Ergonomic awareness and musculoskeletal pain suffered by dental professionals of Western Maharashtra

Renuka Pawar; Chanamallappa Ganiger; Sandesh Phaphe; Yusuf Ronad; Pratap Mane; Monica Satpute; Karan Gaikwad

doi:10.4103/jdmimsu.jdmimsu_57_20

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ORIGINAL ARTICLE

Year : 2020 | Volume : 15 | Issue : 3 | Page : 414-420

Ergonomic awareness and musculoskeletal pain suffered by dental professionals of Western Maharashtra

Renuka Pawar, Chanamallappa Ganiger, Sandesh Phaphe, Yusuf Ronad, Pratap Mane, Monica Satpute, Karan Gaikwad
Department of Orthodontics and Dentofacial Orthopaedics, School of Dental Sciences, Krishna Institute of Medical Sciences, Karad, Maharashtra, India

Date of Submission	06-Mar-2020
Date of Decision	10-Apr-2020
Date of Acceptance	15-May-2020
Date of Web Publication	1-Feb-2021

Correspondence Address:
Dr. Monica Satpute
Department of Orthodontics and Dentofacial Orthopedics, School of Dental Sciences, Krishna Institute of Medical Sciences, Malkapur, Karad - 415 110, Maharashtra
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/jdmimsu.jdmimsu_57_20

Abstract

Context: Musculoskeletal pain, in particular back pain, has been found to be a major health problem for most dental practitioners. Thus, it was necessary to investigate the ergonomic awareness and musculoskeletal pain among dental health professionals. Aims: The aim of this study was to investigate and bring awareness among dental practitioners regarding ergonomics and determine the proportion of dentists suffering from musculoskeletal pain. Materials and Methods: A cross-sectional survey was conducted for a period of 2 months on 500 dental professionals practicing in the region of Western Maharashtra. A set of closed-ended questions along with the informed consent form were tabulated on the basis of type of pain, onset, working position, operating hand, duration of work hours, type of practice, use of proper measures while working, and time since practice started. Practicing dental professionals were included, whereas those having musculoskeletal problems before joining dentistry or who had suffered any physical injury previously were excluded. Statistical Analysis: Data were analyzed using the Statistical Package for the Social Sciences, version 16, Illinois, Chicago, USA. The Chi-square test was used for assessing categorical data, and an independent t-test was used for comparing means. Results: General practitioners and specialists reported a prevalence of pain on different anatomical locations depending on their specialty. Conclusions: Musculoskeletal disorder (MSD) remains a major occupational problem. The awareness of MSD among the dentists practicing in Western Maharashtra was low. Majority of the dentists reported more neck pain and lower back pain. Hence, maintaining proper posture will ensure a significant decrease in MSDs, thus improving their work efficiency and preventing burnout.

Keywords: Dental specialists (MDS), ergonomics, general practitioners (BDS), musculoskeletal disorders, prevalence, Western Maharashtra

How to cite this article:
Pawar R, Ganiger C, Phaphe S, Ronad Y, Mane P, Satpute M, Gaikwad K. Ergonomic awareness and musculoskeletal pain suffered by dental professionals of Western Maharashtra. J Datta Meghe Inst Med Sci Univ 2020;15:414-20

How to cite this URL:
Pawar R, Ganiger C, Phaphe S, Ronad Y, Mane P, Satpute M, Gaikwad K. Ergonomic awareness and musculoskeletal pain suffered by dental professionals of Western Maharashtra. J Datta Meghe Inst Med Sci Univ [serial online] 2020 [cited 2021 Mar 7];15:414-20. Available from: http://www.journaldmims.com/text.asp?2020/15/3/414/308571

Introduction

Musculoskeletal pain is found to be a major health problem and the most common problem for most dental practitioners both in India and abroad. Dentistry requires the adoption of fixed postures, adequate vision, and use of precisely repetitive hand and finger movements. However, posture out of all factors reflects the position that an individual maintains in his space through his musculoskeletal system. These factors in combination with psychological stress lead to the development and progression of musculoskeletal pain and disorders.^[1] To minimize the risk of work-related injury, it is necessary to have a proper understanding of the underlying physiological mechanisms that lead to the development of these problems.

