|Year : 2019 | Volume
| Issue : 2 | Page : 114-118
Assessment of musculoskeletal disorders and associated risk factors among dentists in Rajahmundry City: A cross-sectional study
Anvesh Gandham, Naveen Kumar Boppana, Narayana Rao Vinnakota, Kiran Karthik Burri, Usha Kiran Th, Akhil Pallepati
Department of Public Health Dentistry, Lenora Institute of Dental Sciences, Rajahmundry, Andhra Pradesh, India
|Date of Submission||25-Jan-2019|
|Date of Acceptance||27-Apr-2019|
|Date of Web Publication||20-Jun-2019|
Dr. Anvesh Gandham
Department of Public Health Dentistry, Lenora Institute of Dental Sciences, NH-16, Rajanagaram, Rajahmundry - 533 294, Andhra Pradesh
Source of Support: None, Conflict of Interest: None
Background: Like any other profession, dentistry is also plagued by many occupational health hazards (OHHs). Musculoskeletal disorders (MSDs) are one of the most common OHHs witnessed among dental practitioners. Aim: This study aimed to assess the prevalence and associated risk factors for MSDs among dental practitioners. Material and Methods: A prevalidated questionnaire was distributed among 150 dentists practicing in Rajahmundry city. The questionnaire was designed to procure information on demographic details and associated risk factors of MSDs experienced by them in the last 6 months. Chi-square test and multivariate regression analysis were employed to find significance among the study parameters and associated risk factors. Statistical analysis was performed using SPSS software (version 23.0, IBM, Chicago, IL, USA), and P < 0.05 was considered to be statistically significant. Results: Among the 150 respondents, 62.7% were males and 37.3% were females. The prevalence of MSD was observed as 58.7% and showed higher rates of pain in the neck (24%) followed by lower back region (20%) and upper back (14.7%). The associated risk factors were found to be number of working hours, number of cases treated per day, posture, and repetitive shoulder and hand movements (P < 0.05). Conclusion: This study revealed a relatively high prevalence of musculoskeletal pain among dentists, and there is a need to implement and practice preventive measures in order to minimize the problem.
Keywords: Dental practitioner, musculoskeletal disorders, risk factors
|How to cite this article:|
Gandham A, Boppana NK, Vinnakota NR, Burri KK, Kiran Th U, Pallepati A. Assessment of musculoskeletal disorders and associated risk factors among dentists in Rajahmundry City: A cross-sectional study. J Indian Assoc Public Health Dent 2019;17:114-8
|How to cite this URL:|
Gandham A, Boppana NK, Vinnakota NR, Burri KK, Kiran Th U, Pallepati A. Assessment of musculoskeletal disorders and associated risk factors among dentists in Rajahmundry City: A cross-sectional study. J Indian Assoc Public Health Dent [serial online] 2019 [cited 2019 Aug 24];17:114-8. Available from: http://www.jiaphd.org/text.asp?2019/17/2/114/260877
| Introduction|| |
The World Health Organization has characterized “work-related diseases” as multifactorial to indicate that a number of risk factors (e.g., physical, work organizational, psychological, psychosocial, individual, and sociocultural) contribute to these diseases. Musculoskeletal disorders (MSDs) are defined as a group of disorders that affect various organs of the musculoskeletal system. The term musculoskeletal disorders refers to conditions that involve nerves, tendons, muscles, and supporting structures of the body. They may be caused by an interplay of specific risk factors acting during work-related activities, such as repetitive motions, obstinate or static positions, forceful movements, exposure to vibration (Raynaud's disease), and mechanical stress. When these factors exist simultaneously, the risk of developing MSDs increases significantly. Inappropriate work area design, insufficient equipment, direct injuries, repetitive movements in working areas with dental instruments, and sitting for extended time with a flexed and twisted back are contributing factors to various neck and low-back ailments.
