Prevalence of musculoskeletal disorders among dental practitioners in Nellore City: A cross-sectional study
Beulah Amulyavathi Gangaraju, R V. S. Krishna Kumar, V Chandrasekhara Reddy, P Symon Prasanth, V Prathyusha Reddy
Department of Public Health Dentistry, Narayana Dental College, Nellore, Andhra Pradesh, India
Date of Decision 10-Aug-2020
Date of Web Publication 2-Aug-2021
Beulah Amulyavathi Gangaraju
Department of Public Health Dentistry, Narayana Dental College, Nellore, Andhra Pradesh
Background: Literature reviews over the world have shown a high prevalence of musculoskeletal disorders (MSDs) among dental practitioners. 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. Purpose: The purpose of the study is to determine the prevalence and distribution of MSDs among dental practitioners in Nellore city of Andhra Pradesh, India. Materials and Methods: A descriptive cross-sectional study was conducted using the Standard Nordic Questionnaire for MSDs. All the dental practitioners in Nellore city who were registered in the state dental council and are members of Indian Dental Association were included in the study. Results: Neck pain (57.5%) is the most prevalent MSD followed by lower back pain, and wrists and upper back trouble. Elbow pain, lower back, knee, and foot/ankle trouble were more common among males than females and this difference was found to be statistically significant. Neck-related MSDs have shown more amount of reduction in working hours (17.0%) and leisure activity (9.4%) and more doctor consultations (11.3%). Conclusion: High prevalence of MSDs exists among the dental practitioners. There is a need for the integration of ergonomic awareness and health promotion with the professional practice for dentists.
Keywords: Dentists, India, musculoskeletal disorders, neck pain
Gangaraju BA, Kumar R V, Reddy V C, Prasanth P S, Reddy V P. Prevalence of musculoskeletal disorders among dental practitioners in Nellore City: A cross-sectional study. J Indian Assoc Public Health Dent 2021;19:129-33
Gangaraju BA, Kumar R V, Reddy V C, Prasanth P S, Reddy V P. Prevalence of musculoskeletal disorders among dental practitioners in Nellore City: A cross-sectional study. J Indian Assoc Public Health Dent [serial online] 2021 [cited 2022 Jan 20];19:129-33. Available from: https://www.jiaphd.org/text.asp?2021/19/2/129/322862
The term "musculoskeletal disorders (MSD)" refers to conditions that involve the nerves, tendons, muscles, and supporting structures of the body. MSDs, including pain, weakness, and paresthesia, are reported to be caused by repetitive, awkward, or stressful motions. Dental personnel are at an increased risk of developing MSD. The common sites of musculoskeletal complaints among the dental personnel were neck, shoulder, and lower back region with diverse prevalence[1],[2],[3],[4],[5] reported in different studies. The working characteristics of dentist include high demands on vision and precision and fine manipulative hand movements and work with unsupported, elevated arms.[6] Although occasional backache or neckache is generally not a cause for concern, the cumulative physiological damage that results from ignoring regular pain and discomfort can lead to an injury or a career-ending disability.[7],[8] 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, this study aimed to determine the prevalence and distribution of MSD among dental practitioners in Nellore city of Andhra Pradesh, India. The objectives were to assess the prevalence of MSD, common sites involved, the effect of MSD on the practitioners and their profession, and the prevalence of MSD among male and female practicing dentists.
Ethical approval for the study was obtained from the institutional ethics board. Informed consent was obtained from all the study participants.
A cross-sectional descriptive study was designed to determine the prevalence and distribution of MSDs among dental practitioners in Nellore city, Andhra Pradesh. Dentists that are registered in the state dental council and are members ofIndian Dental Association were included in the study. Prevalidated Standard Nordic Questionnaire[9] was used to collect data on musculoskeletal symptoms. The questionnaire consists of five sections. Section A comprises seven questions which record basic demographic details, whereas Sections B, C, D, and E record musculoskeletal symptoms. The study was conducted over a period of 1 month in the respective clinics of dentists. The source of data is primary. Of 147 dentists, 106 dentists were finally included in the study based on the inclusion and exclusion criteria, and availability.
Both genders, aged 25 years and above, with minimum qualification of BDS and practicing dentistry for a minimum period of 1 year.
Any practicing dentist with a history of known orthopedic, neurological, or cardiorespiratory illnesses.
Statistical package for the Social Sciences version 18 was used to determine the frequency distributions, means, and proportions. A Chi-square test was used to find the association between the prevalence of MSD and males and females and between the prevalence of MSD and duration of practice. Fisher's exact test was used to find the association between area-wise predilection of MSD and males and females. P = 0.05 was set as statistically significant.
A total of 106 dentists participated in the study. Of the total participants, 55.7% were male and 44.3% were female. General dental practitioners accounted for 36.8% of the studied participants and remaining specialists. Majority of the participants (99.1%) were right hand oriented. Most of the practitioners (71.6%) in the study worked 4–8 h. Majority of them (76.4%) practiced full time. The average duration of practice was 1–3 years [Table 1].
Table 1: Sociodemographics and working experience of the dental practitioners
Overall, 76.4% of the study participants had a prevalence of at least one MSD symptom [Graph 1].
