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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 6  |  Issue : 1  |  Page : 50-54

Prevalence of musculoskeletal disorders among dental students: A questionnaire survey


1 Department of Oral and Maxillofacial Surgery, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, Tamil Nadu, India
2 Department of Public Health Dentistry and Oral Pathology, Sri Ramachandra Dental College and Hospital, Chennai, Tamil Nadu, India

Date of Submission06-Oct-2021
Date of Acceptance07-Oct-2021
Date of Web Publication29-Nov-2021

Correspondence Address:
Dr. N Sharada
Department of Oral Pathology, Sri Ramachandra Dental College and Hospital Porur, Chennai - 600 116, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijosr.ijosr_32_21

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  Abstract 


Introduction: The most important causes of this disorder can be awkward postures, repetitive and rapid movements, excessive force, psychological factors, and genetic and generally inappropriate body condition. Damage or injury can be defined as a disorder of the musculoskeletal system (muscles, ligaments, tendons, joints, nerves, blood vessels, and soft tissues). The symptoms of musculoskeletal disorders (MSDs) increase with the number of years of practice. The prevention and reduction of MSDs among dentists should include their knowledge in dental ergonomics and awareness regarding the importance of work-related risk factors. This study aimed to identify risk factors for MSDs among dentists and identify its effective risk factors, in order to reduce musculoskeletal problems, and is designed to improve the work environment. Materials and Methods: The target population of this investigation was the students of dental school. A sample of 300 questionnaires were distributed. To determine the prevalence of MSDs, the questionnaire was prepared. The questionnaire assessed the MSDs, pain in different organs of the body. Finally, the results are evaluated in percentage. Results: Out of 300 questionnaires distributed, the female prevalence was higher. Eighty-six percent of the people do not do physical exercise daily. Seventy-one percent of the dental students take rest after each patient, 15% take rest once an hour, and 13% of the students never take rest at all. Ninety-five percent of the dental students involve frequent bending of elbows and joints. Ninety-one percent of them feel some kind of musculoskeletal discomfort in the body and other 9% are free from it. Most discomfort is felt in the neck region that is 41% and 23% in one or both elbows, 15% in one or both shoulders, and 20% in back/spine. Sixty-six percent of the students feel the pain most of the time and 22% always and 11% at times. Fifty percent of the students follow periodic stretching and breaks as the pain relief strategy. Thirty-six percent follow postural awareness strategy and 13% follow strengthening exercises. Conclusion: Therefore, dentists should implement right ergonomic designs in their dental clinics along with doing regular exercise and relaxation techniques, which help them to combat stress, thus improving the quality of life and resulting in consistent long-lasting work efficiency of the dentists.

Keywords: Dentists, long-lasting work, musculoskeletal, occupational, pain


How to cite this article:
Geethika S, Sharada N. Prevalence of musculoskeletal disorders among dental students: A questionnaire survey. Int J Soc Rehabil 2021;6:50-4

How to cite this URL:
Geethika S, Sharada N. Prevalence of musculoskeletal disorders among dental students: A questionnaire survey. Int J Soc Rehabil [serial online] 2021 [cited 2022 Nov 27];6:50-4. Available from: https://www.ijsocialrehab.com/text.asp?2021/6/1/50/331478




  Introduction Top


Today, work-related musculoskeletal disorders (WMSDs) are one of the most common occupational diseases and causes of disability in developing countries.[1] The most important causes of this disorder can be awkward postures, repetitive and rapid movements, excessive force, psychological factors, and genetic and generally inappropriate body condition. Damage or injury can be defined as a disorder of the musculoskeletal system (muscles, ligaments, tendons, joints, nerves, blood vessels, and soft tissues).[2] Studies have shown that the best strategy to prevent WMSDs is to reduce exposure to risk factors such as repetitive movements, excessive force, awkward postures, vibration, and static work.

This study aimed to identify risk factors for MSDs among dentists and identify its effective risk factors, in order to reduce musculoskeletal problems, and is designed to improve the work environment. MSDs have become increasingly common worldwide during the past decades. It is a common cause of work-related disability among workers with substantial financial consequences due to workers' compensation and medical expenses. Various work-related factors have been established as predisposing the disorders. A slight hand neuropathy has also been reported caused by exposure to high-frequency vibration tools. In most studies, only a few of these risk factors have been taken into account simultaneously.

