Ghosh A. Prevalence of musculoskeletal disorders among dentists: A pilot cross-sectional survey. J Indian Assoc Public Health Dent [serial online] 2015 [cited 2019 Jun 26];13:307-12. Available from: http://www.jiaphd.org/text.asp?2015/13/3/307/165281
| Introduction|| |
The practice of dentistry involves laborious high finesse dental preparations, precision, and control in executions that require a particular attention, concentration, and patience of the dentist; and finally, the dentist's physical and mental resistance. If ergonomics principles are applied in the field of dentistry, it helps to reduce cognitive and physical stress, prevent occupational hazards, thus, helps to improve productivity and more comfort to the dentist and the patient. 
According to WHO and National Institute for Occupational Safety and Health, the causes of work related musculoskeletal disorder (WRMSD) are multi-factorial which includes exposure to clinical condition, work place environment, organizational, psychosocial, and sociocultural variables amongst others. 
Ergonomics is the science that fits the job to a person's anatomical physiological and psychological characteristics in such a way that it enhances human efficiency and well-being. (International ergonomic Association).  The goal of ergonomics is to stabilize a safe, healthy, and comfortable working environment, thereby preventing health problem and improving productivity.  Dentistry is a profession where clinically operational skill is restricted to an area covering the teeth and the mouth, which requires repeated, precise force application while delivering oral health services.
The prevalence of work related musculoskeletal complaints in dentists is high and the past two decades have witnessed a sharp rise in the incidence of various disorders.  The specific nature of dental work is connected and accompanied by numerous harmful effects on the musculoskeletal systems. Standing or sitting positions which are frequently adopted, movement of body for access to the oral cavity, and adjusting dental chair positions during patient care, also connected with excessive tightening of some tissues and the straining of others, could be the source of painful disorders and diseases of musculoskeletal system. 
The prevalence of MSD among dental practitioners is not well documented in India.  Moreover, since the number of dentists in Delhi National Capital Region (NCR) is increasing exponentially, it becomes imperative to research any such WRMSD in such population. Thus, there arises a need to know about WRMSD among dentists in Gurgaon, part of Delhi NCR.
- To assess the prevalence of self-reported work related musculoskeletal complaints among dentists
- To assess the anatomic distribution of dentists with work related musculoskeletal complaints.
| Materials and methods|| |
Delhi NCR is expanding as part of the modernization of our country. NCR is India's largest and one of the world's largest agglomerations with a population of over 47,000,000.  There are a total of 23 districts within NCR covering a total area of 51,109 km 2 . 
With the motive of researching, an occupational hazard WRMSD in the field of dentistry a pilot cross-sectional study was conducted in Gurgaon, a part of Delhi NCR where the population of dentists is 682.  A close-ended, self-administered questionnaire survey with 21 items were recorded by paying a visit to 235 dental clinics in Gurgaon. It involved information on the respondent's individual characteristics, job history, method of work, and physical load. Musculoskeletal complaints were identified by the presence or absence of pain in each specific body region using Standardized Nordic Questionnaire (SNQ). The SNQ was aimed to develop and test a standardized questionnaire methodology allowing comparison to include a body map to indicate 9 symptom sites-neck, shoulder, upper back, elbows, lower back, wrist/hands, hip/thigh, knees, and ankles/feet. 
Data were collected in a set time frame of 4 months from March 2014 to June 2014 and by random convenience sampling a set of 206 dentists voluntarily participated in the study. The inclusion criteria were set with only those dentists having a clinical practice of 3 or more than 3 years. As exclusion criteria those unwilling to participate and having experience <3 years were not included in the study. The reason being that they must not be exposed to the practice to develop musculoskeletal complaints.