Ergonomics is defined as the science of fitting workplace condition and job demands to the capabilities of the working population. The goal of ergonomics is to establish a healthy and comfortable as well as safe working environment, thus prevent health-related problems, and improve the working capability and productivity.

With increasing awareness among the population regarding proper oral health has proportionally increased the demand to seek dental health care; this, in turn, has increased the workload on dental health-care professionals. An inappropriate working posture, prolonged static postures (scaling and root planing or time-consuming dental surgeries), lack of working space, vibrations (handpiece), and long working hours contribute to multiple occupational hazards to dental health-care providers.

Musculoskeletal disorders (MSDs) are defined as musculoskeletal complaints, musculoskeletal symptoms, or musculoskeletal pain that reflect a number of conditions, such as neck pain, back pain, shoulder pain, arm pain, hand pain, wrist pain, and leg pain.^[2] Musculoskeletal pain, in particular back pain, has been found to be a major health problem for most dental practitioners.^[3] The spectrum of this disease varies from mild and infrequent to severe, chronic, and debilitating consequences. Recently, the use of advanced techniques and equipment has reduced several problems related to MSDs, this is more noticed in developed countries, while in developing nations like India where every day has its own challenges, most dental professionals are unaware about the ergonomics or tend to be careless about their own health. Unfavorable work environment could be responsible for improper sitting postures and movements, thus causing unwanted musculoskeletal load, discomfort, and fatigue. Thus, the aim of this study was to investigate the ergonomic awareness and musculoskeletal pain among the dental health professionals in the Western part of Maharashtra.

Materials and Methods

A cross-sectional survey was conducted on 500 dental professionals practicing in the region of Western Maharashtra. The survey was carried out in a period of 2 months. A set of closed-ended questions were prepared, and the format along with the informed consent form was distributed among these dentists in order to collect the relevant information pertaining to the study. Questions were tabulated on the basis of: type of pain, when did the pain start (onset of pain), working position (standing position/sitting position/both), operating hand (left handed/right handed), number of working days in a week, break taken in-between two patients, number of patients visiting daily (PVD), type of practice (specialization), use of proper measures while working (proper magnification and proper illumination), time since practice started (TSPS), and daily practice hours (DPH). Photographs of a dentist in working position were taken for records.

Ethical clearance was obtained from the institutional ethical review board.

Inclusion criteria: Active dental professionals practicing in the region of Western Maharashtra were included in the study
Exclusion criteria: Dental professionals having musculoskeletal problems before joining dentistry or who had suffered any physical injury previously were excluded from the study.

Data were anonymously coded and entered into a spreadsheet program before being analyzed using the? Statistical Package for the Social Sciences, version 16, (SPSS Inc., Chicago, Ill., USA). Test used for categorical data: Chi-square test and for comparing means: independent t-test.

Ethical clearance

The Institutional Ethics Committee of KIMS has approved the Research work proposed to be carried out at School of Dental Sciences, KIMSDU, Karad, Maharashtra Date: 17^th Oct 2019 with Reference no KIMSDU/EC/2019/555.

Results

Of the 500 participants, one dentist was excluded from the study as the form was incompletely filled, which made the total count to 499. P < 0.05 was considered statistically significant.

Neck pain

Statistically, no significant difference was seen in the prevalence of neck pain for variables such as gender, age, and specialization.

Arm pain

No statistically significant difference in the prevalence of arm pain among males/females and specialists was seen in our sample, but there was a statistically significant difference in the prevalence of arm pain among different age groups (P = 0.006), and the highest was found among those between 31 and 40 years (53%).