This makes it difficult to appreciate the impact of specific risk factors since most studies did not control appropriately for concurrent risk factors. In Greece, very few studies have been undertaken in occupational groups with respect to the simultaneous occurrence of different musculoskeletal complaints and their interrelationships. The first aim of this study was to investigate associations between personal characteristics, physical load, psychosocial factors, and general health status with complaints of back, neck, shoulder, and hand/wrist. The second aim was to analyze the interrelations between these musculoskeletal complaints and its effect on associations between work-related risk factors and musculoskeletal complaints. Dental surgeons often cannot avoid prolonged static postures. Even in optimal seated postures, more than one-half of the muscles of the body are contracted statically and there is little movement of the vertebral joints. This may result in damaging physiological changes that can lead to back, neck, or shoulder pain or MSDs.

If regularly occurring pain or discomfort is ignored, the cumulative physiological damage can lead to an injury (macro change) or a career-ending disability. Basic operating posture is considered an important occupational health issue for dental surgeons. It is generally agreed that the physical posture of the operator should be such that all the muscles are in a relaxed, well-balanced, and neutral position. Postures outside of this neutral position are likely to cause musculoskeletal discomfort. A thorough understanding of the underlying physiological mechanism leading to these problems is necessary to develop and implement a comprehensive approach to minimize the risk of work-related injury.[3],[4] In dentistry, bad working habits and repetitive tasks such as scaling, root planing, and uncomfortable physical postures contribute greatly to MSDs, stress, and loss of productivity. The key objective for clinicians is to find a position that allows them to achieve optimum access, visibility, comfort, and control at all times.


  Materials and Methods Top


The target population of this investigation was the students of dental school. A sample of 300 questionnaires were distributed. To determine the prevalence of MSDs, the questionnaire was prepared. The questionnaire assessed the MSDs, pain in different organs of the body. Finally, the results are evaluated in percentage. These questions addressed items such as tiredness after work, fatigue, lack of concentration, putting interest in other people, the ability to recover from work, and the influence on work performance. For both general health endpoints, subjects with a score above the median value were considered to have a high need for recovery or a moderate/bad general health. Musculoskeletal complaints were measured using the standardized Nordic questionnaire. Four endpoints for each body site were defined: (i) musculoskeletal complaint of back, neck, shoulder, or hand/wrist was defined as pain in the past 12 months, which had continued for at least a few hours during the past 12 months; (ii) chronic musculoskeletal pain in the past 12 months, referred to a complaint that was present almost every day in the preceding 12 months with a minimal presence for at least 1 month; (iii) musculoskeletal complaint which led to a period of sickness absence in the past 12 months; and (iv) musculoskeletal complaint which led to medical care seeking in the past 12 months.


  Results Top


Out of 300 questionnaires distributed, the female prevalence was higher. Eighty-six percent of the people do not do physical exercise daily. Seventy-one percent of the dental students take rest after each patient, 15% take rest once an hour, and 13% of the students never take rest at all. 40% of the practitioners did a alternative of sitting and standing position [Table 1]. Ninety-five percent of the dental students involve frequent bending of elbows and joints. Ninety-one percent of them feel some kind of musculoskeletal discomfort in the body and other 9% are free from it [Table 2]. Most discomfort is felt in the neck region that is 41% and 23% in one or both elbows, 15% in one or both shoulders, and 20% in back/spine [Table 3]. Sixty-six percent of the students feel the pain most of the time and 22% always and 11% at times. Fifty percent of the students follow periodic stretching and breaks as the pain relief strategy. Thirty-six percent follow postural awareness strategy and 13% follow strengthening exercises.


  Discussion Top


The number of years of practice plays an important role in the occurrence of MSDs, although both younger and older dentists report the same symptoms, as confirmed in other studies also. Young general dental practitioners work very intensively in the 1st years of practice, often over 8 h a day, which causes an early occurrence of MSDs, even within 3 years. Possibly due to experiencing pain and muscle stiffness, they start to keep fit and work less intensively; this is why they do not experience the pain in the next few years.[6],[7],[8] Findings suggest that by raising awareness of these problems among students, the risk of MSDs can be reduced. It has been recommend that as a preventive measure, students should be taught, from the beginning of their undergraduate studies, about optimal working postures and good work habits. In this cross-sectional study, we found high prevalence for back pain, neck, shoulder, and hand/wrist complaints. Musculoskeletal problem was too high, and a proportion of the subjects reported chronic complaints and seeking absenteeism.