Dental professionals are commonly exposed to a variety of occupational risks such as chemical, mechanical, biological, and ergonomic issues, which create MSDs. The overall prevalence of MSDs in dentistry ranges from 63% to 93% worldwide. As a result, they commonly experience musculoskeletal pain during the course of their careers and often have to limit or even abandon their professional activities. This has a negative impact on their finance and even on their healthy life.
The awareness of MSDs in the dental profession has led to the development of a great deal of ergonomics and new technology in dentistry. By changing the ergonomic of dentistry from standing to seated four-handed dentistry, there is only a change in parts of the body, which experience pain. The cumulative effects of these occupational health hazards on the productivity of the dental practitioners may be detrimental.
Literatures on MSDs among dentists indicate that these complaints have contributed considerably to morbidity; hence, there is a need to address these issues in the overall interest of the dental practitioner's health, which is significant for his/her productivity. Therefore, a study was conducted to assess the prevalence of MSD and risk factors associated among dental practitioners in Rajahmundry city, Andhra Pradesh, India.
| Material and Methods|| |
A descriptive cross-sectional study was carried out on registered dental practitioners of Rajahmundry city to assess the prevalence of MSDs. The list of registered dental practitioners was procured from District Medical and Health Office, Kakinada. There were a total of 150 registered dental practitioners, and all were included in the study, i.e., the total sample was 150. The study was done between July 2017 and September 2017. Ethical clearance was obtained from the Institutional Ethical Committee, Lenora Institute of Dental Sciences, Rajahmundry (Ref no. 88/IEC/LIDS/2017). Informed consent was obtained from all the study participants. Incompletely returned forms were excluded from the study. The study was done using Nordic Musculoskeletal Questionnaire (NMQ) which was previously used in many studies. This questionnaire (NMQ) is suitable for application in workplaces and for a large number of participants very quickly and cheaply. The questionnaire included nine body areas including neck, shoulder, upper back, lower back, elbows, wrist/hands, thighs, knees, and ankles. Musculoskeletal complaints were defined as pain perceived in the last 6 months experienced as ache, discomfort, and numbness. It also includes demographic details and questions regarding the risk factors of MSDs that include number of years in dental profession, number of cases done per day, number of working hours, and awkward posture. It was pretested for comprehensibility and relevance among thirty dental practitioners prior to the study. The questionnaire was distributed to the dentists and collected after 1 day. Data obtained through the survey were coded and subjected for statistical analysis.
Statistical analysis was performed using SPSS software version 23, IBM, Chicago, IL, USA. Descriptive and inferential statistical analyses were carried out in the present study, with results on categorical measurements presented in frequency (%). Chi-square test was used to find the significance of the study parameters on categorical scale between the groups. Logistic regression analysis was performed to evaluate the individual characteristics and risk factors for the occurrence of MSD. Statistical significance level was assessed at 5% (P < 0.05).
| Results|| |
Among the study participants, majority belongs to the age group of 26–35 years (60.7%), followed by 36–45 years (36.7%), 22–25 years (1.3%), and above 45 years (1.3%). The mean age of the study sample was 29.06 ± 3.37 years. Among the study participants, 62.7% were males and 37.3% were females and 57.3% were MDS graduates and 42.7% were BDS graduates [Table 1].
|Table 1: Distribution of participants according to age, gender, and education|
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In the present study, 35.3% of dentists were practicing dentistry for more than 8 years, 23.3% were practicing for 6–8 years, 22% were in practice for <6 years, and 19.3% were practicing for 2–3 years. Majority of the study participants reported with treating 5–10 patients daily, i.e., 46%, followed by <5 cases, i.e., 34% and 18.7% of the study participants reported with treating about 11–20 cases [Table 2].
|Table 2: Distribution of participants according to educational qualification, years of practice, and number of cases treated per day|
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The highest prevalence was observed in the neck region (24%), followed by lower back region (20%), upper back (14.7%), and wrist/hand (12.7%); however, 20.7% of the dentists have not reported with any pain symptoms for the last 6 months.