Shoulder pain

No statistically significant difference in the prevalence of shoulder pain among males and females was seen in our sample. There was a statistically significant difference in the prevalence of shoulder pain among different age groups (P < 0.001), and the highest was found among those between 31 and 40 years (56.8%). Similarly, a significant difference was found in prevalence based on specialty (P = 0.003); the highest prevalence was reported by BDS graduates (44.3%), whereas the lowest prevalence was reported by oral pathologists (1.7%).

Hand pain

No statistically significant difference in the prevalence of hand pain among males and females was seen in our sample, but there was a statistically significant difference in the prevalence of hand pain among different age groups (P < 0.001), and the highest was found among those between 31- and 40 years (46.4%). Similarly, a significant difference was seen in prevalence based on specialty (P < 0.001); the highest prevalence was reported by BDS graduates (28.6%), whereas the lowest prevalence was reported by OMDR specialists (1.2%).

Wrist pain

No statistically significant difference in the prevalence of wrist pain among males and females was seen in our sample, but there was a statistically significant difference in the prevalence of wrist pain among different age groups (P < 0.001), and the highest was found among those between 31 and 40 years (42.2%). Similarly, a significant difference was seen in prevalence based on specialty (P < 0.001); the highest prevalence was reported by BDS graduates (32.8%), whereas the lowest prevalence was reported by OMDR specialists (1.6%).

Upper back pain

No statistically significant difference in the prevalence of upper back pain among males and females was seen in our sample, but there was a statistically significant difference in the prevalence of upper back pain among different age groups (P < 0.006), and the highest was found among those between 31 and 40 years (47.6%). Similarly, a significant difference was seen in prevalence based on specialty (P < 0.014); the highest prevalence was reported by BDS graduates (31%), whereas the lowest prevalence was reported by OMDR specialists (1.2%).

Middle back pain

No statistically significant difference in the prevalence of middle back pain among different age groups was seen in our sample, but there was a statistically significant difference in the prevalence of middle back pain among males and females (P = 0.025), and the highest was found among females (58.8%). Similarly, a significant difference was seen in prevalence based on specialty (P < 0.001); the highest prevalence was reported by BDS graduates (32.4%), whereas the lowest prevalence was reported by orthodontists (2%).

Lower back pain

No statistically significant difference in the prevalence of lower back pain among males and females was seen in our sample, but there was a statistically significant difference in the prevalence of lower back pain among different age groups (P < 0.001), and the highest was found among those between 31 and 40 years (55.6%). Similarly, a significant difference was seen in prevalence based on specialty (P 0.002); the highest prevalence was reported by BDS graduates (46.9%), whereas the lowest prevalence was reported by OMDR specialists (2.9%).

Leg pain

No statistically significant difference in the prevalence of leg pain among males/females and specialists was seen in our sample, but there was a statistically significant difference among different age groups (P < 0.001), and the highest was found among those between 31 and 40 years (44%).

Various operating positions [Table 1] reported by the sample individuals were found to be significantly different among males and females. Majority of the males reported both standing and sitting (combination) posture (52.1%) or only sitting posture (47.2%) or only standing posture (100%), whereas females reported sitting position (52.8%) or both standing and sitting (combination) posture (47.9%), and none of them reported standing posture (0%). Similarly, a statistically significant difference was seen in working posture implemented by different specialists (P < 0.001); most of sitting postures (55.6%) and both sitting and standing postures (36.1%) were adopted by BDS graduates, and standing posture (37.5%) was majorly used by BDS graduates as well as prosthodontists. It was seen both sitting and standing (combination) posture was used by majority of the dentists in Western Maharashtra.

Table 1: Various operating positions reported by the sample individuals were found to be significantly different among males and females

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A statistically significant difference in the mean [Table 2] TSPS, daily practicing hours (DPH), and PVD was found among those who suffered from neck pain.

Table 2: A statistically significant difference in the mean TSPS, daily practicing hours (DPH), and PVD was found among those who suffered from neck pain

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A statistically significant difference in the mean [Table 3] TSPS and days working weekly (DWW) was found among those who suffered from shoulder pain.