Self-reported physical risk factors were important for the occurrence of musculoskeletal complaints, whereas age, gender, and perceived moderate/bad general health were strongly associated with chronicity of complaints and medical care seeking. Musculoskeletal sickness absence was related to perceived exertion and family situation. In this survey, self-administered questionnaires were used to collect information about physical and psychosocial load and perceived health. Like most studies, significant relations were found between self-reported physical risk factors and the occurrence of MSDs in various body sites. Since our study did control appropriately for concurrent risk factors, it was possible to disentangle the most important risk factors among the strongly interrelated factors of physical load, psychosocial load, and general health. The results demonstrate the importance to separate risk factors for the occurrence of musculoskeletal complaints from factors that determine their aggravation and consequences for disability. The occurrence of musculoskeletal complaints among dentists was associated with which seems to be especially important for hand/wrist complaints. Work-related psychosocial factors played an inconsistent role in the development of chronicity of complaints. The strongest impacts in all outcomes under study, i.e. occurrence, chronicity, comorbidity, and medical care seeking, were held by perceived general health.[5],[6],[7]

Perceived health partly incorporates psychosocial factors such as low control and working without breaks. High job demands increase the need for recovery, which is related to worst perceived health. This might reflect an influence, particularly on more severe disease or an effect on people's ability to cope when symptoms occurred. The clear differences between work-related risk factors and general health with respect to the observed associations with different endpoints of musculoskeletal health call for further exploration of these associations in various occupational groups and national settings.[8],[9],[10] Dental surgeons are normally included within the group of professionals at risk of suffering from MSDs due to prolonged awkward or forced postures at work and failure to adopt preventive measures. The present study found that most of the dental surgeons had some kind of musculoskeletal pain and stiffness while performing their professional work in the last 6 months.

The mechanism of musculoskeletal pain production has been studied extensively. The onset of modern dentistry, as evidenced by four-handed dentistry, has made the major part of the dentist tasks purely sedentary in nature. This has resulted in dramatic rise in musculoskeletal symptoms. Alexopoulos EC et al. reported that the symptoms are a product of many risk factors including prolonged static postures, repetitive movements, and poor positioning. Ratzen, on the other hand, linked musculoskeletal pain occurrence in the dentists to the frequent assumption of static postures, which usually requires more than 50% of the body's muscles to contract to hold the body motionless, while resisting gravity.[11],[12] The static forces resulting from these postures have been shown to be much more tasking than dynamic forces. Repeated prolonged static postures are thought to initiate a series of events that could account for pain, injuries, or career-ending problems seen in MSDs. Karasek R et al. reported that all dental specialties show a high occurrence of MSDs but with variations in frequency and locations. In this study, we found that frequency of pain varies with the number of patients treated per day in the area of hip/thigh and with the height of the dentists in case of hip/thigh and knee joints.[13],[14],[15]


  Conclusion Top


The prevalence of MSDs in young dentists is 41%. Neck is the most commonly affected region.[16],[17] Stress and lack of exercise are the main associated factors for musculoskeletal problems in dentists. The symptoms of MSDs increase with the number of years of practice. The prevention and reduction of MSDs among dentists should include their knowledge in dental ergonomics and awareness regarding the importance of work-related risk factors.[18],[19],[20] The MSD is one of the diseases that are mostly related to the dentist work. Therefore, dentists should implement right ergonomic designs in their dental clinics along with doing regular exercise and relaxation techniques, which help them to combat stress, thus improving the quality of life and resulting in consistent long-lasting work efficiency of the dentists.[21],[22]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

Appendix 1: The questionnaire is as follows

PREVALENCE OF MUSCULOSKELETAL DISORDERS AMONG DENTAL STUDENTS – A QUESTIONNAIRE SURVEY

AGE- YEARS OF CLINICAL PRACTICE- NO OF CASES PER DAY-

1. Gender

a) Male b) Female

2. Will you do physical exercise daily?

a) Yes b) No

3. How long do you take rest while working?

a) Never b) Once in an hour c) Once for every patient

4. Which is your mostly followed working position?

a) Sitting b) Standing c) alternating

5. Does your working position involve frequent bending of elbows and joints?

a) Yes b) No

6. Do you feel any musculoskeletal discomfort in your body?

a) Yes b) No

7. If so, in which part of the body do you feel the most discomfort?

a) Neck b) One or both shoulders c) One or both elbows d) Back/Spine

8. Musculoskeletal symptoms are most felt in which part of the body?

a) Upper limb b) Lower limb c) Both

9. How long is the duration of pain?

a) At times b) Most of the time c) Always

10. Do you follow any pain relief measures?

a) Postural awareness strategy b) Periodic breaks and stretching c) Strengthening exercises

