|Year : 2023 | Volume
| Issue : 1 | Page : 24-29
|Prevalence and determinants of (work-related) musculoskeletal disorders among dentists - A cross sectional evaluative study
Hardi Thacker1, Sandul Yasobant2, Ankit Viramgami3, Somen Saha4
1 Department of Research, Indian Institute of Public Health Gandhinagar (IIPHG), Gandhinagar; Department of Clinical Epidemiology, ICMR- National Institute of Occupational Health (NIOH), Ahmedabad; Centre for One Health Education, Research and Development (COHERD), Indian Institute of Public Health Gandhinagar (IIPHG), Gujarat, India
2 Centre for One Health Education, Research and Development (COHERD), Indian Institute of Public Health Gandhinagar (IIPHG), Gujarat, India
3 Department of Clinical Epidemiology, ICMR- National Institute of Occupational Health (NIOH), Ahmedabad, Gujarat, India
4 Department of Research, Indian Institute of Public Health Gandhinagar (IIPHG), Gandhinagar, Gujarat, India
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|Date of Submission||28-Apr-2022|
|Date of Decision||24-Aug-2022|
|Date of Acceptance||17-Feb-2023|
|Date of Web Publication||05-Jul-2023|
| Abstract|| |
Background: Work-related musculoskeletal disorders (WMSDs) are the second most common cause of disability, accounting for 17% of all Years lived with a disability (YLDs) worldwide. Healthcare professionals, especially dentists, are known to be at a higher risk of WMSDs. Therefore, this study aims to determine the point and period prevalence of WMSDs among dentists and to assess the risk factors for WMSDs, including workstation analysis. Methods: This cross-sectional study was conducted among 120 dentists from three dental colleges in Gujarat (Ahmedabad and Gandhinagar), India. A structured questionnaire was used to collect sociodemographic and occupational history along with pre-validated standardized tools such as the Nordic Musculoskeletal Questionnaire (NMQ), Rapid Entire Body Assessment (REBA) score sheet and Quick Exposure Checklist (QEC). Data analysis was performed using SPSS version 20. Results: The period prevalence of MSDs and WMSDs were 85% and 75.8% respectively, and the point prevalence was 39.2% and 23.3% respectively. Prosthodontists reported the highest prevalence of WMSDs. The neck (64.7%) was the most commonly affected area. A statistically significant result was obtained between MSDs and BMI (P = 0.02), qualification (P = 0.01) and between WMSDs and duration of work in the sitting posture (P = 0.03). Conclusions: The prevalence of both MSDs and WMSDs was found to be high. Dentists with higher BMI, higher qualifications, lack of breaks, having poor workstations and higher REBA and QEC scores, whose job tasks involve continuous inspection, frequent bending of elbow joints, frequent repetitive motions, tasks that require them to reach distances greater than 20 inches and tasks that involve twisting of the waist are at a higher risk of developing MSDs.
Keywords: Dentists, musculoskeletal disorders, musculoskeletal pain, work-related musculoskeletal disorders
|How to cite this article:|
Thacker H, Yasobant S, Viramgami A, Saha S. Prevalence and determinants of (work-related) musculoskeletal disorders among dentists - A cross sectional evaluative study. Indian J Dent Res 2023;34:24-9
|How to cite this URL:|
Thacker H, Yasobant S, Viramgami A, Saha S. Prevalence and determinants of (work-related) musculoskeletal disorders among dentists - A cross sectional evaluative study. Indian J Dent Res [serial online] 2023 [cited 2023 Oct 4];34:24-9. Available from: https://www.ijdr.in/text.asp?2023/34/1/24/380516
| Introduction|| |
Globally, 1.71 billion people have musculoskeletal conditions, accounting for 17% of all YLDs worldwide. The global burden of disease (GBD) study mentioned the second most common disability as MSDs, with lower back pain being the most prevalent condition. MSDs could also be related to one's occupation and are referred to as work-related musculoskeletal disorders (WMSDs), which are responsible for lowering the worker's efficiency and productivity, lowering the quality of life and amounting to an increased financial burden. Work absenteeism, career-ending injuries, early retirement, etc., are some of the situations that WMSDs have reportedly caused., In India, WMSDs contribute to approximately 40% of work-related injuries' treatment costs.