When the association of various risk factors related to MSD was analyzed, it was observed that the difference observed among gender, age, working position, working hours, awkward posture, repetitive shoulder and hand movements, and number of cases treated per day was statistically significant (P < 0.05) [Table 3].
|Table 3: Distribution of musculoskeletal disorder problem in relation to risk factors|
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Considering the number of cases treated per day, dentists who treated > 30 cases per day were found to have two times more chance of having MSDs followed by those treating 20–30 cases with 1.95 times more and by those treating 10–20 cases per day with 1.75 times more chance of having MSDs, which was statistically significant [Table 4].
|Table 4: Multivariate analysis of risk factors of musculoskeletal disorders|
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Among the Dental practitioners, 2.7% reported using ergonomically designed chairs,1.3% reported using support of upper arm, 3.3% reported using indirect vision, 17.3% using proper patient seating position, 5.3% reported using proper lighting for good visibility and 70.3% responded utilizing all the above mentioned factors for reducing MSDs.
| Discussion|| |
The present cross-sectional study was conducted to find the prevalence and associated risk factors of MSD among dental practitioners in Rajahmundry city. The dental practitioners were asked to report the symptoms related to MSD over the last 6 months through a prevalidated questionnaire.
Almost all the published studies on MSD in dentistry had an observational design, which in turn helped in determining the clinical features of MSDs among the study participants and designing possible preventive strategies. The practice of dentistry is characterized by high visual demands because of which the dental practitioners have to adopt convenient postures, which creates less strain.
In our study, more than half of the dental practitioners (58.7%) had experienced MSD. Whereas in a study conducted among Greece dentists, the prevalence of MSD was found to be 62%. Respondents reported with MSD showed higher rates of pain in the neck (24%), lower back region (20%), and upper back region (14.7%). A study conducted on 204 dental practitioners in Riyadh city reported 54.4% of respondents with neck pain and 73.5% with back pain. In another study, the prevalence of neck and back pain was found to be 81.9% and 88.1%, respectively. In a review on MSD of neck and shoulder in dental professionals, neck symptoms were reported in 26%–73% of the respondents. The probable reason for the high prevalence of MSD in the neck and lower back regions was treating more number of patients in less time and unable to follow proper ergonomic positions, leading to muscle strain.
In the present study, it was observed that the number of years of practice and the number of working hours per day, number of cases treated per day, faulty dentist's position, and repetitive shoulder and hand movements are the risk factors of MSD. Similar findings were observed in few other studies.,
Maintaining awkward position while treating patients plays an important role in the occurrence of MSDs due to high load on soft tissues and strain on the muscles. In the present study, there was a statistical difference to this factor. Working position has found a statistical difference; it is more prevalent in respondents reported with seated dental practice. Direct vision plays a critical role in the occurrence of MSDs due to continuous forward bending of the operator during treatment, and there was a statistically significant difference observed in the present study.
Among the various symptoms of MSDs, pain in the neck and lower back was more prevalent in our study participants, followed by pain in the wrist/hand, shoulder, forearms, and upper back. As it is known commonly, maintaining poor posture for long periods 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.,
A statistically significant association was observed in our study, as when the number of cases treated per day increases, the severity of problem also increases. It was observed that the number of years of activity and the number of working hours/day are predisposing factors for MSDs. In our study, results showed that the prevalence of MSDs increased with years in profession, i.e., 37%. Similar findings were observed in dentists of Saudi Arabia. It was observed that, in the present study, there was a statistically significant difference in reporting the burden of symptoms of MSDs among younger and older dentists; as when age increases, there was a high prevalence of MSDs, similar results were observed in a study conducted on Greek dentists.
In the present study, statistically significant differences were found between male and female groups; this is in line with the study conducted in Saudi Arabian dentists. However, contrary to this, in a study conducted in Al Medina, a significant association was observed.