As the occupational hazard of WRMSD would become a major concern if dentistry is practiced in an un-ergonomic manner and also for a longer duration in the same manner. The sample was divided on the basis of four age groups. The data were analyzed to check for associations by Statistical package of social sciences. (SPSS, Chicago, IL, USA) version 17. The statistical significance was set at P < 0.05.
| Results|| |
A total of 206 dentists formed part of a study with 106 being males and 100 females. The sample was categorized into four age groups 20-29 years, 30-39 years, 40-49 years, and above 50 years [Table 1]. The gender distribution among dentists and number of patients treated and the amount of time spent on a patient per day revealed a higher statistical significance (P = 0.00 and P = 0.022) [Table 2]. The physical activity among male and female dentists was found to be statistically significant P = 0.005. The amount of time spent by the male and female dentists for exercise in a day was statistically significant (P = 0.002) [Table 3].
|Table 2: Gender-wise distribution of practice characteristics of dentists |
Click here to view
|Table 3: Distribution and comparison of gender of dentists and different variables related to exercises |
Click here to view
According to the Nordic questionnaire the regions affected among male and female dentists were statistically significant (P = 0.00). The different self-management strategies among dentists showed a statistically significant value (P = 0.00) [Table 4].
|Table 4: Distribution and comparison of gender with different variables of MSD and its management |
Click here to view
The association between age of dentists and daily practice hours had a statistically significant value (P - 0.00). When checked for a number of patients treated per day also had a statistically significant value (P - 0.00) [Table 5]. The time denoted for exercise per day by the dentists revealed a statistically significant value (P - 0.00) [Table 6].
|Table 5: Distribution and comparison of different age groups of dentists with all the variables measured |
Click here to view
|Table 6: Distribution and comparison of different age groups of dentists with the variables of exercise |
Click here to view
The regions affected among different age groups of dentists had a statistically significant value (P - 0.00). The self management strategies used by the dentists for the prevention of MSD also had a highly significant value (P - 0.00) [Table 7].
|Table 7: Distribution and comparison of different age groups of dentists with musculoskeletal complaints and its management |
Click here to view
| Discussion|| |
The study highlights and supports the established facts that WRMSD is a major concern for the dentists. The instrument used in this study is a self-administered questionnaire and SNQ, which records musculoskeletal symptoms and screens for MSD in an ergonomic context. It serves as a diagnostic tool for analyzing the work environment and identifying incompatibilities in the working environment. , This study has shown a high prevalence (81.06%) of MSD among dentists as compared to earlier studies, which reported the response rate ranging from 46% to 75%. ,,,
Results regarding the associations between different body regions with male and female dentists revealed a statistically significant value (P = 0.00). Female dentists were experiencing more pain in lower back (14.07%), ankle/foot (6.7%), and hip/thigh (3.39). On the other part, the male dentists experienced pain in other regions such as neck, wrist/hand, shoulder/arm, and knee/leg according to the present study.
In the present study, MSD increased with the age. Young dentists (20-29 years) were found to be less prone to MSD as compared to the older ones (above 40 years), which was statistically significant* (P = 0.00). Supporting results were seen in the study done in Mysore, Karnataka by Meenakshi et al.,  Puriene et al. in Poland,  and Lithuania.  These findings can be attributed to younger practitioners may be more aware of ergonomical positions, performing stretching exercises in between, took other self management measures, used better ergonomically oriented chairs when compared with older dentists. In contrast, other studies such as in Saudi Arabia and New South Wales revealed that MSDs decreases with age. ,
The practicing posture of the dentists revealed that dentists chose working in alternative sitting and standing position more. Ratzon et al.  concluded that those working in sitting position alone had more severe low back pain than those who alternated between sitting and standing positions.
Maintaining poor posture for long periods of time, can result in chronic muscular fatigue, discomfort, or pain, even if the soft tissues are not structurally altered. More significantly, prolonged exposure to high static muscle and joint load may lead the soft tissues to adaptively change, and with time may lead to pathological effects and permanent disability. 
Dentists predispose to pain/injury in different regions of the body depending on the type of work and position adopted. In the present study, the commonly affected areas were neck and lower back, which were similar to the study from Newzealand,  which showed a high prevalence of MSD among General Dental Practitioner regardless of the qualification and specialty, the prevalent site affected was low back and neck. These results indicate that most of the practitioners adopt positions, which frequently result in MSD of the neck and low back regions. However, Puriene et al.  have reported that most prevalent musculoskeletal complaint was MSD of the low back, which could be attributed to forward positioning of the operator to gain access to operating site.
Sustained forward bent posture not only fatigues the extensor musculature but also eccentrically overloads them, leading to ischemia and strain thus predisposing myofascial trigger points in low back muscles. 
Most of the dentists were found to be physically active. The association between physical activity and gender of dentists was justified in this study by showing a significant value. Kumar et al.  found a significant association between lack of physical activity and a number of regions affected and also with the percentage of dentists with recurrence for symptoms.
