Risk Factors of Musculoskeletal Problems among Dental Professionals in a Dental Institute: A Cross-sectional Survey

DISCUSSION

The present study found that females are more prone to MSDs when compared to males. Many previous studies have supported the same findings.²,⁶,⁹,¹² Physiological and anatomical differences in men and women coupled with effect of hormones on bones and connective tissues and decreased total muscle cross-sectional area may play a role. Strenuous physical work with higher psychosocial stress was found in female dentists which may contribute to higher prevalence of MSDs among women.¹³,¹⁴ A study by Alexopoulos et al. stated that female dentists associated with MSDs perceived bad/ moderate health with increase in morbidity and chronic complaints in response to age.¹⁵ In the present study, risk of developing musculoskeletal symptoms was (OR = 0.711) less among males as compared to females. On the contrary, a recent study by Alyahya et al. states that female dentists had better awareness in ergonomics when compared to their male counterparts.⁵

It was also found that vegetarians showed more risk of developing MSDs as compared to non-vegetarians. However, a study conducted by Rayman and Pattison stated that fraction of patients following a vegetarian or Mediterranean-type diet experienced benefit in clinical symptoms.¹⁶ This benefit of vegetarian diet can be attributed to the high number of anti-oxidants obtained from various plant foods to combat oxidative stress during chronic inflammation but its role in acute WMSDs remains questionable.¹⁶ To our knowledge, no study has been conducted to investigate the relationship of diet with that of WMSDs. Dentists usually avoid physical exercise and activities due to exhaustion and fatigue, caused by heavy workload and long working hours.¹⁷,¹⁸ Present study showed that those who were not involved in regular physical and recreational activity showed more risk of developing MSDs. This is consistent with previous findings⁶,¹⁸,²⁰ but is contrasting results were noted by Yasobant et al.² Routine physical activity has shown to maintain and improve muscle tone, improve posture, increase in flexibility of joints and blood supply to various parts of body.¹¹ Available literature shows the importance of physical activity as a preventive ergonomic measure. Aerobic exercises increase the flow of oxygen to tissues, thereby increasing efficiency. Stretching exercise is an effective measure for relaxing and reducing muscle tension caused by improper posture.¹¹ Smoking and alcoholism are the other important predicting factors for MSDs. The plausible reason for this is that alcohol drinking and smoking are common health risk behaviors that might weaken body’s normal functioning capacities and defense mechanisms. More possible explanation is that alcohol drinking might influence behavior of the people that often prohibits them from practicing a healthy lifestyle.

In the present survey, participants mostly suffered from neck pain (48.9%) followed by lower back pain (46.2%) and shoulder pain (45.8%). These areas may correspond to the burdening of the spine at work. Dentists usually attain an awkward posture while sitting as well as standing with their head bent excessively and their body in uncomfortable position with their lumbar spine twisted in unnatural postures. The marked prevalence of shoulder pain among dentists can be explained by the fact that while working, the shoulders are often burdened during the extended periods of arm elevation and leaning forward in sitting or standing positions.²¹,²² Similar findings were seen in a research conducted on a group of dental practitioners.²³,²⁴ A study done by Al-Wassan et al. showed that the occurrence of neck pain was significantly higher among dentists than other oral healthcare professionals and 84% of oral healthcare workers flexed their neck while working.²⁵ An EMG study of muscle activity during dental operating procedures was done by Finsen et al. which found that protracted neck flexion and shoulder abduction along with increased muscle activity with upper trapezius and splenius were seen on the working side.²⁶

Working in an awkward position, bending or twisting back or neck, performing same tasks over and over again, performing manual tasks such as hand scaling, using manual techniques during root canal procedures, etc. were some of the self-reported job risk factors for MSDs in the present study. Awkward postures exert excessive force on joints and overload the muscles and tendons around the affected joint. Joints of the body are most efficient when they operate closest to the mid-range motion of the joint. Risk of MSD is increased when joints are worked outside of this mid-range repetitively or for sustained periods of time without adequate recovery time. Available literature states specific factors which pose a definite risk of causing MSD are prolonged static posture, long operating periods, handling of delicate instruments with significant force, reduced inter appointment breaks causing fatigue and micro injuries, etc.²⁰,²⁷,²⁸ A recent study by Kumar et al. has suggested that prolonged muscle tension caused by incorrect posture can be relieved by stretching exercises.²¹ In the present study it was found that oral healthcare workers who work for more than 8 hours daily affected more (86.7%) than those who work for less than 8 hours a day (77.4%). A study done by Alyahya et al. has found that in the initial years of the practice, dental practitioners often work over 8 hours a day leading to early occurrence of MSD within 3 years.⁵ Also, it was found that professionals working at institutional setting as well as clinical setting had higher rates of MSD.² Kierklo et al. stated that constant workings without breaks are associated with musculoskeletal discomfort.²⁹ Thus, taking rest breaks with casual exercises between patients is imperative to reduce the incidence MSD.

Even though it is evident that regular exercise is of exceptional importance to the musculoskeletal health, only about two-thirds of respondents exercised regularly. The percentage of respondents who were utilizing alternative methods such as massages, spas or sports activities was even lower (16%). Besides the high percentage of musculoskeletal complaints among respondents, only 16.88% sought professional help, which comes as a result either from the respondent’s carelessness or the frivolous approach to this issue. High number of musculoskeletal problems should alert the practitioners and make actively concerned about their early diagnosis and treatment.

Dental institutes are training grounds for future dentists. Throughout the preclinical curriculum, special emphasis should be given on following the right posture and techniques. Short breaks between patients should be encouraged to allow for stretching exercises and a time limit should be established for treating a particular case. The benefit of this approach is twofold, it limits static postures thus reducing fatigue and helps patients from developing potential TMJ problems from excessive mouth opening for longer periods. As with any health hazard, prevention is better than cure. Dental colleges should address this issues by conducting periodic workshops with a team of dentists, physiotherapists and dietitians to sensitize the students the implications of poor posture in their professional career, promote physical activities, and encourage a healthy lifestyle.

The study was cross-sectional in nature and has its own limitations such as the representativeness of the sample and the ability of respondents to give correct answers. Small sample size and the use of one study area to recruit the participant’s limits the results of the study in terms of generalizability. A larger sample size would achieve more comprehensive results. Dentists working in and around Sangli district should be included in future research investigations on MSDs. Study incorporated a structured questionnaire to collect the data. Questionnaire inquiry is an economical and proper way of collecting the data, but it can lead to recall bias. Perhaps more accurate results would require thorough physical examinations and assessments.