Healthcare professionals are known to be at a higher risk of developing WMSDs. Among these, dentists are susceptible to developing work-related musculoskeletal disorders., Dentistry is a profession that requires a narrow working area and limited visual field because of the oral cavity, working with a limited scope of movement, prolonged working hours, static and awkward postures, prolonged engagement with vibratory instruments and repeated gripping of small-sized instruments, which expose dental professionals to significant risk factors that are responsible for acquiring MSDs., The static or awkward posture during various dental procedures such as cavity filling, preparation of the root canal, or tooth extraction includes flexion of the head and neck to the front and side combined with an inclination rotation trunk towards the patient, further adding to acquiring MSDs.
Very few studies have documented the prevalence of MSDs among various dental specialties and their determinants in Gujarat.,,,,,, Additionally, there is a dearth of information on workstation analysis, including the predictors of WMSDs. To bridge the existing knowledge gap, the present study is aimed to assess the prevalence of WMSDs and their associated risk factors in Ahmedabad and Gandhinagar, India. The study objectives are
- To determine the point and period prevalence of (W) MSDs among dentists and understand the differentiation among various dental specialties.
- To assess the risk factors for (W) MSDs and their association with various workplace-related factors, including workstation analysis.
| Methods|| |
This cross-sectional study was conducted among dentists in Ahmedabad and Gandhinagar, India, from April to July 2021.
Study setting and sampling
The present study was conducted at dental colleges in Western India, Gujarat State. Two districts of Gujarat, Ahmedabad and Gandhinagar, were purposively selected. The deans of all six dental colleges were approached for the study, and those who provided consent were included in the study. Three dental colleges were included in the present study: two dental colleges from Ahmedabad and one from Gandhinagar. These dental colleges are engaged in tertiary care services. Dentists within the dental colleges were selected through simple random sampling. The targeted sample comprised 120 dentists, calculated based on 92.4% prevalence from a previous study, 95% confidence interval, 5% precision, and 10% non-response rate. The study included all dentists (with a minimum one year of experience) who were present on the day of data collection and ready to provide written informed consent. The undergraduate students and interns were excluded from the study.
Study data collection
A structured questionnaire was used to collect both self-reported and observational data, including demographic details, physical history and habits, occupational profile, medical history, self-reported ergonomic hazards, ergonomic awareness, work environment and workstation analysis. A trained researcher administered the questionnaire. Some of the pre-validated tools, such as the Nordic Musculoskeletal Questionnaire (NMQ), Rapid Entire Body Assessment (REBA) and Quick Exposure Checklist (QEC), were embedded in the tool. To determine whether the reported musculoskeletal pain was work-related, three screening questions were asked: a) Do symptoms increase during working days? b) Do symptoms increase at the end of the work shift? c) Do symptoms decrease during holidays? If the sampled dentist met any of the above-mentioned criteria, they were classified as having work-related musculoskeletal pain (WMSDs).
Study data analysis
Study data were entered into MS Excel and analysed using SPSS v20. For continuous variables, descriptive statistics such as mean, standard deviation and range were used. For categorical data, frequency (n), percentage distribution (%) and inferential statistics, such as Chi-square, were used to determine the association. Pearson's correlation test was used to determine the correlation between exposures to the risk of (W) MSDs. Multinomial regression was conducted to estimate risk factors for (W) MSDs.
The Institutional Ethical Committee—Indian Institute of Public Health Gandhinagar (TRC-IEC No: 2020-21/053) approved this study. A written consent was obtained from all the recruited participants.
| Results|| |
Out of the total sampled dentists surveyed (n = 120), 64.2% were females and 35.83% were male. A total of 82.5% of the dentists consumed a vegetarian diet, while the remaining 17.5% consumed a mixed diet. Only 4.2% of the dentists had addictive habits, such as smoking and consuming tobacco or alcohol. Nearly, 75% of dentists were involved in at least one physical activity, such as exercise, sports or yoga. Anthropometric measures such as mean age, height, weight and BMI of the sampled dentists were 30.7 ± 7.6, 164.5 ± 13.2, 65.7 ± 11.3 and 24 ± 3.4, respectively. Occupational work profiles such as total years of clinical/academic experience were 7.4 ± 6.8, total working hours were 46 ± 12.1 hours/week, a total number of patients were 36.6 ± 34.1, total durations in standing posture and sitting posture were 14 ± 8.4 and 31.5 ± 12.4 hours/week, respectively, and total travel durations were 5.2 ± 3.5 hours/week.