The difference in the predilection of the areas affected - lower back (59.4%), knees (27.9%), elbows (22.8%), and foot/ankle (19%) - between males and females was statistically significant [Table 2].
Table 2: Area-wise predilection of musculoskeletal disorders in relation to the gender of the dental practitioners
Lower back, neck, and shoulder MSDs all had an effect on the daily activities of the dentists, but this was not statistically significant [Table 3].
Table 3: Effect of musculoskeletal disorders on the daily activities of the dental practitioners
The difference in prevalence between males and females was not statistically significant [Table 4].
Table 4: Distribution of musculoskeletal disorders in relation to gender
The prevalence of MSDs was 72.7% among 36–45 years old, 75.9% among 25–35 years old, and 100% among those >45 years old [Table 5].
Table 5: Age-wise prevalence of musculoskeletal disorders
Among the study participants, those that had a work experience of 1–3 years had a prevalence of 35.8% [Table 6].
Table 6: Distribution of musculoskeletal disorders in relation to the duration of practice
MSDs are a diverse group of disorders with regard to pathophysiology. 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.[10] The instrument used in this study is the Standardized Nordic Questionnaire (SNQ) which records musculoskeletal symptoms and screens for MSDs in an ergonomic context.[9] SNQ is shown to be a valuable diagnostic tool in screening for musculoskeletal symptoms in occupational health-care service research to analyze the work environment and identify incompatibilities in the working environment.
The present study revealed that almost 77% of the dentists had experienced one or more symptoms of MSDs. This result corroborates with studies done by Muralidharan et al.[11] and Gupta et al.[12]
The prevalence of MSD in the present study was higher among males than in females although this difference was not statistically significant. The prevalence of MSD among the general population of India showed females to have a higher prevalence compared to males.[13] The current study in contrast revealed no difference in the prevalence of MSD between male and female practitioners.
Predisposition to pain or injury in different regions of the body depends on the type of work and the position adopted. Among the dentists who had MSDs in this study, neck pain occurred most frequently (57.5%) followed by lower back pain (31%). The findings by Yasobant and Rajkumar,[14] Batham and Yasobant,[15] and Gandham et al.[3] regarding the most affected body regions are consistent with our results. However, Szymańska[7] and Puriene et al.[16] in their series have reported MSD of low back to be the most prevalent musculoskeletal complaint.
Assessment of MSDs in different regions of the body has shown that in male practitioners, MSDs of the lower back, knees, elbow, and foot/ankle are more common than among female practitioners and this difference was statistically significant. This is in contrast to other studies where the elbow region is more commonly affected among males, whereas in females, the common regions affected were shoulders, neck, wrist/hand, and upper back regions.[17],[18]
Studies among dental practitioners in Lithuania and Poland[16],[19] have shown MSD to increase with age. The results of the present study similarly showed that all practitioners in the oldest age group had MSD, but this prevalence was not significantly different from practitioners below 45 years of age. Our study sample comprised only five dental practitioners aged 45 and above which could be the reason for lack of statistical significance. In contrast, other studies among dental practitioners of Saudi Arabia and New South Wales showed that MSD decreases with age and duration of practice.[20],[21] Their findings were attributed to older practitioners working on less number of patients as a result of age or having developed coping measures (posture adjustment, better ergonomically oriented dental chairs, exercise, medication, and rest) for MSD over the years of practice.
MSD affects the physical, psychological, and social aspects of practitioners.[18],[22] This, in turn, impacts on their productivity and ultimately reducing the quality of life of the practitioners. In the present study, over a period of 12 months, MSD has affected the practitioners as evident from the reduction in work activity, leisure activity, alterations of duties, and consultations with doctor and hospitalization, with neck MSD affecting the most followed by shoulder and low back. This finding is similar to the study done by Muralidharan et al.[11]
The high prevalence of MSD in this study reveals the need to identify the factors predisposing to MSD among the dental practitioners. Lack of an ergonomically oriented work practice among the Indian dental practitioners might be the reason for the high prevalence, but further studies need to be conducted to make logical conclusions. To conclude, a high prevalence of MSD exists among the dental practitioners and this affects their daily practice.
Literature has shown that predisposing factors for MSD are multifactorial.[23],[24],[25] As this study was cross-sectional in design, the causal variables could not be identified which can be considered as a limitation of the present study. The subjectivity of the responses may also be a limitation. Practitioners with recent episodes of MSD will remember the events much better and hence can affect the response to the questionnaire. The major limitation of this study, however, is the sample size (n = 106) which limits the generalizability of the findings. The power of the study would have improved with a larger sample size.
Knowledge about the ergonomics as well as health and safety measures at the place of work should be imparted professionally during the dental schooling in general at graduate and particularly at postgraduate level. Continuing distance education programs should be conducted as they offer a unique opportunity to benefit from the expertise and best resources that are currently available. Further studies are needed to identify the specific risk factors for MSD so as to introduce effective remedial measures.
High prevalence of MSDs exists among the dental practitioners and this affects their daily practice. There is a need for the integration of ergonomic awareness and health promotion with the professional practice for dentists
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]
Gangaraju BA
Kumar R V
Reddy V C
Prasanth P S
Reddy V P