The inclusion criteria of minimum 3 years of experience for the dentists participated was the limitation of the study, whereas all the dentists who practice, irrespective of experience should be assessed for the musculoskeletal complaints.
The high prevalence of MSD in this study suggests the need to identify the factors predisposing to MSD among the dental practitioners. Dental surgeons must become more educated regarding the impact of their choices in seating in their work area. Therefore, the smart and modern dentist would definitely opt for the better option of adopting ergonomics rather than suffer its contrary.
| Conclusion|| |
Based on the findings of this study, it is concluded that WMSDs occurred in higher rate (81%) in Delhi NCR. All the dentists in the study had a musculoskeletal complaint with regard to one or more anatomical sites. Dental surgeons must become more educated regarding the impact of their choices in seating in their work area. Improper adoption of ergonomics may cause untoward changes in our body leading to WMSD. The prevention and reduction of MSDs among dentists should include their education in dental ergonomics through regular CDE programs and awareness regarding the importance of work related risk factors.
I want to thank all the people who helped in my study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Karibasappa GN, Sujatha A, Rajeswari K. Dentist′s knowledge, attitude and behavior towards the dental ergonomics. IOSR J Dent Med Sci 2014;13:86-9.
Khan SA, Chew KY. Effect of working characteristics and taught ergonomics on the prevalence of musculoskeletal disorders amongst dental students. BMC Musculoskelet Disord 2013;14:118.
Meenakshi S, Raghunath N, Nandlal, Murlidhar NV. Work related musculoskeletal disorders among general dental practitioners of Mysore district, Karnataka - A questionnaire survey. Int J Health Sci Res 2014;4:131-41.
Sharma P, Golchha V. Awareness among Indian dentist regarding the role of physical activity in prevention of work related musculoskeletal disorders. Indian J Dent Res 2011;22:381-4.
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.
Mamatha Y, Gopikrishna V, Kandaswamy D. Carpal tunnel syndrome: Survey of an occupational hazard. Indian J Dent Res 2005;16:109-13.
Crawford JO. The Nordic musculoskeletal questionnaire. Occup Med 2007;57:300-1.
Muralidharan D, Fareed N, Shanthi M. Musculoskeletal disorders among dental practitioners: Does it affect practice? Epidemiol Res Int 2013;2013:1-6.
Choobineh A, Tabatabaei SH, Tozihian M, Ghadami F. Musculoskeletal problems among workers of an Iranian communication company. Indian J Occup Environ Med 2007;11:32-6.
Gupta D, Batra R, Mahajan S, Bhaskar DJ, Jain A, Shiju M, et al.
Comparative evaluation of the complementary and alternative medicine therapy and conventional therapy use for musculoskeletal disorders management and its association with job satisfaction among dentists of West India. J Tradit Complement Med 2014;4:263-7.
Puriene A, Janulyte V, Musteikyte M, Bendinskaite R. General health of dentists. Literature review. Stomatologija 2007;9:10-20.
Puriene A, Aleksejuniene J, Petrauskiene J, Balciuniene I, Janulyte V. Self-reported occupational health issues among Lithuanian dentists. Ind Health 2008;46:369-74.
Abduljabbar TA. Musculoskeletal disorders among dentist in Saudi Arabia. Pak Oral Dent J 2000;28:135-44.
Marshall ED, Duncombe LM, Robinson RQ, Kilbreath SL. Musculoskeletal symptoms in New South Wales dentists. Aust Dent J 1997;42:240-6.
Ratzon NZ, Yaros T, Mizlik A, Kanner T. Musculoskeletal symptoms among dentists in relation to work posture. Work 2000;15:153-158.
Pandis N, Pandis BD, Pandis V, Eliades T. Occupational hazards in orthodontics: A review of risks and associated pathology. Am J Orthod Dentofacial Orthop 2007;132:280-92.
Ayers KM, Thomson WM, Newton JT, Morgaine KC, Rich AM. Self-reported occupational health of general dental practitioners. Occup Med (Lond) 2009;59:142-8.
Barry RM, Woodall WR, Mahan JM. Postural changes in dental hygienists. Four-year longitudinal study. J Dent Hyg 1992;66:147-50.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]