 
  References Top

1.
Åkesson I, Johnsson B, Rylander L, Moritz U. 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.  Back to cited text no. 1
    
2.
Åkesson I, Hansson GA, Balogh I, Moritz U, Skerfving S. Quantifying work load in neck, shoulders and wrists in female dentists. Int Arch Occup Environ Health 1997;69:461-74.  Back to cited text no. 2
    
3.
Alexopoulos EC, Stathi IC, Charizani F. Prevalence of musculo- skeletal disorders in dentists. BMC Musculoskelet Disord 2004;10:1-8.  Back to cited text no. 3
    
4.
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.  Back to cited text no. 4
    
5.
Finsen L, Christensen H, Bakke M. Musculoskeletal disorders among dentists and variation in dental work. Appl Ergon 1998;29:119-25.  Back to cited text no. 5
    
6.
Johnston V, Souvlis T, Jimmieson NL, Jull G. Associations between individual and workplace risk factors for self-reported neck pain and disability among female office workers. Appl Ergon 2008;39:171-82.  Back to cited text no. 6
    
7.
Kerosuo E, Kerosuo H, Kanerva L. Self-reported health complaints among general dental practitioners, orthodontists, and office employees. Acta Odontol Scand 2000;58:207-12.  Back to cited text no. 7
    
8.
Korhan O. Work-related Musculoskeletal Disorders [Internet]. BoD – Books on Demand; 2019. 82 p. Available from: https://books.google.com/books/about/Work_related_Musculoskeletal_Disorders.html?hl=&id=zJj8DwAAQBAJ.  Back to cited text no. 8
    
9.
Burdorf A, Sorock G. Positive and negative evidence of risk factors for back disorders. Scand J Work Environ Health 1997;23:243-56.  Back to cited text no. 9
    
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Devereux JJ, Vlachonikolis IG, Buckle PW. Epidemiological study to investigate potential interaction between physical and psychosocial factors at work that may increase the risk of symptoms of musculoskeletal disorder of the neck and upper limb. Occup Environ Med 2002;59:269-77.  Back to cited text no. 10
    
11.
Alexopoulos EC, Burdorf A, Kalokerinou A. Risk factors for musculoskeletal disorders among nursing personnel in Greek hospitals. Int Arch Occup Environ Health 2003;76:289-94.  Back to cited text no. 11
    
12.
Borg G. Psychophysical scaling with applications in physical work and the perception of exertion. Scand J Work Environ Health 1990;16 Suppl 1:55-8.  Back to cited text no. 12
    
13.
Karasek R, Brisson C, Kawakami N, Houtman I, Bongers P, Amick B. The Job Content Questionnaire (JCQ): An instrument for internationally comparative assessments of psychosocial job characteristics. J Occup Health Psychol 1998;3:322-55.  Back to cited text no. 13
    
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van den Bergh O, Winters W, Devriese S, et al. Learning subjective health complaints. Scand J Psychol 2002;43:147-52. 10.1111/1467-9450.00280.  Back to cited text no. 14
    
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Sluiter JK, Van der Beek AJ, Frings-Dresen MH. The influence of work characteristics on the need for recovery and experienced health: A study on coach drivers. Ergonomics 1999;42:573-83.  Back to cited text no. 15
    
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Arthisri AS, Jain AR, Philip JM, Venkata Krishnan CJ, Chandran CR (2016) A Novel Method for the Risk Assessment of Dental Practitioners in Chennai City for Occupational Musculoskeletal Disorders. Biol Med (Aligarh) 8: 308. doi:10.4172/0974-8369.1000308.  Back to cited text no. 16
    
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Silvian SP, Maiya A, Resmi AT, Page T. Antecedents of work related musculoskeletal disorders in software professionals. Int J Enterprise Netw Manage 2009;65:516-24.  Back to cited text no. 17
    
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Zaki Bin MQ, Rasidi M, Gheena S. Awareness on musculoskeletal disorder among dental students in Chennai. Int J Curr Res 2016;8:43868-73.  Back to cited text no. 18
    
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Karahan A, Kav S, Abbasoglu A, Dogan N. Low back pain: Prevalence and associated risk factors among hospital staff. J Adv Nurs 2009;65:516-24.  Back to cited text no. 19
    
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21.
Fulton-Kehoe D, Franklin G, Weaver M, Cheadle A. Years of productivity lost among injured workers in Washington state: Modeling disability burden in workers' compensation. Am J Ind Med 2000;37:656-62.  Back to cited text no. 21
    
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