MSDs vs WMSDs among dentists
The period prevalence (12 months) of MSDs and WMSDs were 85% and 75.8% respectively, and the point prevalence (7 days) of MSDs and WMSDs was 39.2% and 23.3% respectively. Among the symptomatic dentists, the most affected body part was neck (64.7%), followed by the lower back (55.9%), shoulders (43.1%), upper back (42.2%) and wrist/hand (20.6%), respectively, over the past one year. Furthermore, the point prevalence trend of the involvement of body parts remained the same. Neck pain (21.6%) was the most common, followed by lower back pain (14.7%), shoulder pain (14.7%), upper back pain (12.7) and wrist/hand pain (7.8%) respectively, as shown in [Figure 1]. Of all the sampled dentists, 75.8% reported work-related MSDs and 9.2% reported non-work-related MSDs. Prosthodontists (95.2%) had reported the highest prevalence of WMSDs, followed by pedodontists (81%), orthodontists (80%) and endodontists (75%), respectively, as indicated in [Figure 2].
|Figure 1: Prevalence of MSDs according to specific body parts among sampled dentists surveyed (n = 120) between March and July 2021 in Ahmedabad and Gandhinagar, India|
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|Figure 2: Prevalence of (W) MSDs among sampled dentists (n = 120) in various dental departments surveyed between March and July 2021 in Ahmedabad and Gandhinagar, India|
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Risk factors (W) MSDs
As shown in [Table 1] and [Table 2], the Chi-square test was applied between sociodemographic and occupational variables with the presence or the absence of MSDs and WMSDs. A statistically significant difference was reported in BMI and qualification while comparing the presence of MSDs, whereas the duration in sitting posture during work was significantly different with the presence of WMSDs. The REBA assessment showed that 9.2% had low risk, 38.3% had medium risk, 40% had high risk, and 12.5% had very high risk of developing WMSDs. The QEC assessment indicated that all dentists had a neck region with very high exposure, followed by moderate exposure in the shoulder region. The correlation coefficient for the final QEC and REBA scores was r = 0.4535. Therefore, the risk and exposure scores were positively (+ve) correlated with a moderate effect. Frequent bending of the neck joint is one of the most reported ergonomic risk factors (90.8%). These findings, in a way, coincide with the most affected body part, the neck (period: 64.7%, point: 21.6%). Other self-reported job risk factors included frequent bending of the finger joints (82.5%), frequent bending of the elbow joints (79.2%), frequent repetitive motion (79.2%), finger pinch gripping (76.7%), bending of the waist (70.8%) and others.
|Table 1: Association of (W) MSDs with various sociodemographic profiles among sampled dentists surveyed between March and July 2021 in Ahmedabad and Gandhinagar, India|
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|Table 2: Association of (W) MSDs with various occupational profile-related variables among sampled dentists surveyed between March and July 2021 in Ahmedabad and Gandhinagar, India|
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As indicated in [Table 3], it was observed that female dentists (OR = 1.20), dentists with higher BMI (OR = 1.05), were not involved in any physical activity (OR = 6.17), had greater clinical/academic experience (OR = 1.24), did not take breaks after treating patients (OR = 1.89), had poor workstation analysis (OR = 10.49), had a higher REBA score (OR = 2.01) and higher QEC score (OR = 1.31) and had higher chances/odds of developing MSDs. Furthermore, dentists who reported that their job involved continuous inspection (OR = 1.98), tasks with frequent bending of elbow joints (OR = 1.50), tasks with frequent repetitive motions (OR = 8.63), tasks that required them to reach distances greater than 20 inches (OR = 1.45) and tasks that involved twisting of the waist (OR = 1.06) had higher chances/odds of developing MSDs.
|Table 3: Multiple logistic regression analysis of MSDs with various risk factors of sampled dentists surveyed between March and July 2021 in Ahmedabad and Gandhinagar, India|
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| Discussion|| |
The current cross-sectional study showed that the period prevalence of MSDs was 85% and the point prevalence was 39.2% among the sampled dentists. This result coincides with the results of various other studies. A study conducted in Andhra Pradesh in 2013 showed that 73.9% reported MSDs. However, the point prevalence in the current study was comparatively less than the period prevalence, probably due to the ongoing COVID-19 pandemic. Another study showed that at least 83.10% of dentists in the past 12 months had at least one musculoskeletal pain, which is very similar to our results. One of the risk assessment studies from Bhopal reported a 92.4% prevalence of MSDs among dentists. One study from Karnataka showed that 58.3% of dentists suffered from MSDs, which is comparatively less than our result.