Table 3: A statistically significant difference in the mean TSPS and days working weekly (DWW) was found among those who suffered from shoulder pain

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A statistically significant difference in the mean [Table 4] TSPS and DPH was found among those who suffered from arm pain.

Table 4: A statistically significant difference in the mean TSPS and DPH was found among those who suffered from arm pain

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A statistically significant difference in the mean [Table 5] TSPS was found among those who suffered from hand pain.

Table 5: A statistically significant difference in the mean TSPS was found among those who suffered from hand pain

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A statistically significant difference in the mean [Table 6] DPH and rest break (RB) was found among those who suffered from wrist pain.

Table 6: A statistically significant difference in the mean DPH and rest break (RB) was found among those who suffered from wrist pain

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A statistically significant difference in the mean [Table 7] TSPS and RB was found among those who suffered from upper back pain.

Table 7: A statistically significant difference in the mean TSPS and RB was found among those who suffered from upper back pain

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On comparing mean [Table 8] of TSPS, DPH, number of working days (DWW), number of PVD, and RB among those with or without middle back pain, there was no significant difference among variables.

Table 8: On comparing mean of TSPS, DPH, number of working days (DWW), number of PVD, and RB among those with or without middle back pain, there was no significant difference among variables

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A statistically significant difference in the mean [Table 9] TSPS and DPH was found among those who suffered from lower back pain.

Table 9: A statistically significant difference in the mean TSPS and DPH was found among those who suffered from lower back pain

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A statistically significant difference in the mean [Table 10] TSPS and RB was found among those who suffered from leg pain.

Table 10: A statistically significant difference in the mean TSPS and RB was found among those who suffered from leg pain

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Based on the results, dental specialists from

Endodontic section were more prevalent to hand pain and leg pain
Prosthodontic section were more prevalent to hand pain and middle back pain
Oral and maxillofacial surgeons were more prevalent to wrist pain and upper back pain
Periodontic section were more prevalent to arm pain and middle back pain
Pedodontic section were more prevalent to arm pain and upper back pain
Orthodontic section were more prevalent to hand pain and wrist pain.

Discussion

This study examined the prevalence of MSD and ergonomic awareness among dental professionals of Western Maharashtra. The response rate for the study was very good. This study was conducted on 500 dental practitioners in which majority were BDS graduates and the rest were MDS graduates. Of all the samples, 463 were right handed, whereas 37 were left handed, but there was no obvious difference seen in the type of pain suffered. According to the World Health Organization, the burden of MSD can be assessed in terms of problems associated with them, that is, the pain and impaired functioning (disability) related to the musculoskeletal system or in relation to the cause such as joint disease or trauma.^[12]

The reported prevalence of MSD was high; almost all dentists were suffering from one of the other musculoskeletal pain. No significant differences were seen between males and females for musculoskeletal pain in various body parts such as neck, arm, shoulder, hand, wrist, lower back, and leg; however, a significant difference was observed for middle back pain, but variables such as TSPS, DWW, DPH, PVD, and RB did not show significant differences for middle back pain among males and females. This could be explained, as women work far closer to the patient which makes them feel uncomfortable. They also tend to sit back while working on the patient, thus causing strain in the middle back region. Further, while treating hefty patients, adjusting the dental stool to compensate for the height is against ergonomics.

Age also plays an important role, and it was observed that most of the participants suffering from MSD were in the range of 31–40 years, whereas practitioners above 41 years reported less musculoskeletal pain as compared to earlier years as they developed various coping measures (regular exercise, body massage therapies, yoga, rest, adjusting positions, and better ergonomically oriented dental chairs) and adopted the modern ergonomic techniques. Similar findings were seen among elderly dental practitioners of Saudi Arabia and New South Wales.^[13],[14]

It was also observed that BDS graduates were most affected, this showed that MDS graduates had better knowledge about ergonomics and tried to adopt it to some extent, while most of the BDS graduates did not adopt ergonomics position, and hence, there was a significant difference between them; similar findings were seen in other Indian studies.^[11]Considering the working positions reported by dentists, it was observed that majority used a combination of both standing and sitting postures in their day-to-day practice.