Long working hours may have a significant role to play in being responsible for various MSD and health-related issues among dental practitioners as they do not provide enough rest to their body and mind. Nutalapati et al. advised a number of different strategies to limit musculoskeletal problems among dentists by improving surgery ergonomics. These strategies involve proper chair side positioning, avoidance of prolonged static postures, excessive twisting motions, periodic breaks, and stretching. All these strategies could be taught under a wider health promotion preventive program as part of an undergraduate curriculum. Use of ergonomic design and appropriate selection of hand tools can reduce exposure to cumulative trauma. Hence, the preventive strategies of MSD should focus on ergonomics, breaks at work, general health, and physical exercise.
The limitation of this study was the inclusion of only one geographic area to recruit the participants. Dentists practicing in different geographical regions of different states can be included in future research investigations on MSDs in order to obtain more comprehensive data.
| Conclusion|| |
As the prevalence of musculoskeletal symptoms among dentists in Rajahmundry city seems to be high, it emphasizes that MSD remains a major occupational health problem for dentists with the most common problem of neck and lower back pain. Therefore, it is of vital importance to promote occupational health and preventive programs regarding ergonomic postures and conducting awareness programs that must be acquired by the dentists during their day-to-day clinical practice.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Shankar R, Kalappa S. Practice patterns and their influence on prevalence of musculoskeletal disorders among Indian dentists. Int J Res Med Sci 2015;3:3459-64.
Kierklo A, Kobus A, Jaworska M, Botuliński B. Work-related musculoskeletal disorders among dentists – A questionnaire survey. Ann Agric Environ Med 2011;18:79-84.
Nasl SJ, Hosseini MH, Shahtahei SJ. Golbabaei F, Ghasemkhani M. Evaluation of ergonomic postures of dental professions by REBA. J Dent 2005;18:61-8.
Rabiei M, Shakiba M, Shahreza DH. Musculoskeletal disorders in dentists. Int J Occup Hyg 2012;4:36-40.
Alexopoulos EC, Stathi IC, Charizani F. Prevalence of musculoskeletal disorders in dentists. BMC Musculoskelet Disord 2004;5:16.
Al Wazzan KA, Almas K, Al Shethri SE, Al-Qahtani MQ. Back & neck problems among dentists and dental auxiliaries. J Contemp Dent Pract 2001;2:17-30.
Abiodun-Solanke IM, Agbaje JO, Ajayi DM, Arotiba JT. Prevalence of neck and back pain among dentists and dental auxiliaries in South-Western Nigeria. Afr J Med Med Sci 2010;39:137-42.
Valachi B, Valachi K. Mechanisms leading to musculoskeletal disorders in dentistry. J Am Dent Assoc 2003;134:1344-50.
Oliveira Dantas FF, de Lima KC. The relationship between physical load and musculoskeletal complaints among Brazilian dentists. Appl Ergon 2015;47:93-8.
Garbin AJ, Garbin CA, Moimaz SA, Baldan RC, Zina LG. Dental practice and musculoskeletal disorders association: A look at the evidence. Arch Environ Occup Health 2011;66:26-33.
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.
Gunaid TH, Abdulhai R, Flemban B. Prevalence of musculoskeletal disorders among dentists in Al-Madinah, Kingdom of Saudi Arabia. Int J Recent Surg Med Sci 2017;3:15-9.
Abduli Jabbar TA. Musculoskeletal disorders among dentists in Saudi Arabia. Pak Oral Dent J 2008;28:135-44.
Kaul R, Shilpa PS, Sanjay CJ. Musculoskeletal disorders and mental health related issues as occupational hazards among dental practitioners in the city of Bengaluru: A randomized cross-sectional study. Int J Med and Dent Sci 2015;4:589-98.
Nutalapati R, Gaddipati R, Chitta H, Pinninti M, Boyapati R. Ergonomics in dentistry and the prevention of musculoskeletal disorders in dentists. Internet J Occup Health 2009;1:1-9.
[Table 1], [Table 2], [Table 3], [Table 4]