Over the past 12 months, neck pain (64.7%) was the most common, followed by lower back (55.9%), shoulder (43.1%) and upper back (42.2%) pain. Moreover, a systematic review and meta-analysis carried out among dentists in Western countries showed that the neck was the most affected body part, followed by the lower back, shoulder and upper back, which is consistent with our results. Another study carried out in Saudi Arabia showed that the lower back (85%) and neck (84.6%) were the most common locations for WMSDs pain.
A statistically significant result was obtained between MSDs and BMI (P = 0.0228), qualification (P = 0.0121) and between WMSDs and duration of work in the sitting posture (0.0308). In addition, a study conducted in Puducherry reported that a statistically significant association was observed between MSDs (P = 0.036), qualification (P = 0.029) and years of practice (P = 0.032), which supports our results.
The present study identified that dentists with higher BMI, greater clinical/academic experience, lack of breaks, poor workstation analysis and higher REBA and QEC scores were at a higher risk of developing MSDs in their professional lives. It also identified that dentists whose job tasks involve continuous inspection, frequent bending of elbow joints, frequent repetitive motions, tasks that require them to reach distances greater than 20 inches and tasks that involve twisting of the waist are at a greater risk of developing MSDs. A comparative study conducted in Andhra Pradesh documented that obesity is a significant risk factor for MSDs. In their study, it was observed that any form of physical activity helped decrease MSDs in any age group.
A research study reported that tasks involving sustained muscle contraction activity (OR = 1.12), task having repetitive movements (OR = 1.11) and having higher risk scores (OR = 1.39) were considered major risk factors for the occurrence of MSDs.
Thus, the prevalence of both MSDs (85%) and WMSDs (89.2%) in our study was found to be high. Prosthodontists and orthodontists have reported the highest prevalence of WMSDs. The neck (64.7%) was the most affected area. A statistically significant result was obtained between MSDs and BMI (P = 0.0228), qualification (P = 0.0121) and between WMSDs and duration of work in the sitting posture (0.0308).
The present study was carried out with a small sample size (n = 120) in a limited geographical area, specifically tertiary care hospitals; therefore, the results cannot be generalized to all dentists (who are doing private practices or working in primary health centers (PHCs) or sub-district hospitals). There might be chances of recall bias for questionnaire-based results, as the findings were self-reported by dentists. For observational analysis, there might be chances of subjective bias, as observations were performed just once for a period of 15 minutes. Few sampled dentists did not exclusively practise specialized dentistry, so the prevalence of MSDs among dentists in the individual departments could be biased.
| Conclusion|| |
The prevalence of MSDs (85%) and WMSDs (75.8%) in our study was found to be high. Prosthodontists and orthodontists have reported the highest prevalence of WMSDs. The neck (64.7%) was the most commonly affected area. A statistically significant result was observed between MSDs and BMI (P = 0.02), qualification (P = 0.01) and between WMSDs and duration of work in the sitting posture (P = 0.03). It also identified that dentists with higher BMI, greater clinical/academic experience, not taking breaks, having poor workstation analysis and higher REBA and QEC scores, whose job tasks involve continuous inspection, frequent bending of elbow joints, frequent repetitive motions, tasks that require them to reach distances greater than 20 inches and tasks that involve twisting of waist, are at a higher risk of developing MSDs. A multicentric risk assessment study with a larger sample size or a prospective study is recommended to overcome the limitations of the current study. To minimize personal risk factors, dentists are advised to practise ergo-friendly activities in the workplace, consider micro-breaks and avoid static posture during job performance. Periodic monitoring of workstations along with awareness training programmes and continuing education programmes on ergonomics should be conducted for dental practitioners to reduce the risk of development of (W) MSDs among dentists.
We are extremely thankful to Dr. Dolly Patel, the Dean of AMC Dental College, Dr. Mihir Shah, the Dean Ahmedabad Dental College and Dr. Alpesh Patel, the Dean of Goenka Research Institute for granting permission to carry out the research work at their esteemed institutions.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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Dr. Hardi Thacker
Indian Institute of Public Health Gandhinagar, Opp. Air Force Head Quarters, Nr. Lekawada, 382 042 Gandhinagar, Gujarat
Source of Support: None, Conflict of Interest: None
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3]
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