Based on the results from the study, the main affected sites were neck (49%), lower back (48.6%), and shoulder (34.2%) regions. Similar results were reported in other studies conducted on dentists and dental students in India and abroad,^{[4],[8],[9],[15]} whereas in one Indian study conducted by Karibasappa et al., lower back pain was reported more than neck pain.^[11] This variation was due to differences in the sample size.

The study was conducted only on one symptom, namely pain. Further detailed studies need to be conducted at a larger scale taking into consideration stiffness, discomfort, joint clicks, fatigue, etc., which are often not reported. The present study shows a lack of awareness of MSD among the dentists, mostly among the BDS category. A dentist should be encouraged, motivated, and updated regarding the importance of dental ergonomics and should apply it in daily practice. Further, the importance of ergonomic principles should and must be taught to budding dental graduates. It should be added into the curriculum and periodic assessments to be carried out for better understanding and importance of ergonomics. Every student should be made aware of his wrong posture while working on patients, which could be done by showing the students' own photographs taken during dental procedures. Those suffering from MSD should be encouraged to seek medical health [Table 11].^{[5],[6],[7],[10]}

Table 11: MSD should be encouraged to seek medical health

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Conclusion

MSD remains a major occupational problem. Majority of the dentists in our study reported more of neck pain and lower back pain, followed by shoulder pain and other body parts when compared to other anatomical locations. Thus, from the present study, it can be concluded that the awareness of MSD among the dentists practicing in Western Maharashtra was found to be low.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1.	Hayes MJ, Smith DR, Cockrell D. An international review of musculoskeletal disorders in the dental hygiene profession. Int Dent J 2010;60:343-52.
2.	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.
3.	Hayes MJ, Smith DR, Taylor JA. Musculoskeletal disorders and symptom severity among Australian dental hygienists. BMC Res Notes 2013;6:250.
4.	Leggat PA, Smith DR. Musculoskeletal disorders self-reported by dentists in Queensland, Australia. Aust Dent J 2006;51:324-7.
5.	Chopra A. Musculoskeletal disorders in dentistry-A review. JSM Dent 2014;2:1032.
6.	Bramson JB, Smith S, Romagnoli G. Evaluating dental office ergonomics risk factors and hazards. J Am Dent Asoc 1998;129:174-83.
7.	Valachi B, Valachi K. Mechanisms leading to musculoskeletal disorders in dentistry. J Am Dent Assoc 2003;134:1344-50.
8.	Ramarao D, Veeresh Y. Prevalence of musculoskeletal disorder symptom in dentists in Davangere, Karnataka, India – A cross sectional survey. E J Dent 2014;4:596-601.
9.	Muralidharan D, Fareed N, Shanthi M. Musculoskeletal disorders among dental practitioners: Does it affect practice? Epidemiol Res Int?2013;2013:?1-6.
10.	Shaik AR, Rao BH, Husain A, D'Sa J. Work-related musculoskeletal disorders among dental surgeons: A pilot study. Contemp Clin Dent 2011;2:308-12. [PUBMED] [Full text]
11.	Karibasappa GN, Anandan S, Rajeshwari K. Dentists' knowledge, attitude and behaviour towards the dental ergonomics. IOSR J Dent Med Sci 2014;13:86-9.
12.	Woolf AD, Pfleger B. Burden of major musculoskeletal conditions. Bull World Health Organ 2003;81:646-56.
13.	Abduljabbar TA. Musculoskeletal disorders among dentists in Saudi Arabia. Pak Oral Dent J 2000;28:135-44.
14.	Marshall ED, Duncombe LM, Robinson RQ, Kilbreath SL. Musculoskeletal symptoms in New South Wales dentists. Aust Dent J 1997;42:240-6.
15.	Atme YS, Melis M, Zawawi KH, Cottogno L. Five-year follow-up of temporomandibular disorders and other musculoskeletal symptoms in dental students. Minerva Stomatol 2007;56:603-9.